What are the main postoperative problems which occur in the first 24 hours following a coronary artery bypass graft? Outline their management.

Coronary artery bypass grafting (CABG) is a common procedure in the developed world, but although it has become routine there remain a large number of potential complications, many of them related to cardiopulmonary bypass (CPB), which can affect every organ system. The question is testing your appreciation of the main principles rather than specifics. If you are struggling then it may help to consider the worse case scenarios, given the huge array of complications of CPB that have been described.

Introduction

Surgery for coronary artery disease involves the insertion of a vascular graft in an organ which may have precarious function. The surgery may be prolonged and is enabled by the use of cardiopulmonary bypass, which as a non-physiological process has been associated with a large number of complications. There are, therefore, several problems which may occur in the first postoperative day.

Cardiovascular

• Cardiac failure. Cardiac output may be compromised because of pre-existing ischaemic damage or because the myocardium is stunned after CPB and prolonged surgery.

1. — Deterioration is prevented by optimising oxygen supply in face of demand.

2. — Monitor function (PAcatheter) and manage accordingly: inotropic support and vasodilators may suffice. May need intra-aortic ballon pump counterpulsation or assist devices (depending on the centre).