Postoperative Care of the Emergency Coronary Artery Bypass Surgery

Urgent surgical revascularization often is indicated for life-threatening clinical situations clinical situations, such as cardiogenic shock, severe mitral valve regurgitation, repair of post-infarction ventricular septal defects, and unstable angina those do not respond to medical therapy or non-surgical intervention is not possible. The technical aspects of the surgical procedure differ little from those used in elective CABG; however anesthetic and postoperative management differ majorly from those used in elective CABG. Usually the patients are very unstable and the care should be well-organized. Invasive hemodynamic monitoring must be carried out continuously during patient transition from operating room to intensive care unit and hemodynamic support should be maintained or increased if needed. Transferring the care of a cardiac patient to the ICU staff must be done in an orderly and methodical fashion. Full support ventilation should be set considering patients hemodynamic in order to reduce work of breathing. Fast tracking is not recommended and weaning typically should be postponed to help cardiac recovery. Homodynamic support should be optimized using valid data such as invasive BP, cardiac output, SVR, ventricular and valvular function, ABG, TEE, laboratory tests. It is encouraged to prevent any event that can increase metabolic demand (or cardiac work demand); sedating the patient, decreasing work of breathing, preventing infection, optimizing volume status. Also a variety of techniques can be used; often an IV infusion of narcotic agonist agent and benzodiazepine cocktail is the best pain management method. Because most of organs are at risk of the postoperative dysfunction; any effort must be directed to reduce organ demand and increase organ supply. Postoperative complications should be expected, prevented, early diagnosed and managed promptly. Patient management always should be run multidisciplinary with close co-working.