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J Thorac Cardiovasc Surg 2003;125:32-35
© 2003 The American Association for Thoracic Surgery

Editorials

The unwanted response to cardiac surgery: Time for a reappraisal?

From the Department of Anaesthesia and Critical Care,^a Royal Brompton and Harefield NHS Trust, Harefield Hospital, Harefield, United Kingdom, and the Heart Science Centre,^b Imperial College London, London, United Kingdom.

Received for publication May 28, 2002. Revisions requested Aug 14, 2002; revisions received Aug 29, 2002. Accepted for publication Sept 12, 2002. Address for reprints: David Royston, Consultant Anaesthetist, Department of Anaesthesia, Harefield Hospital, Harefield, Middlesex UB9 6JH, United Kingdom (E-mail: dave@tharg.demon.co.uk).

The first 300 words of the full text of this article appear below.

	Introduction

 
See related article on page 184.

A scientist must always be absolutely like a child. If he sees a thing, he must say that he sees it, whether it was what he thought he was going to see or not. See first, think later, then test. But always see first. Otherwise you will only see what you are expecting. Most scientists forget that.

        —Douglas Adams
So Long, and Thanks for All the Fish

The overwhelming majority of readers of this editorial will be cardiothoracic surgeons. Many may have returned from the operating room knowing they have performed a technically good cardiac procedure and can confidently tell the patient that all went very well and an excellent result is anticipated.

Before leaving the hospital for the day, the reader would like to confirm the patient is warm to the periphery, passing adequate volumes of urine, requiring no inotropic drugs, is extubated, and is talking rationally and coherently with his or her loved ones. A small minority of the patients with no obvious risk or preoperative problems will not have this recovery pattern. These patients may be slow to rewarm, possibly with a mild acidosis. They may require low doses of inotropic agents, regular diuretics to maintain an adequate urine output, and their oxygen transfer may not be quite good enough to allow weaning from the ventilator. This response is never anticipated and is rarely fatal, but it slows the progress of the patient's recovery and is usually attributed to an abnormal inflammatory response to the operation.

The term systemic implies that the normally localized and integrated hemostatic and immune response to trauma or invasion ¹ has become unleashed on the whole body. The extracorporeal system (and sometimes its driver) usually takes the blame for this!

The definition of systemic inflammatory . . . [Full Text of this Article]

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