TY - CHAP M1 - Book, Section TI - Principles of Postoperative Critical Care A1 - Simmons, Jonathan A1 - Adam, Laura A. A2 - Hall, Jesse B. A2 - Schmidt, Gregory A. A2 - Kress, John P. PY - 2015 T2 - Principles of Critical Care, 4e AB - The initial sign that a malignant hyperthermia crisis is developing is a rise in end-tidal CO2 levels. The treatment of choice is dantrolene.Twitch monitors should be utilized to ensure that neuromuscular blockade has been adequately reversed as physical examination is not generally adequate. Residual neuromuscular blockade is an important cause of postoperative respiratory failure.Unfractionated heparin for DVT prophylaxis offers no benefit for trauma patients. Low-molecular-weight heparin should be used unless contraindicated.Patients with systolic anterior motion (SAM) of the mitral valve or significant ventricular hypertrophy should undergo fluid resuscitation as the mainstay of post-cardiac surgery management as inotropes may cause severe obstructive cardiogenic shock.Cardiac tamponade, massive hemothorax, and right heart failure are significant causes of morbidity and mortality in cardiac surgery. Their presentations can be similar and distinguishing between the different causes is imperative to ensure that proper medical and/or surgical treatment is performed.Inhaled pulmonary vasodilators are important adjuncts in the treatment of acute right heart failure in the postoperative period as they do not have the systemic effects of hypotension and hypoxemia seen with intravenous agents.β-Blockers and amiodarone are the main agents used for perioperative prevention of atrial fibrillation in cardiac surgery patients.Augmentation of mean arterial pressure, maintenance of cardiac output, and monitoring and drainage of cerebrospinal fluid with a lumbar drain are important adjunctive therapies to reduce rates of paralysis following aortic surgery.Cardiac herniation following pneumonectomy and pericardial patch breakdown is characterized by acute obstructive shock, jugular venous distention, and discoloration of the upper torso. The mortality rate is 50%; therefore, immediate recognition and surgical treatment are imperative.Bilateral recurrent laryngeal nerve injury leads to acute, emergent respiratory failure requiring intubation, followed by tracheostomy. SN - PB - McGraw-Hill Education CY - New York, NY Y2 - 2024/03/28 UR - accesssurgery.mhmedical.com/content.aspx?aid=1107712468 ER -