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Despite the widespread availability of investigational tests and imaging techniques for the diagnosis and management of cardiac disease, eliciting a comprehensive history and performing a systematic physical examination remain essential clinical skills.
Since its introduction into clinical practice in the early 1950s, the indications for CPB have broadened, from operations on or within the heart, to include non-cardiac thoracic, abdominal and neurological procedures. The indications for CPB for non-cardiac surgery are shown in Box 28.1.
In animals that maintain body temperature within a tight range (homeotherms), thermoregulation represents the balance between heat production (thermogenesis) and heat loss. Thermogenesis occurs as a result of metabolic activity, particularly in skeletal muscle, the kidneys, the brain, the liver and (in infants) adipose tissue. Body heat is lost by conduction, convection, radiation and evaporation (Table 24.1). Cold-induced hypothalamic stimulation activates autonomic, extra-pyramidal, endocrine and behavioural mechanisms to maintain the core temperature.
The AV is composed of three semilunar cusps left (posterior), right (anterior) and non-coronary cusp, which are related to the three sinuses of Valsalva. The main functions of the AV are to permit unimpeded LV systolic ejection and to prevent regurgitation of the LV stroke volume during diastole. The normal adult AV orifice area is 2-4 cm2.
A comprehensive review of the complications of cardiac surgery would fill an entire volume. This chapter covers the more common and life-threatening complications. The reader is directed to the publications list under further reading.
This fully-updated third edition provides a practical and concise guide to all aspects of the perioperative care of cardiac surgical patients. Produced by recognised leaders from world-renowned cardiac centres, this is the authoritative text for residents and fellows in anaesthesia and cardiac surgery, clinical perfusionists, and critical care nurses. Updated chapters include regional anesthesia, paediatric cardiac anaesthesia, and anaesthesia for specific procedures such as aortic valve surgery and cardiac transplantation. An entire section is dedicated to transoesophageal echocardiography (TOE) in recognition of the increasing demand for basic TOE training. The book also includes an expanded chapter on the applications and anaesthetic implications of extracorporeal membrane oxygenation (ECMO). The text focuses on clinical practice and the basic science and pharmacology underpinning cardiac anaesthesia, ensuring the reader can easily apply the knowledge gained to real-life situations.
As the indications for these devices has widened, the prevalence of permanent pacemakers (PPMs) and ICDs has increased. The complexity of these devices makes them susceptible to perioperative interference and inadvertent reprogramming, placing patients at greater risk of perioperative morbidity. Management guidelines are largely based on case series and expert consensus rather than prospective, randomized studies.