The document discusses guidelines for managing cardio-circulatory therapy and hemodynamics for cardiac surgery patients, including recommended goals for parameters such as blood pressure, cardiac index, oxygen saturation, and diuresis. It also outlines causes and risks of postoperative hypertension and provides guidance on pharmacological management using intravenous vasodilators, beta blockers, and diuretics to control blood pressure in the postoperative period.

1. PO
STO
PER
ATIV
E
H
Y
PER
TEN
SIO
N
IN
C
A
R
D
IA
C
SU
RG
ERY
PATIEN
TS
B
Y- D
R
. A
R
M
A
A
N
SIN
G
H

2. GOALS FOR CARDIO-CIRCULATORY THERAPY
Parameters recommended:
• MAP >65 mm Hg
• Cardiac Index >2.0 L/min/m2
• SvO2 >65%
• PAD 10–15 mm Hg
• CVP 8–12 mm Hg (dependent on ventilation mode)
• Lactate <3 mmol/L
• Diuresis >0.5 ml/kg BW/h
Carl M, et al: S3 guidelines for intensive care in cardiac surgery patients. GMS 2010;8:1-25.

3. GOALS FOR CARDIO-CIRCULATORY THERAPY
Blood Pressure targets during the first 48 hours:
• Normal (MAP >65 mm Hg) Default BP goal
• High (MAP >75 mm Hg) Age >75
Poorly controlled HTN
Pre- or postop- renal impairment
Uncorrected carotid artery stenosis
Pre- or postop- ischemic stroke
• Low (MAP 55-60 mm Hg) Age <50 (with low preop- BP)
High bleeding risk
Surgery for chronic valve regurgitation
Sidebotham D, et al: Cardiothoracic critical care. Butterworth-Heinemann, Philadelphia 2007;20:295-297.

4. GOALS FOR CARDIO-CIRCULATORY THERAPY
Postoperative hypertension:
• Surgical stress
• Inadequate analgesia
• Anxiety
• Withdrawal of antihypertensive medications
• Hypothermia
• Patient-ventilator dysynchrony
Sidebotham D, et al: Cardiothoracic critical care. Butterworth-Heinemann, Philadelphia 2007;20:295-297.

5. GOALS FOR CARDIO-CIRCULATORY THERAPY
Postoperative hypertension may cause:
• Low cardiac output and tissue hypoperfusion
• Myocardial ischemia and arrhythmias
• Pulmonary edema
• Precipitate or exacerbate mediastinal bleeding
• Cerebral edema
• Precipitate intracranial bleed
Sidebotham D, et al: Cardiothoracic critical care. Butterworth-Heinemann, Philadelphia 2007;20:295-297.

6. GOALS FOR CARDIO-CIRCULATORY THERAPY
Management of postoperative hypertension:
• Adequate analgesia and sedation
• Assess intravascular volume status
• IV vasodilators (nicardipine, nitroglycerine, nitroprusside)
• Selective arterial vasodilators (hydralazine)
• IV metoprolol, esmolol or diltiazem (if patient tachycardic)
• IV diuretics (if filling pressures are elevated)
• Reversed Trendelenburg (if filling pressures are elevated)
Sidebotham D, et al: Cardiothoracic critical care. Butterworth-Heinemann, Philadelphia 2007;20:295-297.

7. MANAGEMENT OF POSTOPERATIVE
HYPERTENSION
Nicardipine (Cardene):
• Standard Dilution:
Total volume: 250 mL [25 mg/10 mL] [240 mL D5W or NS]
• Dosage and Administration:
Initial: 5 mg/hour
increase by 2.5 mg/hour every 15 minutes
to a maximum of 15 mg/hour
• Consider reduction to 3 mg/hour after response is achieved.
Titrate to lowest dose necessary to maintain stable BP.

8. MANAGEMENT OF POSTOPERATIVE
HYPERTENSION
Hydralazine (Apresoline):
• Standard Dilution:
[20 mg] [50 mL NS]
• Usual dosage:
10 to 40 mg IV q4-6h prn
• IV push rate: 10 mg/min
• May be given q20-30 minutes (until adequate response)
for the treatment of severe hypertension.

9. MANAGEMENT OF POSTOPERATIVE
HYPERTENSION
Metoprolol (Lopressor):
• Standard Dilution:
[20 mg] [50 mL D5W or NS]
• Usual dosage:
5 mg IV bolus x3 q2min
• Followed by 2 to 5 mg IV hourly
• Titrate to minimum HR of 60 or minimum systolic BP of 90

10. MANAGEMENT OF POSTOPERATIVE
HYPERTENSION
Esmolol (Brevibloc):
• Standard Dilution:
[2500 mg] [250 mL D5W or NS]
• Initial dosage:
500 mcg/kg over 1 min
• Followed by 50-100 mcg/kg/min
• Titrate to minimum HR of 60 or minimum systolic BP of 90