Johnny's Basic Open Heart Step List

This list is only meant as a guide, and in no way indicates the only way to provide anesthesia. I place all liability on the provider.(That was a disclaimer).

pre-op, pre-med as per attending.
Standard room setup, check pt in holding, npo etc.,
to table, monitors on,
start archive,My program under sciarra is:CV1 or CV2
titrate midaz.,
r-rad a-line, pa cath via rij., #14 iv probably in lue,
titrate in panc/fentanyl
8.0 ett, check bp/hr right before intubation,
tuck arms/prep,ngt, abx(triple abx if tee used),
aprotinin (if redo & aneurysm)1cc test,200cc load,50cc/h infusion,
Infusion drugs to infusion port of pa cath
base line ABG, 1/3cc
lungs down for sternotomy,
decrease tv and inc.rate if IMA takedown and back up when done,
heparin (1/3 cc/kg)or ask perfusion to calculate dose,
ACT/hep level after 4 min, Act after 20 min. if not on bypass,
bp down for Ao cannulation,no discetions please.
on bypass, vent off, air on, alarms off, inf. pumps off, empty UO,
m. relaxant and narcs to pump,if aprotinin then 200cc to pump,
blanket T down,
rewarming:blanket T up,
Ao clamp off & NTG on,
pacer on if needed, ask RN for device,
expand lungs with 100% O2, hand bag, vent on, alarms on
various infusion on as needed,
off bypass,
protamine(per surgeon request) 5mg/kg or as by heparin assay,
notify perfusion when protamine 1/2 in & UO on bypass
ABG & ACT/hep level after 4 min.,
hang cellsaver,
Ngt in when TEE probe out
Opsites over central line
empty urimeter
Heplock extra ports and IVs
transport with monitors and O2,mask,emergency drugs,
close archive,
bring down pumps from CSICU and plug in,
get next pt or go home.

Links to other anes. sites on the Web
The ASA's site
The APSF's site Patient safety, plus protocols, guidelines, videos, software. .
The Virtual Anesthesia Textbook
WWW Virtual Liberary:Anesthesiology
Journal Anesthesiology
The Virtual Museum of Anesthesiology An electronic repository of historical images and information, run by my friend Carlos.
The Brand Institute An on-line survey org.
U. of Miami Dept of Anes. basic department page
Anesthesiology and critical care resources on the internet
GASWORKa free job placemet service
Penn State eAnesthesia also has an employment archive
Internationa Assoc for the study of Pain
Cardiovascular Heart Surgery Forum---Warnings
The Airway Gazette As it sounds and a resoursce for airway images.