Pacu and Icu Care

The dynamic physiologic changes that occur in the early postoperative period place the cardiac patient at increased risk for a variety of cardiovascular complications. The limitations in cardiac reserve in patients with cardiac disease also increase the clinical significance of any postoperative problems. For example, the development of hypertension is usually well tolerated in healthy patients, but may precipitate congestive heart failure (CHF), myocardial ischemia, or arrhythmias in the patient with underlying cardiac pathology. The anesthesiologist's responsibility to the patient with heart disease extends to the post-anesthesia care unit (PACU) and intensive care unit (ICU). Appropriate perioperative management can lower the incidence of potentially life-threatening postoperative problems. This article discusses three common postoperative complications (myocardial ischemia/infarction, hypertension, arrhythmias) that occur with increased frequency in patients with cardiac disease. Understanding the mechanisms of their development, their physiologic impact, and available treatment options should lead to optimal postoperative care of the cardiac patient undergoing noncardiac surgery.