Postoperative care of the cardiac surgical patient requires a multidisciplinary approach. A brief period of sedation and ventilation is followed by protocol-guided recovery with some patients going on to require more complex care. Specific complications need to be recognized and managed, including bleeding, cardiac tamponade, arrhythmias, renal failure and gastrointestinal complications. Prompt diagnosis and treatment can be life saving and requires effective communication and teamwork. An array of bedside tests is available to aid decision-making, including point of care coagulation tests, lung ultrasound and echocardiography. Advanced life support necessitates a unique approach requiring the provision of resuscitation and anaesthesia for prompt surgical re-exploration. Pharmacological and mechanical assistance is readily available to treat cardiovascular instability as well as the ability for invasive cardiac output monitoring. Analgesia is an important aspect of postoperative care as well as active recognition of delirium.