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Heart Disease (Expert Forum)
after heart surgery
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after heart surgery
by jw123, Jul 18, 2007 12:00AM
Hi,
My dad had a heart operation a little less than 2 days ago as he had aortic dissection and aortic valve regurgitation (was urgent). The operation was successful as far as i know but he still hasn't woken up properly yet. The doc at ICU said he should be awake, they took him for a scan to see if he had a stroke but there was no sign of a stroke. When they put the medicine that keeps him asleep down, he moves his leg, arms, mouth and opens his eye lids without moving his pupils and doesn't respond to anything i say. the nurse tried shaking him and speaking very loudly but there was no reaction besides opening his eye lids. What is the problem? What can we do besides wait and approx. how many days would it take for him to wake.
Regards
My dad had a heart operation a little less than 2 days ago as he had aortic dissection and aortic valve regurgitation (was urgent). The operation was successful as far as i know but he still hasn't woken up properly yet. The doc at ICU said he should be awake, they took him for a scan to see if he had a stroke but there was no sign of a stroke. When they put the medicine that keeps him asleep down, he moves his leg, arms, mouth and opens his eye lids without moving his pupils and doesn't respond to anything i say. the nurse tried shaking him and speaking very loudly but there was no reaction besides opening his eye lids. What is the problem? What can we do besides wait and approx. how many days would it take for him to wake.
Regards
Doctor's Answer
by Forum-M.D.-CA, Jul 18, 2007 12:00AM
Generally when we see proximal aortic dissections the patients are critically ill and are taken emergently for surgery. The surgery is not like the planned open heart surgeries as the aorta is dissected and bypass cannot be initiated normally, and the aorta cannot be cross clamped. What they do is decrease the heart temperature to induce circulatory arrest and then also decrease the brain temperature to diminish metabolic activity because for a period of time the brain is not receiving any oxygenated blood. There is for this reason a much higher rate of neurological complications with this kind of surgery, but this is acceptable because the risk of death from the surgery is so high. It may be that they gave him so much sedation over the last two days that it is going to take him several more days to recover his bearings. This is usually seen in the elderly who may be slow metabolizers of sedatives. It is encouraging that the CT of the brain did not show a stroke, but be aware that the kind of a stroke that patients get from low flow of oxygenated blood is not the same as a primary stroke and only an MRI may detect it this early.
My advice is that you and the physicians wait at least 2 more days and see if he recovers his bearings and higher degree mental functions before placing in an MRI to exclude global encephalopathy from hypoxia.
My advice is that you and the physicians wait at least 2 more days and see if he recovers his bearings and higher degree mental functions before placing in an MRI to exclude global encephalopathy from hypoxia.
