Pre and Postoperative Care for Patients Undergoing Open Cardiac Surgery

¹ The Department of Surgery and Variety Club Heart Hospital, University of Minnesota Medical School., Research Fellow, Dazian Foundation.
² The Department of Surgery and Variety Club Heart Hospital, University of Minnesota Medical School., Research Fellow, American Heart Association.
³ The Department of Surgery and Variety Club Heart Hospital, University of Minnesota Medical School.

The important aspects in the pre and postoperative care of patients undergoing open heart surgery based upon our experience at the University of Minnesota Variety Club Heart Hospital with more than 700 patients are discussed.

The careful preparation of the operative field with phisohex and the preoperative use of antibiotics and a good diet supplemented by vitamins will assist in obtaining smooth convalescence free of infections and complications.

Patients with a high pulmonary flow or pulmonary congestion are prone to infections of the tracheobronchial tree and lungs and should be adequately treated before surgery.

Overt or incipient heart failure should be treated with salt restriction, diuretics, and digitalization, but routine preoperative digitalization is not recommended.

Tracheostomies are performed preoperatively in patients with high pulmonary artery pressures and resistances to enable one to deal more adequately with secretions postoperatively and to assist respiration in this period if necessary.

Accurate preoperative weight should be obtained just before induction of anesthesia to enable one to calibrate the change in blood volume when compared with the immediate postoperative weight.

In the immediate postoperative phase, careful measurement and replacement of blood loss from the chest catheters and care of the tracheobronchial tree are some of the most important aspects leading to a low mortality.

Clearing of secretions from the mouth, nasopharynx, and hypopharynx by careful suctioning is recommended. Oxygen and humidity often supplemented with bronchial detergents are used routinely.

Unless there are unusual losses, electrolyte imbalance is not a problem in the postoperative phase. Intravenous fluids should be limited to 1 to 2 cc.Kg./hour for the first 24 hours to minimize the risk of pulmonary edema. Enough sodium chloride is given to cover losses due to gastric suction and sweating.

Prevention of acidosis in the postoperative period is of greatest importance. An adequate circulation is the most important single factor in the prevention of this grave complication, however, control of restlessness and high temperatures and the use of sodium bicarbonate will be of some help.

Heart failure should be treated in the usual manner postoperatively. Temporary cardiac decompensation that occurs 10-14 days after surgery due to the traumatic myocarditis is seen occasionally especially in patients with low cardiac reserve preoperatively. This is detected early by following daily weights and responds well to digitalization, salt restriction, and in no way jeopardizes an ultimately good prognosis if properly managed.

The treatment of heart block is managed with a myocardial (internal) electrode and artificial pacemaker constructed to give the small voltages necessary (1-10 volts). Isuprel is occasionally utilized to supplement the pacemaker and facilitate reconversion to a sinus rhythm.

Antibiotics are used for 10-12 days postoperatively.

The patients are discharged 14-21 days after surgery.