Perioperative management in cardiovascular emergency surgery
Tanaka, A.; Okita, Y.
Kyobu Geka. Japanese Journal of Thoracic Surgery 61(8 Suppl): 640-643
2008
ISSN/ISBN: 0021-5252 PMID: 20715402 Document Number: 616351
Perioperative management in emergency cardiac operation is challenging because general condition of the patient is often poor and only little preoperative information is available. In order to obtain an optimal surgical outcome, careful assessment of preoperative problems and prevention and detection of complications must be done without any delay. Preoperative carotid duplex scan should be performed in every case to assess the steno-occlusive lesion or unstable plaque, which affect the surgical strategy (eg. selection of arterial cannulation site and cerebral protection). Regional cerebral oxygen saturation (rSO2) must be monitored in all the operation. If intraoperative drop in rSO2 is detected, administration of inotropic agents and increase in cardiopulmonary bypass flow is needed to maintain the mean blood pressure at higher level. Intraaortic balloon pumping (IABP) insertion should be considered when rSO2 cannot be recovered with those procedures. We have to keep in mind that many of the patients undergoing emergency surgery are at high risk for coronary artery disease. If one cannot be weaned from cardiopulmonary bypass, coronary artery bypass grafting to a major branch may be performed. Coronary angiography should be performed immediately when ST-T changes in electrocardiogram (ECG) or chest symptoms appear in the postoperative period. Hesitation in making a decision will only jeopardize the situation.