Anesthesiology and Intensive Care

It is indicated in cases of heart valve lesions (mainly stenotic), prosthetic  valve or previous endocarditis: Amoxycillin 1g plus gentamicin, 120 mg IV at induction, then amoxicillin 500 mg, orally 6 hours later. If urine infected, prophylaxis should cover causative organism. If allergic to penicillin, or have received more than one dose of penicillin in preceding month: Vancomycin 1g IV over 100 minutes plus gentamicin 120 mg IV at induction, or Teicoplanin 400 mg IV plus gentamicin 120 mg IV at induction.

The activated clotting time (ACT) is a point-of-care test most commonly used to monitor for heparin effect during cardiovascular surgery. The test consists of adding whole blood to a test tube most often containing either diatomaceous earth (celite) or kaolin. These particulate activators induce thrombus formation, which is timed. Normal ACT values range between 80 and 120 seconds. The ACT test is useful in that it uses whole blood, can be performed easily at the point of care, and provides results relatively quickly. It is important to realize, however, that ACT is a nonspecifi c test of coagulation. That is to say, a prolonged ACT can be caused by almost anything that decreases coagulation, not just heparin . While ACT is most affected by the state of the intrinsic coagulation system, the extrinsic system and platelet function also play a role. Therefore, heparin, warfarin, platelet dysfunction, protamine excess, and hemodilution would all be expected to increase...

The distal end of a pulmonary artery catheter is typically directed into a branch of the right pulmonary artery. This is due to the orientation of the natural curvature of the catheter relative to the path of the catheter through the right heart. During diastole, when the balloon on the tip of the pulmonary artery catheter is inflated, a fluid chamber connection from the tip of the pulmonary artery catheter to the left ventricle is established. This is referred to as the pulmonary artery occlusion pressure or “wedge” pressure. This pressure is not equal to but is related to the pulmonary artery diastolic pressure, which is measured when the balloon is deflated. Any pathology that occurs between the tip of the catheter and the left ventricle will affect and degrade the relationship between pulmonary artery diastolic pressure and left ventricular end-diastolic pressure . Pulmonary artery hypertension from changes in pulmonary vascular resistance, whether from reversi...