| Cardiac management in the ICU. | |
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MedLine Citation:
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PMID: 10331347 Owner: NLM Status: MEDLINE |
Abstract/OtherAbstract:
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Coronary artery disease (CAD) is common in the surgical population, with up to 50% of postoperative deaths due to cardiac events. Most of these events are ischemic, with some being exacerbations of underlying congestive heart failure (CHF). Recent data indicate that acute perioperative beta-adrenergic blockade can reduce ischemia and ischemic events. Postoperative monitoring should focus on myocardial ischemia, with preparation for rapid treatment using IV therapy. A few studies suggest that elderly patients with known CAD undergoing major procedures might benefit from perioperative treatment guided by information from a pulmonary artery catheter. Postoperative CHF, which is likely to present early after surgery, may need aggressive management with diuretics, vasodilators, and inotropic drugs. Mechanical ventilation should be considered. When the patient develops severe or refractory dysrhythmias, serum magnesium levels should be supplemented and consideration given to IV use of amiodarone. Postoperative hypertension is common and can precipitate ischemia, CHF, and arrhythmias as well as cause bleeding. Newer IV drugs are arterial specific and can lower BP in a smooth and predictable manner. All acute cardiac disorders can be precipitated or exacerbated by inadequate pain control, hypoxemia, and fluid or electrolyte disorders. |
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Authors:
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J G Ramsay |
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Publication Detail:
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Type: Journal Article; Review |
Journal Detail:
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Title: Chest Volume: 115 ISSN: 0012-3692 ISO Abbreviation: Chest Publication Date: 1999 May |
Date Detail:
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Created Date: 1999-06-02 Completed Date: 1999-06-02 Revised Date: 2007-11-15 |
Medline Journal Info:
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Nlm Unique ID: 0231335 Medline TA: Chest Country: UNITED STATES |
Other Details:
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Languages: eng Pagination: 138S-144S Citation Subset: AIM; IM |
Affiliation:
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Department of Anesthesiology, Emory University School of Medicine, Atlanta, GA, USA. james_ramsay@emory.org |
Export Citation:
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APA/MLA Format Download EndNote Download BibTex |
| MeSH Terms | |
Descriptor/Qualifier:
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Aged Arrhythmias, Cardiac / drug therapy Coronary Disease / therapy Heart Failure / therapy Humans Hypertension / drug therapy Intensive Care* Intensive Care Units* Myocardial Ischemia / therapy* Postoperative Care* Respiration, Artificial Surgical Procedures, Operative |
From MEDLINE®/PubMed®, a database of the U.S. National Library of Medicine
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