From the Guidelines
Post-operative management of a Glenn operation should prioritize careful monitoring and supportive care to prevent complications and ensure optimal outcomes, with a focus on maintaining adequate preload, preventing volume overload, and managing pulmonary vascular resistance. The management strategy should include monitoring in an intensive care unit with continuous cardiorespiratory monitoring, including central venous pressure (CVP) and ventilatory management aiming for mild hypocarbia to prevent pulmonary vasoconstriction 1. Key aspects of care include:
- Inotropic support with medications such as milrinone and low-dose epinephrine as needed
- Fluid management with restriction to prevent volume overload while maintaining adequate preload
- Anticoagulation to prevent thrombosis, initiated with heparin followed by aspirin or warfarin for long-term thromboprophylaxis
- Pain control with acetaminophen and morphine
- Diuretics like furosemide to manage fluid balance
- Sildenafil to reduce pulmonary vascular resistance if necessary
- Monitoring for complications including pleural effusions, chylothorax, arrhythmias, and thrombosis, with oxygen saturation targets typically between 75-85% It is also crucial to consider the potential long-term complications of the Glenn procedure, such as acquired pulmonary arteriovenous malformations, as noted in the acc/aha 2008 guidelines 1. Early mobilization, respiratory therapy, and nutritional support are important components of recovery, along with follow-up echocardiography to assess Glenn shunt function and pulmonary artery growth in preparation for eventual Fontan completion.
From the Research
Postoperative Management of a Glenn Operation
The postoperative management of a Glenn operation involves several key considerations, including:
- Monitoring for potential complications such as infection, excess fluid volume, and risk for decreased cardiac output 2
- Implementing an individualized care plan that addresses the patient's unique needs and health patterns, such as nutritional-metabolic and activity-exercise patterns 2
- Using standardized nursing taxonomies, such as NANDA-I, NOC, and NIC, to guide nursing assessments and interventions 2
Risk Factors for Morbidity and Mortality
Several risk factors have been identified as contributing to morbidity and mortality after a Glenn operation, including:
- Elevated central venous pressure and transpulmonary gradient 3
- Prolonged cardiopulmonary bypass time 3
- Right ventricular morphology 3
- Patient characteristics, such as weight and age at the time of surgery 3
Management of Postoperative Complications
The management of postoperative complications after a Glenn operation involves a general approach that includes:
- Early mobilization and freedom from tethers 4
- Effective pain control and treatment of malnutrition 4
- Prevention of pressure ulcers and reduction of risk for pulmonary, urinary, and wound infections 4
- Management of cognition and promotion of early mobility 4
Assessment of Postoperative Recovery
The assessment of postoperative recovery after a Glenn operation involves the use of various instruments and timing of assessments, including:
- Identification of instruments used in clinical trials to assess postoperative recovery, such as Quality of Recovery 5
- Determination of how, when, and the number of times postoperative recovery is measured, with most assessments occurring on postoperative day 1 5
- Exploration of whether the four dimensions of postoperative recovery (physical, psychological, social, and habitual) are represented in the identified instruments 5