Postoperative Care of the Open-Cardiotomy Patient

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OPEN-CARDIOTOMY patients require a postoperative program that is individualized and meticulously supervised. There are no rules that can serve as a fixed guide for proper care. Experience in 103 operations, in 86 of which we performed elective cardiac arrest with potassium citrate,1,2 has established for us a set of procedures useful in the postoperative care. It is the intent of this paper to elaborate upon these basic observations. It is not necessary to review the general care of patients recovering from thoracic surgical procedures; our interest is confined at present to patients who have undergone open cardiotomy. The details of this postoperative program are of particular import in the care of children; adults do not require such precise attention, as their larger body mass makes small variations relatively less important.

Immediately Postoperative Care

The changes in patients during the hours immediately after open cardiotomy are sufficiently rapid and severe that it is mandatory to have a qualified team in constant attendance. This is best accomplished with a special-care unit designed and equipped exclusively for these patients. The basic team should include a resident physician well trained in thoracic surgery, and experienced nurses who are particularly interested in the field of cardiac surgery. A fortunate selection of capable personnel may be rewarded by a self-perpetuating system as the service demands grow. A detailed description of the equipment will not be given here; suffice it to say that the usual implements of the recovery room are basic and must be augmented by . . .



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