Preface

The perioperative period is vitally important in outcomes of patients undergoing cardiac surgery. The proper evaluation of preoperative period, as well as improvement in standards of perioperative care of these patients have been helping to reduce mortality and morbidity rates following the cardiac surgery. Accordingly, the content of present textbook mainly covers various topics related to perioperative period in cardiac surgery. In order to organize the content, two books have been created. The first book focuses on topics both in preoperative and early postoperative periods of cardiac surgery. The book covers not only classical chapters such as anesthesia for pediatric heart surgery and management of pulmonary hypertension in intensive care unit, but also currently "hot" topics consisting of strategies of blood conversation and heparin induced thrombocytopenia. The second book covers miscellaneous issues such as fungal endocarditis after cardiac surgery, off pump versus on pump coronary artery bypass surgery and arrhythmia after cardiac surgery.

This book should prove to be a useful reference for trainees, senior surgeons and nurses in cardiac surgery, as well as anesthesiologists, perfusionists, and all the related health care workers who are involved in taking care of patients with heart disease which require surgical therapy.

This book aims to improve the knowledge and understanding of readers with regard to the background of perioperative period in cardiac surgery.

I hope these internationally cumulative and diligent efforts will provide patients undergoing cardiac surgery with meticulous perioperative care methods.

Numerous international authors have participated in the creation of this book. I have compiled their valuable experiences and contributions about critical issues in the field of cardiac surgery.

I greatly acknowledge the precious assistance of Ms. Molly Kaliman of InTech Publisher. I also would like to thank Ilker Kiris, MD, for his productive ideas in the course of preparing this book.

### X Preface

Finally, upcoming decades should see even greater advances in the field of care of patients undergoing cardiac surgery. I assure that improvements in technologies and surgical skills will help to accomplish this goal.

To my wife, Gokce and to our children, Kaya and Kayra.

**Assoc. Prof. Cuneyt Narin, MD**  Department of Cardiovascular Surgery, Selcuk University Meram Medical School, Konya, Turkey

X Preface

Finally, upcoming decades should see even greater advances in the field of care of patients undergoing cardiac surgery. I assure that improvements in technologies and

**Assoc. Prof. Cuneyt Narin, MD** 

Turkey

Department of Cardiovascular Surgery,

Selcuk University Meram Medical School, Konya,

surgical skills will help to accomplish this goal.

To my wife, Gokce and to our children, Kaya and Kayra.

**1** 

*México* 

**Intensive Care Management of Patients** 

Villalobos J. A. Silva, Aguirre J. Sanchez, Martinez J. Sanchez,

*Universidad Nacional Autónoma de México (UNAM), Tamaulipas* 

Franco J. Granillo and Garcia T. Zenón

**in the First 24 Hours After Cardiac Surgery** 

The cardiac surgery continues having a fundamental roll in the therapeutic arsenal of many heart deseases in spite of the spectacular advances that determined drugs or different forms of interventionist cardiology have experimented during the past few years. The present impact of the heart surgery is due to the constant increase of the cardiovascular risk factors, related to the increase in the life expectancy in last the three decades, the clinical approach of the ischemic cardiopathy towards the repair has taken to the creation and development of techniques and methods at the moment used in the miocardic revascularization surgery; the roll of the coronary surgery initiated by Sabiston in 1962 and popularized by Favaloro in 1967 has had an exponential development with the purpose of to exclude the ill part from the artery by placing a bypass to improve the perfusion of the ischemic area. Nevertheless the other side of the balance is the pharmacological treatment whose objective is to look for the balance between the supply and demands in the ischemic scope at the expense of a smaller consumption of oxygen (VO2), diminution of the inflammatory local metabolism, control of trombotics phenomena, etc. Now on the basis of the knowledge and acquired experience we establish a margin of durability of 90% to 10years in grafts of internal mammary (AMI) and 50-60% of venous grafts (HV), depending on the vascularized area and the type of vein, in relation to the arterial grafts the average life is of 90% to 5 years with sufficient information of early stenosis problems. Most of the post-operated patients recover in a fast and complete form, which depends on the quality of the performed surgery and an opportune and suitable handling as all the symptoms of the organism recover of the effects of: anesthesia, cardiopulmonary derivation (CEC) and surgical stress. Nevertheless some patients who present combinations of indicators of preoperative risk like: age outpost, antecedents of miocardic revascularization, recent and acute miocardic heart attack (IAM), ejection fraction (EF) low or diabetes, have a much greater surgical risk to the one of the habitual patient. At the moment there are certain characteristics that have determined a fast recovery as they are the early extubation, to avoid major sedation, the disconnection of the support devices and the suspension of drugs as rapidly as possible. A fast treatment before a: Low cardiac cost, alteration of the pulmonary function, hemorrhages, coagulopathy and fever is essential to be able to obtain a fast recovery of the patients; at the moment the surgical indications of the miocardiac revascularization (RVM) have been based in relation to the number and degree of affectation of the coronary arteries, decreased ventricular

**1. Introduction** 
