Post Operative Care After CABG
Dateline: 06/21/98
Welcome back. In case you missed the first part of this article, you can go back and read it now.
What could go wrong with John soon after the operation ?
Immediately after surgery there are some things that the intensive care unit team will watch for and
take precautions to prevent.
Bleeding
Post operative bleeding is one of the complications that might occur immediately after operation.
The bleeding might be from one of the branches of the arteries or veins used as bypass grafts. It
might be from the bed of the IMA graft. Rarely it might be from other sites, or a result of heparin
excess. The amount of blood draining out of the chest drains is measured regularly. If an alarming
amount of blood loss is noticed, rarely, emergency re-operation might be necessary to secure the
site of bleeding and prevent further loss.
Graft Occlusion
This is truly a surgeon's nightmare. One of the bypass grafts inserted might become blocked soon
after operation. This might be a consequence of
- drugs like aprotinin used sometimes in CABG
- dissection of blood into the coronary artery wall at the site of grafting
- technical mistakes in connecting the graft
- graft insertion into a severely diseased coronary artery
Manifestations of graft occlusion might be the development of fresh changes in the EKG, lowering of blood pressure, or heart rhythm disturbances. Early diagnosis might allow a trial of clot busting drugs or indicate early re-operation to fix the problem.
Low Blood Pressure
A drop in blood pressure after surgery needs quick evaluation and prompt treatment. The causes
for low BP after CABG are many. As mentioned above, graft occlusion is the one cause that needs
early intervention. Drugs to step up the BP are added if required. In extremely low BP which does
not respond to drugs, the surgeon can insert a device called an IABP (Intra-Aortic Balloon Pump)
which can assist the heart in maintaining blood pressure.
Heart Rhythm Disturbances
Alterations in the heart's electrical rhythm might occur after surgery. In most cases this can be
controlled by medications. Sometimes, though, it might be necessary to control the rhythm by using
an electrical pacemaker.
What could go wrong with John later ? Read on....
In addition to the problems I've discussed in this article, there are others which will be covered by the other guides in this special. Here is a list of these articles:
- Nursing care after open heart surgery
- Cardiological aspects of post op care
- Importance of Weight control after CABG
And don't forget. You can post your comments on this article on the Heart Disease Bulletin Board or discuss it in the Chat Room.
You can also review articles in the following interest areas dealing with heart disease:
- Minimally Invasive Heart Surgery
- MICAS website
- Fetal Heart Surgery
- Congenital Heart Disease
- Heart Disease in Women
Comments ? Feel free to air your views on this article. You can
- send me e-mail
- post on the heart disease bulletin board
- chat about it in the heart disease chat room.
I'll collect and compile interesting postings into a future article, of course with due credit to the authors. So go ahead and speak up your mind !
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