Postoperative cardiac

Kim KY, McCartney JR, Kaye W, Boland RJ, Niaura R. (1996). The effect of cimetidine and ranitidine on cognitive function in postoperative cardiac surgical patients. Int J Psychiatry Med. 26(3) 295-307. Ko FN, Huang TF, Teng CM. (1991). Vasodilatory action mechanisms of apigenin isolated from Apium graveolens in rat thoracic aorta. Biochim Biophys Acta. 1115(1) 69-74. 

Morady F. Prevention of atrial fibrillation in the postoperative cardiac patient significance of oral class III anti-arrhythmic agents. Am J Cardiol 1999 84(9A) R156-60. 

Zurick AM, Wagner RH, Starr NJ, Lytle B, Estafanous FG. Intravenous nitroglycerin, methemoglobinemia, and respiratory distress in a postoperative cardiac surgical patient. Anesthesiology 1984 61(4) 464-6. 

McPhail NV, Ruddy TD, Calvin JE, et al. A comparison of dipyridamole-thallium imaging and exercise testing in the prediction of postoperative cardiac complications in patients requiring arterial reconstruction. J Vase Surg 1989 10 51-56. 

In a non-randomized study, 391 patients who were given aprotinin after median sternotomy for non-bypass surgery were compared with 370 controls postoperative cardiac, renal, neurological, and respiratory complications and hospital mortality were similar in the two groups [20E]. 

These analgesics are chiefly used for the relief of postoperative pain, cardiac pain and pains of terminal cancer, and in child birth. 

Thromboembolic complications Adjunct to coumarin anticoagulants in the prevention of postoperative thromboembolic complications of cardiac valve replacement. 

Tachy-arrhythmias may be treated with a /3i-selective blocker. Sotalol may be used in the treatment of postoperative atrial fibrillation, which is observed frequently following cardiac surgery. 

Verapamil and a few newer dmgs of this category are vasodilator agents, which in addition impair AV conduction, reduce heart rate and cardiac contractile force. Verapamil was initially developed for the treatment of supraventricular tachycardia and it continues to be an important drug for the management of this condition, also postoperatively. Verapamil is the CA of choice in the management of hypertrophic cardiomyopathy. Verapamil is also used in the treatment of stable angina and, less frequently, essential hypertension. 

Digoxin, prototype of the cardiac glycosides, is frequently used postoperatively for the management of atrial fibrillation. This effect is based on the impairment of AV conduction and unrelated to digoxin s positive inotropic activity. In the treatment of post-operative atrial fibrillation digoxin may be... 

Unlabeled Uses Control of hemodynamicallystableventriculartachycardia, control of rapid ventricular rate due to accessory pathway conduction in preexcited atrial arrhythmias, conversion of atrial fibrillation to normal sinus rhythm, in cardiac arrest with persistent ventricular tachycardia or ventricular fibrillation, paroxysmal supraventricular tachycardia, polymorphic ventricular tachycardia or wide complex tachycardia of uncertain origin, prevention of postoperative atrial fibrillation... 

Postoperative malignant glaucoma Topical Instill Idropofa 10% solution with Idrop of a l%to4%solution3ormoretimesperday. In general, the 2.5%solution is preferred in elderly to avoid cardiac reactions. 

When oral intake of food and water is limited as in pre and postoperative patients or in the patients with severe hepatic or cardiac or GIT disease. 

Succinylcholine Agonist at nicotinic acetylcholine (ACh) receptors, especially at neuromuscular junctions depolarizes may stimulate ganglionic nicotinic ACh and cardiac muscarinic ACh receptors Initial depolarization causes transient contractions, followed by prolonged flaccid paralysis depolarization is then followed by repolarization that is also accompanied by paralysis Placement of tracheal tube at start of anesthetic procedure t rarely, control of muscle contractions in status epilepticus Rapid metabolism by plasma cholinesterase normal duration, 5 min Toxicities Arrhythmias hyperkalemia transient increased intraabdominal, intraocular pressure postoperative muscle pain... 

A 60-year-old white man was admitted for kidney transplantation. Immediately after reperfusion and intravenous methylprednisolone 500 mg, he developed severe bradycardia with hypotension and then cardiac arrest. After resuscitation, his clinical state improved quickly, but on the morning of the first postoperative day directly after the intravenous administration of methylprednisolone 250 mg, he had another episode of severe bradycardia, hypotension, and successful cardiopulmonary resuscitation. A third episode occurred 24 hours later after intravenous methylprednisolone 100 mg, again followed by rapid recovery after resuscitation. Two weeks later, during a bout of acute rejection, he was given intravenous methylprednisolone 500 mg, after which he collapsed and no heartbeat or breathing was detectable after cardiopulmonary resuscitation he was transferred to the intensive care unit, where he died a few hours later. 

Cicek S, Demirkilic U, Ozal E, Kuralay E, Bingol H, Tatar H, Ozturk OY. Postoperative use of aprotinin in cardiac operations an alternative to its prophylactic use. J Thorac Cardiovasc Surg 1996 112(6) 1462-7. 

A retrospective analysis of postoperative renal function in patients undergoing cardiac operations has been conducted to evaluate whether the use of prophylactic intravenous diltiazem, in order to reduce the incidence of ischemia and dysrhythmias, was associated with increased renal dysfunction (10). The incidence of acute renal insufficiency requiring dialysis was 4.4% with diltiazem versus 0.7% in the controls. Logistic regression analysis suggested that the risk of acute renal insufficiency was strongly associated with intravenous diltiazem, age, baseline serum creatinine, the presence of left main coronary disease, and the presence of cerebrovascular disease. 

Thromboplastin accelerates in-vitro coagulation, but only at certain concentrations and has been given intravenously by injection or infusion. Infusion shortens the bleeding time and normalizes both thrombin generation and prothrombin consumption in vitro for up to 3 hours in a small group of uremic patients (20). It has been used to treat postoperative hemorrhage in the oral cavity (21) and bihary tract (22). There were no adverse effects involving circulatory or cardiac function in healthy human subjects after intravenous injection of 10 ml, but rapid injection can reduce the blood pressure (23). 

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