Anesthesiology and Intensive Care

  Persistent Postoperative Hypothermia Postoperative hypothermia is the failure to return to or maintain normothermia (>36°C) 2 to 5 hours after an intensive care unit (ICU) admission associated with Cardiac Surgery (CS). Hypothermia is associated with increased bleeding , infection, a prolonged hospital stay, and death . Large registry observational studies suggest if hypothermia is of short duration, outcomes can be improved. Based on this evidence, we recommend prevention of hypothermia by using forced-air warming blankets, raising the ambient room temperature, and warming irrigation and intravenous fluids to avoid hypothermia in the early postoperative period (class 1, level B-NR). Read Also: Perioperative bleeding. General coagulation management.

Perioperative Pain Management

Table of risk factors for postoperative pulmonary complications. Click to enlarge: ASA, American Society of Anesthesiologists. 1. Within each evidence category, risk factors are listed according to  strength of evidence, with the first factor listed having the strongest evidence. 2. Subsequent evidence indicates that this is a probable risk factor. Data from Smetana GW, Lawrence VA, Cornell JE, et al: Preoperative  pulmonary risk stratifi cation for noncardiothoracic surgery: systematic  review for the American College of Physicians, Ann Intern Med  2006;144(8):581-595.

    Recommendations for Clear Liquids.   It is appropriate to fast from intake of clear liquids at least 2 h before elective procedures requiring general anesthesia, regional anesthesia, or sedation/analgesia (i.e., monitored anesthesia care). Examples of clear liquids include, but are not limited to, water, fruit juices without pulp, carbonated beverages, clear tea, and black coffee. These liquids should not include alcohol. The volume of liquid ingested is less important than the type of liquid ingested.     Recommendations for Breast Milk.   It is appropriate to fast from intake of breast milk at least 4 h before elective procedures requiring general anesthesia, regional anesthesia, or sedation/analgesia  (i.e., monitored anesthesia care).     Recommendations for Infant Formula.   It is appropriate to fast from intake of infant formula at least 6 h before elective procedures requiring general anesthesia, regiona...

Postoperative   (CABG)  Antiplatelet Therapy: Recommendations CLASS I 1. If aspirin (100 mg to 325 mg daily) was not initiated preoperatively, it should be initiated within 6 hours postoperatively and then continued indefinitely to reduce the occurrence of SVG closure and adverse cardiovascular events. (Level of Evidence: A) CLASS IIa 1. For patients undergoing CABG, clopidogrel 75 mg daily is a reasonable alternative in patients who are intolerant of or allergic to aspirin. (Level of Evidence: C)                  AND from 2011 ACCF/AHA CABG Guideline