Cardiac

Question 1

Perioperative assessment:

Answer 1

Primary care:
* Optimise Hb
* Manage pre-existing conditions e.g. DM, HTN

Pre-operative:
* Risk assessment
* Patient information + informed decision making
* Optimise medical conditions
* Therapy, nutritional advice
* Discharge planning

Admission:
* Admit day before
* Optimise fluid hydration
* Minimise fasting period (solids 6 hrs, liquids 2 hrs)
* Avoid routine use of sedative premedication
* Carbohydrate loading
* Gabapentin + PPI

Intraoperative:
* Reduce SSI
* TXA
* Temperature
* Opioid sparing techniques + LA to wound and drains
* Antiemetics

Post-operative:
* Sedation hold and extubation
* Mobilisation within 4 hours of extubation
* Delirium screening
* Early oral hydration + nutrition
* Early drain + catheter removal
* BSL control
* VTE prophylaxis
* Avoid opioid-based analgesia where possible

Follow-up:
* Discharge when criteria met or as planned
* Therapy (PT, dietician, community nurse)
* 24 hr telephone follow-up if appropriate

Question 2

EuroSCORE

Answer 2

• age, sex
• insulin-dependent DM
• chronic pulmonary dysfunction
• neurological or musculoskeletal dysfunction affecting mobility
• creatinine clearance
• critical pre-op state (VT, VF, cardiac massage, ventilation, inotropes, IABP or VAD, acute renal failure = anuria or oliguria less than 10mL/hr)
• NYHA Class
• CCS class 4 (unable to perform any activity without angina or angina at rest)
• extracardiac arteriopathy (claudication, carotid occlusion >50% stenosis, amputation, prev. or planned abdominal aorta surgery, limb arteries or carotids)
• previous cardiac surgery
• active IE
• LVEF
• recent MI within 90 days
• pulmonary arterial systolic pressure
• urgency of procedure
• ‘weight’ of procedure - CABG, isolated non-CABG e.g. single valve replacement, ascending aorta replacement or septal defect correction, 2 major procedures, 3 major procedures
• thoracic aorta surgery