[jetty]

How soon and how much do your postop CABG pt's receive beta- blockers and how does it relate to a-fib rates?

[TraumaQueen]

If they aren't on pressors, etc.... most of our docs order a 5mg dose of kerlone post op and every day. Some prefer a 25-50mg dose of lopressor.....

Personally, I haven't noticed much difference in giving it compared to not giving it as it relates to afib.

More times than not, I've had kerlone come back and bite me in the rear, being the cause of having to go on pressors, heart blocks, etc......

[begalli]

Usually we start metropolol 25 mg bid when the patient starts taking po (post-op day 1).

It all really depends though like TraumaQueen said, if they are on pressors, but if they're extubated and taking po, they probably are not on pressors.

I don't notice any correlation between beta blockers and afib either. If a patient goes into afib post cardiac surgery it seems like it happens within the first 24 hours post-op (about the length of time the pt is in the ICU). We see a-fib a lot, especially with valves.

I can say that once the patient transfers to the step-down, a-fib is rare because they would be coming back to us, the ICU, if they did. A-fib is rarely, rarely a reason a patient comes back.

[my2sons]

We give Lopressor POD #1, 50 mg if they were on a beta blocker before, 25 mg if they were not or if their BP is on the low side. We do give 2 grams of magnesium immediately post op and QD X 3 days and seem to have a very low incidence of post-op A-fib.

[begalli]

Originally Posted by my2sons

We do give 2 grams of magnesium immediately post op and QD X 3 days and seem to have a very low incidence of post-op A-fib.

Yep, in the ICU we monitor lytes closely upon arrival and q 6hr, or more often prn. We have standing K, mag, and cacl replacement orders. Frequently we'll give a gram of mag when the patient goes into a-fib while we await lab results even before an amio bolus.

[jetty]

Originally Posted by begalli

Yep, in the ICU we monitor lytes closely upon arrival and q 6hr, or more often prn. We have standing K, mag, and cacl replacement orders. Frequently we'll give a gram of mag when the patient goes into a-fib while we await lab results even before an amio bolus.

I have heard of k and Mg routine replacement but not CaCl. The only time I give that is if the patient needs a boost to hr and contractility, I have not heard it associated with AFIB

[begalli]

Originally Posted by jetty

I have not heard it associated with AFIB

Yea. Me neither. I was simply stating that we have these standing orders. Ionized ca is one of the first things I check with a low or labile bp. We routinely check i-ca and replace with cacl on all our hearts.