Thoracotomy may be described as posterior, postero-lateral, lateral, anterolateral and anterior. The patient is positioned on their contralateral side ensuring that the arm is flexed at the shoulder, drawing the scapula up the trunk is ‘broken’ at the subcostal margin with a sandbag and bent table. the knee and ankles are protected with jellybags to…
Fashioning the vein This is undertaken after checking for leaks, usually during initial cardioplegia delivery, or just before going on bypass. The proximal end of the vein is held between the left thumb and index finger. Cut the vein end obliquely to make a rhombus-hood using a Mcindoe scissors. Ensure the edges are clean off adventitia.…
Ingredients Mayo vein stripper 11-blade scalpel Artery forceps Ties Ligaclips Technique Make an incision in the groin to find the saphenous vein. Ligate the vein. The distal part of the graft is tied off with a long tie. Insert the tied off distal part into the lumen of the Mayo vein stripper. Push it…
Ingredients Sterile field – gown, gloves, swabs, drapes, povidone-iodine, wound kit with scissors, scalpel, forceps, swab clamp Local anaesthetic – syringe, large needle, small needle, LA agent Balloon – introducer needle, 11 scalpel, guide-wire, dilator(s), balloon Pressure trace – pressurised hepsal bag, long connector Pump – connector Securing – #1 suture, swabs, adherent dressing …
CPB strategy Heparin Expose the heart. Check BP/Aorta. Aortic cannulation; check cannula for pressure/flow Atrial cannulation; venous clamp off; on bypass. Lungs off Inspect the heart. Place aortic/retrograde cardioplegia. Reduce pump flow/cross-clamp aorta. Return to normal flow/check line pressure. Begin cardioplegia. Set patient temperature. Release aortic cross-clamp after warm cardioplegia. Be certain six conditions reviewed…
Preparing for bypass Before the operation Ensure cross-matched blood available for perfusionist, to prime pump if needed, for cardioplegia, for blood loss. Check imaging, planned procedure for anatomy that could complicate cannulation. Aortic: e.g. calcification/plaques, porcelain aorta, aneurysms, number of proximal graft anastomoses, aortic aneurysm/dissection surgery, Venous: type of venous cannulation (bicaval or atrial) Ensure…
Thermoregulation Input: Peripherally, cutaneous cold receptors (unmyelinated C fibres, thinly-myelinated A-delta) – DRG – to posterolateral tract (Lissauer) for 1 or 2 segments up to 2nd order neurons –> 2ON decussate and travel up spinothalamic tract to ventral posterior lateral thalamus. Processor: hypothalamus; Locus coeruleus, nuclear raphe magnus pons, pre-optic anterior hypothalamus Output: sympathetic, endocrine, behavioural, extra-pyramidal …
Isolated rib fractures Most common chest wall injury (others include sternum and clavicle) Clinical diagnosis mainly. Can use CXR to check for lung injury but may not be able to see fractures/all ribs. Can have underlying lung injury resulting in pneumothorax, haemothorax, pulmonary contusion. Management is mainly pain control – paracetamol/NSAIDS/opioids. Or use epidural, intercostal…
Indications Beat-to-beat monitoring required in patients: on vasoactive drugs (e.g. inotropes) blood pressure control prone to rapid change in condition requiring frequent blood sampling extremely hypotensive or arrythmias pulse contour analysis Method Hydraulic coupling – blood vessel connected with incompressible column of fluid that oscillates with changes in pressure (i.e. hydraulic coupling). Tranduction – converting pressure…
Most common adult congenital lesion. More common in women. Classical Types Ostium Primum – 15%; assoc with Mitral regurg, cleft anterior mitral leaflet. Large. Ostium Secondum – 65%; assoc with Mitral regurg in elderly; isolated Sinus venosus – 15%; superior (right PV and SVC mixing; common) or inferior (rare) type. assoc with p/tAPVC which may…