The optimal time for cardiac surgery ∗

Abstract

The optimal time for cardiac surgery occurs following a period of intense preparation, which is often prolonged. Maximal control of congestive failure is accomplished with rest, diuretics, digitalis administration and a low salt, high protein diet. Diuretic therapy should be avoided just prior to surgery since it may cause depletion of fluids and electrolytes, adversely affect operative and postoperative vasopressor responses, and increase digitalis scnsitivity. Prolonged pre-operative administration of digitalis assists in the prevention of operative and postoperative congestive failure and arrhythmias. The beneficial central and peripheral effects of digitalis may be of major importance in patients with no clinical evidence of heart failure as well as in those with manifest or latent failure. The preoperative psychologic preparation assists in preventing postoperative psychiatric disturbances. Other major considerations in the preoperative preparation include: checking of blood and coagulation problems; control of infections; correction of specific etiologic factors that increase cardiac work, such as anemia and hyperthyroidism; recording peripheral pulses, the electroencephalogram, electrocardiogram, phonocardiogram and portable chest x-ray film; the discontinuation of antihypertensive medication; noting the effects of positional changes; and balancing the virtues and hazards of administration of corticosteroids. The preoperative period of preparation and anticipation of the many operative and postoperative problems and complications may help to avoid them entirely, minimize them when they occur, and lead to their earlier and more effective treatment.