CABG - Bypass Surgery - Procedure - www.medodeal.com

How do they do it?

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The patient is brought to the operating room and moved onto the operating table.
An anaesthetist or anesthesiologist places intravenous and arterial lines and injects an analgesic, usually fentanyl, intravenously, followed within minutes by an induction agent, usually propofol or etomidate), to render the patient unconscious.
An endotracheal tube is inserted and secured by the anaesthetist and mechanical ventilation is started. General anaesthesia is maintained with an inhaled volatile anesthetic agent such as isoflurane.
The chest is opened via a median sternotomy and the heart is examined by the surgeon.
The bypass grafts are harvested – frequent vessels are the internal thoracic arteries, radial arteries and saphenous veins. When harvesting is done, the patient is given heparin to inhibit blood clotting.
In the case of "off-pump" surgery, the surgeon places devices to stabilize the heart.
In the case of "On-pump" coronary artery bypass|on-pump]] surgery, the surgeon sutures cannulae into the heart and instructs theperfusionist to start cardiopulmonary bypass (CPB). Once CPB is established, there are two technical approaches: either the surgeon places the aortic cross-clamp across the aorta and instructs the perfusionist to deliver cardioplegia with a cooled potassium mixture to stop the heart and slow its metabolism or performing bypasses on beating state (on-pump beating).
One end of each vein graft is sewn on to the coronary arteries beyond the obstruction and the other end is attached to the aorta or one of its branches. For the internal thoracic artery, the artery is severed and the proximal intact artery is sewn to the LAD beyond the obstruction. Aside the latter classical approach, there are emerging techniques for construction of composite grafts as to avoiding connecting grafts on the ascending aorta (Un-Aortic) in view of decreasing neurologic complications.
The heart is restarted; or in "off-pump" surgery, the stabilizing devices are removed. In cases where the aorta is partially occluded by a C-shaped clamp, the heart is restarted and suturing of the grafts to the aorta is done in this partially occluded section of the aorta while the heart is beating.
Protamine is given to reverse the effects of heparin.
Chest tubes are placed in the mediastinal and pleural space to drain blood from around the heart and lungs.
The sternum is wired together and the incisions are sutured closed.
The patient is moved to an intensive care unit (ICU) or cardiac universal bed (CUB) to recover. Nurses in the ICU monitor blood pressure, urine output, respiratory status, and chest tubes for excessive or no drainage. Excessive drainage suggests continued bleeding which may require re-operation to manage; no drainage suggests an obstructed tube, which can result in cardiac tamponade and/or pneumothorax which can be lethal.
After awakening and stabilizing in the ICU for 18 to 24 hours, the person is transferred to the cardiac surgery ward. If the patient is in a CUB, equipment and nursing is "stepped down" appropriate to the patient's progress without having to move the patient. Vital sign monitoring, remote rhythm monitoring, early ambulation with assistance, breathing exercises, pain control, blood sugar monitoring with intravenous insulin administration by protocol, and anti-platelet agents are all standard of care.
The patient without complications is discharged in four or five days.
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Kidney Transplant, Acute Renal Failure - Earn a New Life, Live Young - www.medodeal.com

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Kidney transplantation or renal transplantation is the organ transplant of a kidney into a patient with end-stage renal disease. Kidney transplantation is typically classified as deceased-donor (formerly known as cadaveric) or living-donor transplantation depending on the source of the donor organ. Living-donor renal transplants are further characterized as genetically related (living-related) or non-related (living-unrelated) transplants, depending on whether a biological relationship exists between the donor and recipient. Exchanges and chains are a novel approach to expand the living donor pool.

The indication for kidney transplantation is end-stage renal disease (ESRD), regardless of the primary cause. Diabetes is the most common cause of kidney transplantation, accounting for approximately 25% of those in the US. The majority of renal transplant recipients are on dialysis (peritoneal dialysis or hemofiltration) at the time of transplantation. However, individuals with chronic renal failure who have a living donor available may undergo pre-emptive transplantation before dialysis is needed.

Contraindications include both cardiac and pulmonary insufficiency, as well as hepatic disease. Concurrent tobacco use and morbid obesity are also among the indicators putting a patient at a higher risk for surgical complications

In most cases the barely functioning existing kidneys are not removed, as this has been shown to increase the rates of surgical morbidities. Therefore, the kidney is usually placed in a location different from the original kidney, often in the iliac fossa, so it is often necessary to use a different blood supply:

The renal artery of the kidney, previously branching from the abdominal aorta in the donor, is often connected to the external iliac artery in the recipient.
The renal vein of the new kidney, previously draining to the inferior vena cava in the donor, is often connected to the external iliac vein in the recipient.

When kidneys fail, there are three treatment choices:

hemodialysis,
peritoneal dialysis
kidney transplantation.

Many people feel that a successful kidney transplant provides a better quality of life because it may mean greater freedom, more energy and a less strict diet. In making a decision about whether this is the best treatment for you, you may find it helpful to talk to people who already have a kidney transplant. You also need to speak to your doctor, nurse and family members.

What is a kidney transplant?

A kidney transplant is an operation in which a person with kidney failure receives a new kidney. The new kidney takes over the work of cleaning the blood.

Are there different kinds of kidney transplants?

Yes. There are two types of kidney transplants: those that come from living donors and those that come from unrelated donors who have died (non-living donors). A living donor may be someone in your family. It may also be your spouse or close friend. In some cases, it may be a stranger who wishes to donate a kidney to anyone in need of a transplant. There are advantages and disadvantages to both types of kidney transplants.

How do I start the process of getting a kidney transplant?

Your doctor can tell you about the transplant process or send you to a transplant center for further evaluation or reach us at www.medodeal.com

What is rejection?

The most important problem that may happen after transplant is rejection of the kidney. The body's immune system guards against attack from anything foreign, such as bacteria. This defense system may recognize tissue transplanted from someone else as "foreign" and attack this "foreign invader."

You will need to take immunosuppressant medicine every day to prevent rejection of your new kidney. Anti-rejection medications have a large number of possible side effects because the body's immune defenses are suppressed.

What are the chances that a transplanted kidney will continue to function normally?

Results of transplants are getting better with new research. If a transplanted kidney fails, a second transplant may be a good choice for many patients.

Will I need to follow a special diet?

After a kidney transplant, you will need to follow a special diet.

What else can I do?

You should learn as much as you can by reading and talking to your healthcare team, as well as patients who already have kidney transplants.

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