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Postoperative Critical
Care for Cardiac
Surgical Patients
Ali Dabbagh
Fardad Esmailian
Sary F. Aranki
Editors
Postoperative Critical Care for Cardiac
Surgical Patients
Ali Dabbagh • Fardad Esmailian • Sary F. Aranki
Editors
Postoperative Critical Care
for Cardiac Surgical
Patients
Editors
Ali Dabbagh, MD
Department of Anesthesiology
and Anesthesiology Research Center
Faculty of Medicine
Shahid Beheshti University
of Medical Sciences
Tehran
Iran
Fardad Esmailian
Heart Transplant and Mechanical
Circulatory Support
Cedars-Sinai Heart Institute
Los Angeles, CA
USA
Sary F. Aranki, MD
Divisions of Cardiac Surgery
Brigham and Women’s Hospital
Boston, MA
USA
ISBN 978-3-642-40417-7 ISBN 978-3-642-40418-4 (eBook)
DOI 10.1007/978-3-642-40418-4
Springer Heidelberg New York Dordrecht London
Library of Congress Control Number: 2013955229
© Springer-Verlag Berlin Heidelberg 2014
This work is subject to copyright. All rights are reserved by the Publisher, whether the whole or part of
the material is concerned, specifi cally the rights of translation, reprinting, reuse of illustrations, recitation,
broadcasting, reproduction on microfi lms or in any other physical way, and transmission or information
storage and retrieval, electronic adaptation, computer software, or by similar or dissimilar methodology
now known or hereafter developed. Exempted from this legal reservation are brief excerpts in connection
with reviews or scholarly analysis or material supplied specifi cally for the purpose of being entered and
executed on a computer system, for exclusive use by the purchaser of the work. Duplication of this
publication or parts thereof is permitted only under the provisions of the Copyright Law of the Publisher's
location, in its current version, and permission for use must always be obtained from Springer.
Permissions for use may be obtained through RightsLink at the Copyright Clearance Center. Violations
are liable to prosecution under the respective Copyright Law.
The use of general descriptive names, registered names, trademarks, service marks, etc. in this publication
does not imply, even in the absence of a specifi c statement, that such names are exempt from the relevant
protective laws and regulations and therefore free for general use.
While the advice and information in this book are believed to be true and accurate at the date of
publication, neither the authors nor the editors nor the publisher can accept any legal responsibility for
any errors or omissions that may be made. The publisher makes no warranty, express or implied, with
respect to the material contained herein.
Printed on acid-free paper
Springer is part of Springer Science+Business Media (www.springer.com)
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To my wife Samira and to my
Parents
Ali Dabbagh
To my family: Yvonne, Gabriel
and Aaron and to my parents
Fardad Esmailian
To Nadia, Alex, Heather and Abla
Sary F. Aranki
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vii
F o r e w o r d
The Handbook of Postoperative Critical Care for Cardiac Surgeries is a superb
amalgamation of a wide variety of clinical expertise in the perioperative and post-
operative care of cardiac surgical patients edited by three very fi ne academicians
from three outstanding medical centers and who are in the position of being able to
judge the best perioperative and postoperative cardiac surgical care. The three edi-
tors have a wide variety of cardiac surgical interest. Dr. Dabbagh is a cardiac anes-
thesiologist, who is intimately involved in the intraoperative and postoperative care
of cardiac surgery patients; Dr. Esmailian is an expert in the care of patients receiv-
ing cardiac assist devices and cardiac transplantation, which are some of the most
challenging postoperative patients; and Dr. Aranki is an extremely talented surgeon
in all aspects of cardiac surgery, especially coronary artery bypass grafting and
valve repair and replacement.
This book brings the entire spectrum of cardiac surgical perioperative treatment
and postoperative care under one cover. Postoperative critical care in cardiac sur-
gery is extremely important and I believe this book has the potential to be the gold
standard in postoperative care for cardiac surgical patients. The key to good surgical
results is the combination of an excellent operation and meticulous perioperative
and postoperative care, the essence of this book.
The authors are to be complimented for providing up-to-date, accurate, and intel-
lectual contributions for this most important area of cardiac surgery. This book is an
excellent effort in advancing the art and science of perioperative and postoperative
surgical care.
Lawrence H. Cohn, MD
Brigham and Women’s Hospital
Harvard Medical School,
Boston, MA, USA
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ix
Pref ace
Cardiac surgery is a process, not an event. Due to the prevalence of cardiac diseases
and conditions within society, cardiac surgeries now rank among the most common
of all surgical procedures. But they are also the most challenging and complicated,
all of which imposes a burden of instructive issues upon students and faculty alike.
The following is a handbook encompassing the entire period of postoperative car-
diac surgical care, including the basic physiologic and pharmacologic knowledge to
clinical aspects of clinical care in different major body organs.
This book stresses on this point that during postoperative period, the patient
commences upon a highly complex set of postoperative challenges and will often
require lifelong monitoring to ensure that the management of all potential morbidi-
ties has been achieved. Surgery is not, therefore, an end, but rather a beginning.
In the often long-term postoperative era, a patient embarks upon a new set of
needs for recovery and lifelong follow-up. Towards this end of perioperative care,
it is most crucial not to view the surgery and anesthesia as the climax of a patient’s
experience, but rather as a bridge between a former and a new life for the patient.
While postoperative care plays a crucial role in determining the clinical result for
the patient, the success of postoperative care is also directly affected by the quality of
the pre- and intraoperative experiences. The chapters of this book, therefore, also
survey these seminal periods for the patient, with particular attention given to cardio-
pulmonary bypass. Other chapters assume an organ-oriented perspective in address-
ing critical care. This broad, intersystemic approach creates a holistic view of the
cardiac domain not only in its functions within itself but also within the entire body,
enabling this to become a reliable guidebook for cardiac intensive care. This book
can then be used by cardiac surgeons, cardiac anesthesiologists, intensivists, and car-
diac intensive care nurses, as well as the students, interns, and residents learning in
such environments, in the successful management of the process of cardiac surgery.
This book could not have been come to fruition without the very committed and
compassionate teamwork of Springer Company, especially Springer-Verlag Berlin
Heidelberg.
The authors should acknowledge among a long list of people especially to the
following people:
Dr Ute Heilmann, Meike Stock, Martina Himberger, Dörthe Mennecke-Bühler,
Sally Ellyson, Margaret Zuccarini, Megan Hughes, Karthikeyan Gurunathan and
Palanisamy Dhanapal.
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