Medical Pharmacology Chapter 43:  Adult Cardiac Procedures

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Coexisting Disease and Adult Cardiac Surgical Procedures:  Anesthesia Implications

Emergency Cardiac Surgery: Indications*



Thoracic aortic aneurysm repair

  • Acute thoracic aorta dissection

Pacemaker implantation

  • Persistent/recurring bradycardia, syncopal episodes with inadequate idioventricular rate and inability to establish temporary transvenous pacing


  • Acute myocardial tamponade with hypotension

Valvular replacement

  • Acute, serious and rapidly developing cardiac failure associated with abrupt valvular or valve prosthesis malfunction

Coronary artery bypass grafting

  • Persistent angina in patients with isolated coronary vessel stenoses supplying large mass of normal ventricular muscle

Pulmonary emboli  

  • Presence of large embolic obstruction, validated by angiography, lung scan or echocardiographic imaging


Adapted from Table 49-9, Shanewise, JS and Hug, Jr., CC, Anesthesia for Adult Cardiac Surgery, in Anesthesia, 5th edition,vol 2, (Miller, R.D, editor; consulting editors, Cucchiara, RF, Miller, Jr.,ED, Reves, JG, Roizen, MF and Savarese, JJ) Churchill Livingston, a Division of Harcourt Brace and Company, Philadelphia, p 1759, 2000.

ECG:  Hyperkalemia

  • "The T waves are tall, peaked and have a narrow base....These changes are characteristic of hyperkalemia.  The QRS is also slightly widened, another feature of hyperkalemia.Q waves in III and aVF indicate an old inferior MI.

  • courtesy of: Frank G.Yanowitz, M.D. and  The Alan E. Lindsey  ECG Learning Center, used with permssion

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