What are the key factors to assess in a post-operative (post-op) cardiac patient?

From the Guidelines

A thorough cardiac post-operative assessment is crucial to identify potential complications early and improve patient outcomes, focusing on vital signs, hemodynamic stability, respiratory function, neurological status, pain control, fluid balance, and wound healing. Begin by checking vital signs including heart rate, blood pressure, respiratory rate, temperature, and oxygen saturation 1. Assess cardiac rhythm via continuous ECG monitoring, watching for arrhythmias like atrial fibrillation which commonly occurs post-cardiac surgery. Evaluate hemodynamic parameters including cardiac output, central venous pressure, and pulmonary artery pressures if available, as recommended by European experts in cardiosurgery 1.

Key Assessment Components

• Examine chest tube drainage for amount, color, and consistency, with bright red drainage exceeding 100-150 mL/hour warranting immediate attention
• Assess respiratory status through breath sounds, respiratory effort, and arterial blood gases if indicated
• Monitor neurological status using the Glasgow Coma Scale and check for focal deficits
• Evaluate pain using a standardized scale and ensure adequate analgesia, typically with IV opioids initially transitioning to oral medications
• Assess fluid balance by monitoring intake/output, daily weights, and laboratory values including electrolytes, BUN/creatinine, and complete blood count

Additional Considerations

• B-type natriuretic peptide (BtNP) levels can be a useful tool in pre-operative risk stratification and monitoring postoperative changes in cardiovascular functioning 1
• Consider the use of volatile anaesthetics and levosimendan as cardioprotective agents, although large trials are still needed to assess their efficacy 1
• In cases of myocardial dysfunction, consider the use of low-to-moderate doses of dobutamine and epinephrine, milrinone or levosimendan, and exclude hypovolemia in patients under vasopressors 1

From the FDA Drug Label

2.5 Cardiovascular Surgery Patients undergoing total body perfusion for open-heart surgery should receive an initial dose of not less than 150 units of heparin sodium per kilogram of body weight. Frequently, a dose of 300 units per kilogram is used for procedures estimated to last less than 60 minutes, or 400 units per kilogram for those estimated to last longer than 60 minutes.

The cardiac post-op assessment for patients undergoing cardiovascular surgery involves administering an initial dose of heparin sodium based on the patient's body weight.

• The recommended initial dose is not less than 150 units/kg.
• For procedures lasting less than 60 minutes, a dose of 300 units/kg is frequently used.
• For procedures lasting longer than 60 minutes, a dose of 400 units/kg is frequently used 2.

From the Research

Cardiac Post-OP Assessment

The assessment of patients after cardiac surgery is crucial to prevent and manage postoperative complications. Some key points to consider in cardiac post-OP assessment include:

• Fluid and inotropes administration should be targeted to maintain a cardiac index above 3 l/min/m throughout the perioperative period 3
• Volatile anaesthesia and mechanical ventilation with low tidal volumes, low driving pressure and moderate-low positive end-expiratory pressure should be preferred 3
• Preoperative steroids could reduce postoperative atrial fibrillation 3
• Familiarity with common complications combined with a structured approach to management facilitates response to even the most complicated postoperative situations 4
• Standardized care and constant self-examination are essential for programmatic improvement and consistent high-quality care 4

Procedure-Specific Considerations

Cardiac surgery procedures have specific management concerns, and knowledge of these concerns is essential for anticipating and preventing complications. Some key points to consider include:

• Routine management of the postoperative cardiac surgical patient includes adequate fluid resuscitation, appropriate inotropic support, attention to rewarming, and ventilator management 5
• Patient safety is enhanced by experienced personnel, a structured handover between the operating room and ICU teams, and appropriate transfusion strategies 5
• The combination of beta-blockers and ACE inhibitors may be beneficial in patients with cardiovascular diseases, including those who have undergone cardiac surgery 6, 7

Management of Complications

The management of complications after cardiac surgery is critical to preventing morbidity and mortality. Some key points to consider include:

• Most complications after cardiac surgery fall into a limited number of categories, and familiarity with these complications can facilitate response to postoperative situations 4
• The use of beta-blockers and ACE inhibitors may be beneficial in managing certain complications, such as arrhythmias and heart failure 6, 7