A list of the operation steps I go through to assure a good outcome for my patients

This is something that I wrote up for myself many years ago. I've edited it a little to account for changes in technology. It gives you a snapshot into my mind as I do an operation.

keep the room quiet

shortest incision for cosmesis, don't compromise the operation

knife down to the sternum rather than cautery

saw from down to up

minimize bone wax

dry entry- control bleeding at the beginning of the operation to minimize bleeding at the end

leave thymus intact

minimize pericardial incision

minimize sternal retraction to reduce pain and nerve damage

no cautery chest tube sites

minimize cautery - to minimize tissue damage

canulate aorta high to make any reoperation easier

minimize stripping of aorta to make any reoperation easier route mammary through pericardium to make any reoperation easier

minimize time on heart lung machine

probe each anasthamosis to check patency

minimimize vein handling

one cross clamp

hemostatic stitches in anasthamoses

inspect each anasthamosis for bleeding

ventricular wires posterior

leave atrial purstring untied until patient stable

give protamine after hemodynamics OK

pace atrially whenever possible

give volume before aortic decannulation

keep systolic low and filling high

systematic search for bleeding

hot irrigation

suck clot out of pleural space

pacer wires and chest tube sites distant from incision

multiple figure-of-8 wires for sternal closure

running closure for subq and skin, no staples

antibiotic irrigation in subq

suction chest tubes after closure

hook chest tubes to suction early

check chest tubes at end of case

autologous transfusion

close eye on volume given by perfusion and anesthesia

minimize transfusion

strict BP control post op

limited post op autotransfusion

keep the operation short