Key Points 1. Active fixation leads can penetrate through structures (e.g., the thin-walled right atrium) during placement and present as pain, pneumomediastinum, or effusions. 2. Active rate modulation in cardiac implantable electrical devices (CIEDs) may result in heart rate changes…
Key Points 1. Percutaneous coronary intervention (PCI) with stent placement is frequently performed, with a substantial number of patients requiring subsequent noncardiac surgery (NCS). 2. Three types of stents are currently available for clinical use: bare metal stents (BMSs), drug-eluting…
Key Points 1. Perioperative triage should determine whether cardiac patients receive outpatient surgery, routine inpatient care, or critical care services. 2. Advanced hemodynamic monitoring may be required in high-risk patients with cardiac disease undergoing noncardiac surgery, including direct arterial pressure…
Key Points 1. Preoperative assessment of the cardiac patient undergoing noncardiac surgery includes risk assessment for major adverse cardiac events (MACEs). 2. Categorizing risk for MACEs is dependent on patient risk factors, including the noncardiac procedure, patient age, emergent status…
Key Points 1. Inadequate postoperative analgesia and/or an uninhibited perioperative surgical stress response has the potential to initiate pathophysiologic changes in all major organ systems, which may lead to substantial postoperative morbidity. Adequate postoperative analgesia prevents unnecessary patient discomfort, may…
Key Points 1. Cardiac surgical patients are at significant risk from preventable adverse events. These events occur through human error, by either faulty decision making (diagnosis, decision for treatment) or faulty actions (failure to implement the plan correctly). 2. Human…
Key Points 1. Despite a progressive decrease in cardiac surgical mortality, the incidence of postoperative neurologic complications has remained relatively unchanged over the decades. 2. The risk for stroke in patients undergoing coronary artery surgery increases progressively with increasing age,…
Key Points 1. Maintaining oxygen transport and oxygen delivery appropriately to meet the tissue metabolic needs is the goal of postoperative circulatory control. 2. Cardiac function worsens after cardiac surgical procedures. Therapeutic approaches to reverse this dysfunction are important and…
Key Points 1. Cardiac anesthesia has fundamentally shifted from a high-dose narcotic technique to a more balanced approach using moderate-dose narcotics, shorter-acting muscle relaxants, and volatile anesthetic agents. 2. This new paradigm has also led to renewed interest in perioperative…
Key Points 1. The key to successful weaning from cardiopulmonary bypass (CPB) is proper preparation. 2. After rewarming the patient, correcting any abnormal blood gases, and inflating the lungs, make sure to turn on the ventilator. 3. To prepare the…