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Beating Heart Bypass Surgery
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exellent links dear
Thanks god you all are out there
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Re: MI-CABG
dear sdkashif,
when they say performing on a beating heart now a days it means, that they like you have mentioned : do not use the heart-lung machine or the cardiopulmonary machine during surgery, instead they use what they call as an OCTOPUS: a small device that has many leg like projections: as the name susgests; and the heart nor the lung is stopped or the functions redirected for this process! In a off pump-CABG the appendeges of the octopus is attached to the area to be opearted upon: the area of the block i.e. and the grafting is performed as the area to be operated upon is stabilised. However the patient is NOT awake and is under GA! The advantage here is that the heart and the lung are saved of the distress they undergo (due to being off-duty : as i would say) when on the heart lung machine, also the surgeon is saved from a lot more post-op pulmonary complications (they also have to take the heart into the hand and give a direct CPR- like cardiac compressions at the end of the surgery, which if fails to reveive the heart .. they have to do a direct defib procedure on the heart itself!) that we come across during a regular CABG.
Moresoever the approach is via a regular sternotomy and costal retraction, so when the patient comes out post surgery he is treated or rehabilitated as a regular CABG case and no difference in the protocols used.. however a Minimally invasive technique that is refered to as a MID-CAB is where the sternum is not opened/ incised and an alternate site of inciscion is via the lat thoracotomy/ paramediatinal incision/ etc.
i believe if you are working in any particular institutution they will have their own cardiac rehab-protocol, and in reality you never get tro see any fresh/acute care case of CABG as an individual/pvt practictioner.
The protocols that i have followed with a major cardiac institutes when i was working with them was that of : in the ICU: chest physio ranging from BID to TID or even Q4hrly... depending on postop pulmonary status. then these were always preceeded by a session of nebulisation with either a combination of salbutamol, or soemtimes DUOLIN salmeterol/fluticasone.. for airway maintainence as prescribed by the surgeon/ cardiac team. during the nebulisation the patient is made to perform breathing exercises: mild emphasising more on the expiratory phase with some vey mild assisted coughing. In the ICU the pat is restricted to bed pan activities only till the 2nd day ,on the 3rd day pat is allowed to perform his toiletting outside his bed/in bed vicinty.
If at the end of the 3rd day all parameters are stable and post op CXR's are all fine , then the patient is shifted to the ward and the 4th day onwards the pat is ambulated/mobilised , here we assess the Dyspnoea and perception of fatigue by the patient to guide on how much the patient is to be exercised. side by side all breathing exercises are begun wioth co-ordinated limb mobility. the Spirometry may /not be introduced in the ICU itself (Depending on post-op condition).
and the breathing co-ordinated with limb exercises as well as the walking schedules are gradually increased and by the end of the 7th day the patient is discharged and requested to continue all exercises at home and also requested to come for regular follow ups to the surgical as well as the rehabilitative team during which the patient is reassessed from the rehabilitation point of view and the exercise are further stepped up or maintained.
whereas the sites you have mentioned are indeed very resourceful but do not pertain to you topic of interest
as they deal with MICAB types of approaches, it too is applicable only to single or maximally 3 blocks and cases where the area of durgery is not debatable i.e. not complicated: e.g: distal infarcts.hope this has not become as confusing as not intended to be!
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hi as u got the reply its the same protocol we people use for post op beating hrt srgry pts but in the inst am working most of the surgeries performed r beating hrt ,but patient is progressed to siiting in chair as soon as drains and lines (femoral and pa ,cvp monitoring lines r removed) mostly post -op day 2 and made to walk to toilet by end of day 2 or beginning of day 3(assissted ).we progress with b/l arm excs and knee excs by day2 itself otherwise spasm of pect msls and horizontal abd increase. incentive spiro ,huffing and relaxed diaphragmatic brthng incorporated day 1 only.
