Anesthesiology and Intensive Care

Hyperthermia during Cardiopumonary Bypass  Moderate-quality prospective studies have demonstrated that when rewarming on cardiopulmonary bypass (CPB), hyperthermia (core temperature >37.9°C) is associated with cognitive deficits, infection, and renal dysfunction.  Any postoperative hyperthermia within 24 hours after coronary artery bypass grafting has been associated with cognitive dysfunction at 4 to 6 weeks.  Rewarming on CPB to normothermia should be combined with continuous surface warming.  Thus, we recommend avoiding hyperthermia while rewarming on cardiopulmonary bypass (class III, level B-R). Source:  Jama

  Surgical Site Infection Reduction To help reduce surgical site infections , cardiac surgery (CS) programs should include a care bundle that includes topical intranasal therapies, depilation protocols, and appropriate timing and stewardship of perioperative prophylactic antibiotics, combined with smoking cessation, adequate glycemic control, and promotion of postoperative normothermia during recovery. Moderate-quality meta-analysis have concluded that care bundles of 3 to 5 evidence-based interventions can reduce surgical site infections . This topic has been reviewed extensively with class of recommendation and level of evidence in an expert consensus review by Lazar et al. Evidence supports topical intranasal therapies to eradicate staphylococcal colonization in patients undergoing CS. From 18% to 30% of all patients undergoing surgery are carriers of  Staphylococcus aureus , and they have 3 times the risk of  S. aureus  surgical site infections and bacteremia. It is recommended tha

  Preoperative Carbohydrate Loading

 Consumption of Clear Liquids Before General Anesthesia

  Preoperative Measurement of Albumin for Risk Stratification

  Preoperative Measurement of Hemoglobin A 1c  for Risk Stratification Optimal preoperative glycemic control, defined by a hemoglobin A 1c  level