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CABG
+ CPB (Cardio
Pulmonary - CPB
Bypass →Heart
Lung Machine)
Effects Of CPB During & After Operation:
Lung Vascular Resistance ↑
Platelet & Leucocyte Aggregation in the Lung
Vasculature
Release of Vasoactive Subtances of Leucocyte & Lung
endothels during CPB → Inflamatory Reaction
→ Respiratory Complication → Post Op:
- Vital Capacity↓
- Spontaneous Respiratory Work ↑
- Inspiratory Cap ↓ Ended up
- Functional Residual Cap↓ ±2 weeks
- Surfactant Production↓ post op
Effect On Renalfuction etc
1. Narcotics & Sedatives Block Respiratory Drive
Activation:
- ↓ Response to Hypoxia
- ↓ Response to Hypercapnia
- ↑ Dead space of the Lung
2. Neuro muscular blocking drugs → Total Minute
Ventilation ↓
Post Op : - Dizziness, Light Headedness
- Muscle weakness
- Prolong time for weaning
- > Ventilator dependency
1. Low Output Syndrome 9. Icteric – Hepatic disorders
2. Cardiac Tamponade (Alb, Glob, etc?)
3. Perioperative myocardial 10. Stress Ulcer
infarction 11. Neurologic Abnormalities
4. Arrhythmia ec Hypoxia, Emboli,
5. Thromboemboli Bleeding, metabolic
6. Haemorrhage post op disorders, anesthetic drugs
7. Post perfusion Syndrom 12. Infection on the surgical
(Effect of CPB) sites →mediastinum, lung,
systemic
8. Acute Renal Failure(CPB)
13. Death
Definition : Interdisciplinary approach to restore
maximally physical, mental emotional, socioeconomic,
sexual & vocational function of patients undergone
CABG.
GOALS:
Return to work → as soon as possible → productive
+/↑
↑ CV Functional cap: optimal → maximal
No return to previous work:
1. maintain active living
→↑Q of L
2. change other job
I. In ICU
1. General Condition
Consciousness, speech, language, perception,
dysarthry, dysphagia, memory GCS
Movement : N/ Paresis/ Chorea/ Dyskinesis
-Hypovolemic →Preload ↓
Cardiac output + SVR ↓
-Ischemic/ myoc. Infarction
↓
→LV Function ↓→RVHF
Hypotension
& Dysfunction →
↓
cardiac tamponade
Cardiogenic shock
-Electrolyte
↓
imbalance→acidosis
Fatal
-Dys/ Arrhythmia→Fatal
Hemodynamic
Surgical Sites !! Arrhythmia
↓
Fatal
7. Psychosocial problems : Anxiety, Depression,
Neurosis → Psychologist / Psychiatrist
8. Vocational problems:
- Occupational Therapist
- Social worker
Breathing Ex, Huffing, Effective coughing
Postural drainage, chest physiotherapy
Respiratory muscles & diaphragm strengthening Ex
General ROM Ex: !! Shoulder!!, Ankle pumping
Static Contraction !! Upper back & shoulder Arm!!
General Ex. →Extremities, neck & Trunk
Mobilization (Gradually) → Up to Sitting on The Bed
Psychosocial Management
Surgical Sites
Haemodynamic !!
II.In High Care Unit
No Complication → Continue Above
Management
Mobilize Patient → Bedside Sitting with
dangling feet → standing
Incentive Spirometry to expand the
thoracic volume & ↑ Lung capacity
Any Complication : Rehab Adapted
specifically (Stroke)
Predictors:-Class of angina
-Hypertension
-Perioperative myocardial infarction
-Renal dysfunction
-Clinical CHF
-Repeated angina
-Obesity/ cachexia
-Less commonly used a. mammaria interna
Thank You