Immediate Preinduction Preparation and Monitoring

Premedication is frequently avoided, not just because these patients are more sensitive to sedatives, but also because these patients are usually well-informed regarding their procedure, and therefore tolerate the transfer to the operating room very well. The anesthesia equipment that is used for routine cardiac procedures should be sufficient for heart transplants. Monitoring includes electrocardiography (leads II and V5), pulse oximetry, and multigas analysis. Urine output is followed. Bladder/rectal, esophageal, and pulmonary arterial temperature are measured. A femoral arterial catheter is placed before induction of anesthesia to allow determination of central aortic pressure, because there may be a discrepancy between radial arterial and central aortic pressure, especially immediately after cardiopulmonary bypass. An oximetric pulmonary artery catheter is inserted through the right internal jugular vein, allowing continuous mixed-venous oxygen saturation (SvO2) measurement. Cardiac output is determined using thermodilution technique. A long sheet is used to cover the pulmonary artery catheter, which allows it to be pulled back into the superior vena cava during cardiopulmonary bypass and readvanced into the pulmonary artery after cardiopulmonary bypass. A transesophageal echocardiography (TEE) probe is placed after induction of anesthesia, and allows for additional monitoring of cardiac function and volume status.

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