Oxford Handbook of Anaesthesia Chp 19 & 20 Cardiac and thoracic anaesthesia
Highlights
- A cautious approach should be taken if administering premedication in
patients with pulmonary hypertension/RV dysfunction, or severe AS (View Highlight)
- CPB causes platelet dysfunction, haemolysis and consumption of
coagulation factors. This is minimal for the first 2h but increases with
prolonged duration. (View Highlight)
- The most widely used cardioplegic solution consists of crystalloid mixed
with blood and can be administered warm or cold. The crystalloid
contains high concentrations of K+ which precipitates the arrest of the
heart in diastole. Glutamate and aspartate may be added to promote
oxidative phosphorylation. (View Highlight)
- Protamine can cause systemic hypotension and pulmonary hypertension
and should be administered slowly to minimise these effects. (View Highlight)
- The lateral decubitus position, with the operating table ‘broken’ to
separate the ribs, is used for the majority of procedures. (View Highlight)
- Postoperative mechanical ventilation stresses pulmonary suture lines
and increases air leaks and risk of chest infection; avoid, if possible. (View Highlight)
- Predicted postoperative (ppo) value of the PFT results is calculated by
the following formula: ppo = preoperative value × (19 – number of
segments resected)/19. (View Highlight)
- If preoperative DLCO or ppoFEV1
is <40% predicted normal, the
patient should undergo CPET prior to surgery (View Highlight)
- CPET assesses VO2
max which is used to inform the risk of
perioperative morbidity and mortality. Patients with a VO2max 10–
15mL/kg/min are higher risk and should have postoperative HDU
admission. VO2
max <10mL/kg/min are very high risk and surgery
may not be appropriate (View Highlight)
- Smoking cessation and reducing alcohol consumption 4w preoperatively
reduces pulmonary complications and risk of death (View Highlight)
- Most volatiles weakly inhibit hypoxic pulmonary
vasoconstriction, but with little impact at ≤1 MAC (View Highlight)
- PONV should be avoided (View Highlight)
- Sizes of plastic DLTs are given in Charrière (Ch) gauge (equivalent to
French gauge), which is the external circumference of the tube in mm.
Thus, a 39Ch tube has an external diameter of about 13mm (View Highlight)
- Advance the tube to around 29cm, which is the average depth for
patients who are 170–180cm tall. There is a 1cm change in depth for
every 10cm variation in the patient’s height from this position (View Highlight)
- Increase FiO2 to 0.5–1.0 before initiating OLV. Note the airway pressure
(Paw
) generated by this VT
. (View Highlight)