Cardiopulmonary bypass is a technique used during cardiac surgery to temporarily take over the function of the heart and lungs. The blood is diverted to an external machine that oxygenates the blood and pumps it through the body, allowing the heart to be stopped so the surgeon can operate. Some key steps in cardiopulmonary bypass include cannulation, hypothermia and cardioplegia to stop the heart, maintenance on bypass, and weaning the patient off bypass. Complications can include ischemia, arrhythmias, bleeding, and metabolic and organ dysfunction. Off-pump bypass is an alternative that avoids stopping the heart.
Cardiopulmonary bypass development and history
Indication of cpb
Hardware in cpb
Arterial and venous cannulation
Oxygenator
Heat exchanger
Filter
How to conduct cpb and problems in cpb
Cardioplegia
Cardiopulmonary bypass development and history
Indication of cpb
Hardware in cpb
Arterial and venous cannulation
Oxygenator
Heat exchanger
Filter
How to conduct cpb and problems in cpb
Cardioplegia
A brief yet comprehensive coverage of ICU role in ECMO cases. Presentation has been prepared in order to help ICU fellows and registrars to understand the importance of their role and to know necessary actions they have to take in case of need.
Shock
what is shock
stages of shock
types of shock, their presentation and management
presentation is made for medical students using kumar and clark and guyton.
Ozempic: Preoperative Management of Patients on GLP-1 Receptor Agonists Saeid Safari
Preoperative Management of Patients on GLP-1 Receptor Agonists like Ozempic and Semiglutide
ASA GUIDELINE
NYSORA Guideline
2 Case Reports of Gastric Ultrasound
Title: Sense of Taste
Presenter: Dr. Faiza, Assistant Professor of Physiology
Qualifications:
MBBS (Best Graduate, AIMC Lahore)
FCPS Physiology
ICMT, CHPE, DHPE (STMU)
MPH (GC University, Faisalabad)
MBA (Virtual University of Pakistan)
Learning Objectives:
Describe the structure and function of taste buds.
Describe the relationship between the taste threshold and taste index of common substances.
Explain the chemical basis and signal transduction of taste perception for each type of primary taste sensation.
Recognize different abnormalities of taste perception and their causes.
Key Topics:
Significance of Taste Sensation:
Differentiation between pleasant and harmful food
Influence on behavior
Selection of food based on metabolic needs
Receptors of Taste:
Taste buds on the tongue
Influence of sense of smell, texture of food, and pain stimulation (e.g., by pepper)
Primary and Secondary Taste Sensations:
Primary taste sensations: Sweet, Sour, Salty, Bitter, Umami
Chemical basis and signal transduction mechanisms for each taste
Taste Threshold and Index:
Taste threshold values for Sweet (sucrose), Salty (NaCl), Sour (HCl), and Bitter (Quinine)
Taste index relationship: Inversely proportional to taste threshold
Taste Blindness:
Inability to taste certain substances, particularly thiourea compounds
Example: Phenylthiocarbamide
Structure and Function of Taste Buds:
Composition: Epithelial cells, Sustentacular/Supporting cells, Taste cells, Basal cells
Features: Taste pores, Taste hairs/microvilli, and Taste nerve fibers
Location of Taste Buds:
Found in papillae of the tongue (Fungiform, Circumvallate, Foliate)
Also present on the palate, tonsillar pillars, epiglottis, and proximal esophagus
Mechanism of Taste Stimulation:
Interaction of taste substances with receptors on microvilli
Signal transduction pathways for Umami, Sweet, Bitter, Sour, and Salty tastes
Taste Sensitivity and Adaptation:
Decrease in sensitivity with age
Rapid adaptation of taste sensation
Role of Saliva in Taste:
Dissolution of tastants to reach receptors
Washing away the stimulus
Taste Preferences and Aversions:
Mechanisms behind taste preference and aversion
Influence of receptors and neural pathways
Impact of Sensory Nerve Damage:
Degeneration of taste buds if the sensory nerve fiber is cut
Abnormalities of Taste Detection:
Conditions: Ageusia, Hypogeusia, Dysgeusia (parageusia)
Causes: Nerve damage, neurological disorders, infections, poor oral hygiene, adverse drug effects, deficiencies, aging, tobacco use, altered neurotransmitter levels
Neurotransmitters and Taste Threshold:
Effects of serotonin (5-HT) and norepinephrine (NE) on taste sensitivity
Supertasters:
25% of the population with heightened sensitivity to taste, especially bitterness
Increased number of fungiform papillae
MANAGEMENT OF ATRIOVENTRICULAR CONDUCTION BLOCK.pdfJim Jacob Roy
Cardiac conduction defects can occur due to various causes.
Atrioventricular conduction blocks ( AV blocks ) are classified into 3 types.
This document describes the acute management of AV block.
Ethanol (CH3CH2OH), or beverage alcohol, is a two-carbon alcohol
that is rapidly distributed in the body and brain. Ethanol alters many
neurochemical systems and has rewarding and addictive properties. It
is the oldest recreational drug and likely contributes to more morbidity,
mortality, and public health costs than all illicit drugs combined. The
5th edition of the Diagnostic and Statistical Manual of Mental Disorders
(DSM-5) integrates alcohol abuse and alcohol dependence into a single
disorder called alcohol use disorder (AUD), with mild, moderate,
and severe subclassifications (American Psychiatric Association, 2013).
In the DSM-5, all types of substance abuse and dependence have been
combined into a single substance use disorder (SUD) on a continuum
from mild to severe. A diagnosis of AUD requires that at least two of
the 11 DSM-5 behaviors be present within a 12-month period (mild
AUD: 2–3 criteria; moderate AUD: 4–5 criteria; severe AUD: 6–11 criteria).
The four main behavioral effects of AUD are impaired control over
drinking, negative social consequences, risky use, and altered physiological
effects (tolerance, withdrawal). This chapter presents an overview
of the prevalence and harmful consequences of AUD in the U.S.,
the systemic nature of the disease, neurocircuitry and stages of AUD,
comorbidities, fetal alcohol spectrum disorders, genetic risk factors, and
pharmacotherapies for AUD.
Report Back from SGO 2024: What’s the Latest in Cervical Cancer?bkling
Are you curious about what’s new in cervical cancer research or unsure what the findings mean? Join Dr. Emily Ko, a gynecologic oncologist at Penn Medicine, to learn about the latest updates from the Society of Gynecologic Oncology (SGO) 2024 Annual Meeting on Women’s Cancer. Dr. Ko will discuss what the research presented at the conference means for you and answer your questions about the new developments.
Lung Cancer: Artificial Intelligence, Synergetics, Complex System Analysis, S...Oleg Kshivets
RESULTS: Overall life span (LS) was 2252.1±1742.5 days and cumulative 5-year survival (5YS) reached 73.2%, 10 years – 64.8%, 20 years – 42.5%. 513 LCP lived more than 5 years (LS=3124.6±1525.6 days), 148 LCP – more than 10 years (LS=5054.4±1504.1 days).199 LCP died because of LC (LS=562.7±374.5 days). 5YS of LCP after bi/lobectomies was significantly superior in comparison with LCP after pneumonectomies (78.1% vs.63.7%, P=0.00001 by log-rank test). AT significantly improved 5YS (66.3% vs. 34.8%) (P=0.00000 by log-rank test) only for LCP with N1-2. Cox modeling displayed that 5YS of LCP significantly depended on: phase transition (PT) early-invasive LC in terms of synergetics, PT N0—N12, cell ratio factors (ratio between cancer cells- CC and blood cells subpopulations), G1-3, histology, glucose, AT, blood cell circuit, prothrombin index, heparin tolerance, recalcification time (P=0.000-0.038). Neural networks, genetic algorithm selection and bootstrap simulation revealed relationships between 5YS and PT early-invasive LC (rank=1), PT N0—N12 (rank=2), thrombocytes/CC (3), erythrocytes/CC (4), eosinophils/CC (5), healthy cells/CC (6), lymphocytes/CC (7), segmented neutrophils/CC (8), stick neutrophils/CC (9), monocytes/CC (10); leucocytes/CC (11). Correct prediction of 5YS was 100% by neural networks computing (area under ROC curve=1.0; error=0.0).
CONCLUSIONS: 5YS of LCP after radical procedures significantly depended on: 1) PT early-invasive cancer; 2) PT N0--N12; 3) cell ratio factors; 4) blood cell circuit; 5) biochemical factors; 6) hemostasis system; 7) AT; 8) LC characteristics; 9) LC cell dynamics; 10) surgery type: lobectomy/pneumonectomy; 11) anthropometric data. Optimal diagnosis and treatment strategies for LC are: 1) screening and early detection of LC; 2) availability of experienced thoracic surgeons because of complexity of radical procedures; 3) aggressive en block surgery and adequate lymph node dissection for completeness; 4) precise prediction; 5) adjuvant chemoimmunoradiotherapy for LCP with unfavorable prognosis.
Flu Vaccine Alert in Bangalore Karnatakaaddon Scans
As flu season approaches, health officials in Bangalore, Karnataka, are urging residents to get their flu vaccinations. The seasonal flu, while common, can lead to severe health complications, particularly for vulnerable populations such as young children, the elderly, and those with underlying health conditions.
Dr. Vidisha Kumari, a leading epidemiologist in Bangalore, emphasizes the importance of getting vaccinated. "The flu vaccine is our best defense against the influenza virus. It not only protects individuals but also helps prevent the spread of the virus in our communities," he says.
This year, the flu season is expected to coincide with a potential increase in other respiratory illnesses. The Karnataka Health Department has launched an awareness campaign highlighting the significance of flu vaccinations. They have set up multiple vaccination centers across Bangalore, making it convenient for residents to receive their shots.
To encourage widespread vaccination, the government is also collaborating with local schools, workplaces, and community centers to facilitate vaccination drives. Special attention is being given to ensuring that the vaccine is accessible to all, including marginalized communities who may have limited access to healthcare.
Residents are reminded that the flu vaccine is safe and effective. Common side effects are mild and may include soreness at the injection site, mild fever, or muscle aches. These side effects are generally short-lived and far less severe than the flu itself.
Healthcare providers are also stressing the importance of continuing COVID-19 precautions. Wearing masks, practicing good hand hygiene, and maintaining social distancing are still crucial, especially in crowded places.
Protect yourself and your loved ones by getting vaccinated. Together, we can help keep Bangalore healthy and safe this flu season. For more information on vaccination centers and schedules, residents can visit the Karnataka Health Department’s official website or follow their social media pages.
Stay informed, stay safe, and get your flu shot today!
- Video recording of this lecture in English language: https://youtu.be/lK81BzxMqdo
- Video recording of this lecture in Arabic language: https://youtu.be/Ve4P0COk9OI
- Link to download the book free: https://nephrotube.blogspot.com/p/nephrotube-nephrology-books.html
- Link to NephroTube website: www.NephroTube.com
- Link to NephroTube social media accounts: https://nephrotube.blogspot.com/p/join-nephrotube-on-social-media.html
New Directions in Targeted Therapeutic Approaches for Older Adults With Mantl...i3 Health
i3 Health is pleased to make the speaker slides from this activity available for use as a non-accredited self-study or teaching resource.
This slide deck presented by Dr. Kami Maddocks, Professor-Clinical in the Division of Hematology and
Associate Division Director for Ambulatory Operations
The Ohio State University Comprehensive Cancer Center, will provide insight into new directions in targeted therapeutic approaches for older adults with mantle cell lymphoma.
STATEMENT OF NEED
Mantle cell lymphoma (MCL) is a rare, aggressive B-cell non-Hodgkin lymphoma (NHL) accounting for 5% to 7% of all lymphomas. Its prognosis ranges from indolent disease that does not require treatment for years to very aggressive disease, which is associated with poor survival (Silkenstedt et al, 2021). Typically, MCL is diagnosed at advanced stage and in older patients who cannot tolerate intensive therapy (NCCN, 2022). Although recent advances have slightly increased remission rates, recurrence and relapse remain very common, leading to a median overall survival between 3 and 6 years (LLS, 2021). Though there are several effective options, progress is still needed towards establishing an accepted frontline approach for MCL (Castellino et al, 2022). Treatment selection and management of MCL are complicated by the heterogeneity of prognosis, advanced age and comorbidities of patients, and lack of an established standard approach for treatment, making it vital that clinicians be familiar with the latest research and advances in this area. In this activity chaired by Michael Wang, MD, Professor in the Department of Lymphoma & Myeloma at MD Anderson Cancer Center, expert faculty will discuss prognostic factors informing treatment, the promising results of recent trials in new therapeutic approaches, and the implications of treatment resistance in therapeutic selection for MCL.
Target Audience
Hematology/oncology fellows, attending faculty, and other health care professionals involved in the treatment of patients with mantle cell lymphoma (MCL).
Learning Objectives
1.) Identify clinical and biological prognostic factors that can guide treatment decision making for older adults with MCL
2.) Evaluate emerging data on targeted therapeutic approaches for treatment-naive and relapsed/refractory MCL and their applicability to older adults
3.) Assess mechanisms of resistance to targeted therapies for MCL and their implications for treatment selection
Basavarajeeyam is an important text for ayurvedic physician belonging to andhra pradehs. It is a popular compendium in various parts of our country as well as in andhra pradesh. The content of the text was presented in sanskrit and telugu language (Bilingual). One of the most famous book in ayurvedic pharmaceutics and therapeutics. This book contains 25 chapters called as prakaranas. Many rasaoushadis were explained, pioneer of dhatu druti, nadi pareeksha, mutra pareeksha etc. Belongs to the period of 15-16 century. New diseases like upadamsha, phiranga rogas are explained.
3. CARDIOPULMONARY BYPASS
• IT IS TO PROVIDE A NON BEATING BLOODLESS
HEART WITH FLOW TEMPORARILY DIVERTED
TO AN EXTRA-CORPOREAL CIRCUIT THAT
FUNCTIONALLY REPLACES HEART AND LUNGS
4. SURGICAL PROCEDURES REQUIRING
CPB
• CORONARY ARTERY BYPASS SURGERY
• CARDIAC VALVE REPAIR AND/OR REPLACEMENT ( MITRAL
VALVE, TRICUSPID VALVE ETC.)
• REPAIR OF LARGE SEPTAL DEFECTS ( ASD,VSD ETC.)
• REPAIR AND/OR PALLIATION OF CONGENITAL HEART DEFECTS
( TOF , TOGV ETC.)
• TRANSPLANTATION ( HEART TRANSPLANT, LUNGS
TRANSPLANT ETC. )
• REPAIR OF SOME LARGE ANEURYSMS LIKE AORTIC ANEURYSM
• PULMONARY THROMBOENDARTERECTOMY AND
THROMBECTOMY
5. PREANAESTHETIC WORKUP
• DO THE PAC OF PATIENT WITH HISTORY AND
PHYSICAL EXAMINATION,METS ETC.
• CBC,COAGULATION PROFILE,RENAL AND LIVER
FUNCTION TESTS,
• CHEST X RAY, RESTING ECG ,2D ECHO, STRESS
ECHO
• MYOCARDIAL PERFUSION SCANS
• ANGIOGRAPHY
• CONTRAST VENTRICULOGRAPHY
6. PATIENT PREPARATION
• PUT A 18G OR PREFERABLY 16G CANNULA
• AN INTERNAL JUGLAR CENTRAL LINE
• A RADIAL AND FEMORAL ARTERIAL LINE( FOR ABG
AND IBP )
• PATIENTS BLOOD TAKEN FOR ACT ( ACTIVATED
CLOTTING TEST) IT IS TIME FROM ADDING BLOOD TO
MACHINE UP TO TIME WHEN FIRST CLOT APPEARS. AN ACT
LONGER THAN 400-480 SECS IS CONSIDERED SAFE.
• HEPARINIZATION FOR ANTICOAGULATION
DURING SURGERY IS BASED ON ACT.
7. PREMEDICATION AND INDUCTION
• NARCOTICS OR ANXIOLYTICS OR BOTH FOR
PAIN AND ANXIETY AS PREMEDICATION
( PATIENTS WITH EF <40% AND PATIENTS WITH LOW CARDIAC
OUTPUT ---SHOULD BE GIVEN PREOP MEDICATIONS SLOWLY
AND CAREFULLY TO AVOID MYOCARDIAL DEPRESSION AND
HYPOTENSION )
• GOAL OF INDUCTION IS TO AVOID
HYPOTENSION AND ATTENUATE
HEMODYNAMIC RESPONSE TO
LARYNGOSCOPY AND INTUBATION
8. • SMALL INCREMENTAL DOSES OF INDUCING
AGENT TO BE GIVEN ( pref. ETOMIDATE)
• IF BP FALLS > 20% OF BASELINE THEN USE
INOTROPES INFUSION
• THERE MAY BE HYPERTENSION ALSO, DUE TO
PRE INDUCTION ANXIETY AND SYMPATHETIC
STIMULATION
• MUSCLE RELAXATION AND CONTROLLED
VENTILATION TO ENSURE ADEQUATE
OXYGENATION AND PREVENT HYPERCARBIA
9. TOTAL INTRAVENOUS ANAESTHESIA
• INFUSION OF PROPOFOL @ 25-100 mcg/kg/min
• REMIFENTANYL 1 mcg/kg FOLLOED BY 0.25-1
mcg/kg INFUSION
• TOATAL DOSE OF FENTANYL SHOULD 5-7 mcg/kg
• REMIFENTANYL should be supplemented by
MORPHINE at the end of sx for post op pain
10. MIXED INTRAVENOUS ANAESTH.
• MIDAZOLAM 0.05mg/kg FOR SEDATION
• ETOMIDATE 0.1-0.3 mg/kg FOR INDUCTION
• OPIOIDS ARE GIVEN INTERMITTENTLY ( total
dose of fentanyl <15mcg/kg and remifentanyl
< 5mcg/kg)
• IN FRAIL PATIENTS KETAMINE AND
MIDAZOALM PROVIDES HEMODYNAMIC
STABILITY, GOOD AMNESIA,ANALGESIA AND
MINIMAL RESPIRATORY DEPRESSION
11. INHALATIONAL ANAESTHESIA
• VOLATILE AGENTS 0.5-1.5 MAC for
maintenance of anaesthesia and sympathetic
response suppression
• ISOFLURANE , SEVOFLURANE OR DESFLURANE
CAN BE USED
12. PRE BYPASS CHECKS
• CHECK B/L AIR ENTRY
• PROTECT EYES
• CHECK ALL MONITORS AND TUBINGS AFTER
FINAL POSITIONING
• ADMINSTER ANTIBIOTICS
• CHECK BASELINE ACT
• CHECK BASELINE ABG
• PRIMING OF BYPASS MACHINE AND CIRCUITS
BY BALANCED SALT SOLUTION (RINGER
LACTATE ETC.) IN SEVERLY ILL PATIENTS WITH
BLOOD
13. CONSIDERATIONS IN STEPS OF BYPASS
• SKIN INCISION MAY CAUSE SYPATHETIC STIMULATION
SO↑ DEPTH OF ANAESTHESIA SO AMNESIC AGENTS
LIKE BENZODIAZEPINES AND PROPOFOL TO BE USED
• AT THE TIME OF STERNAL SPLITTING THERE MAY BE
PAIN, AWARENESS, TACHYCARDIA AND RAISED BP SO
TO BE MANAGED BY NTG OR ESMOLOL AND
FENTANYL HIGH DOSES
• LUNGS TO BE DEFLATED AT THE TIME OF SPLITTING
BY DISCONNECTION OF GAS FROM WORKSTATION
• HEPARINIZATION BEFORE OPENING PERICARDIUM
ACCORDING TO BASE LINE ACT (target 400-480 secs)
@ 300-400mcg/kg .
15. • AORTIC CANNULATION IS DONE FIRST TO
ALLOW RAPID VOLUME INFUSION IN CASES
OF HAEMORRHAGE DURING VENOUS
CANNULATION.
• VENOUS CANNULATION OF MAJOR VEINS-SVC
& IVC OR RIGHT ATRIUM.
22. CARDIOPLEGIA
• TO PROVIDE A MOTIONLESS FIELD,HEART IS
STOPPED IN DIASTOLE BY ADMINISTERING A
POTASSIUM RICH CARDIOPLEGIC SOLUTION
• ( it interrupts myocardial electromechanical
activity, reduces O2 consumption by 90% and
cold cardioplegia reduces it by 97% )
• COMPLETE CARDIOPLEGIA ACHIEVED BY BOTH
ANTEGRADE AND RETROGRADE APPROACH
AND IT IS SUPERIOR TO ONLY ANTEGRADE
TECH.
23. CARDIOPLEGIA
• CARDIOPLEGIA IS USUALLY ADMINISTERED
EVERY 20-30 MINS.(excessive cardioplegia
may cause absence of electrical activity, AV
conduction blockade or a poorly contracting
heart at conclusion of CPB)
• THERE IS OFTEN A PERIOD OF “WASH OUT”
NEEDED IN LONG CASES , TO ALLOW THE
MYOCARDIUM TO CONTRACT FULLY AND
WITHOUT ANY DEPRESSION.
• ARREST IS REVERSED BY REPERFUSING WITH
WARM NORMOKALEMIC BLOOD( HOT SHOT)
24.
25. INTRA OP MONITORING
• HEMODYNAMIC PARAMETERS –HR/NIBP/
SPO2/ INTRAOP ABGs/ INTRAOP ACT
• IBP-dominant hand radial is prefered
• ECG-to see ST changes and T wave changes
• CVP- internal jugular vein
• PA CATHETER ( SWAN GANZ CATHETER)
• TRANSESOPHAGEAL ECHO- can assess regions
supplied by all three major coronary arteries
and regional wall motion abnormality can be
seen before ECG and PA/SGC changes
26. MAINTENANCE OF BYPASS
• ACT repeated every 30-60 min, IF LESS –
supplemental Heparin is to be added.
• ABG to be evaluated every 30-60 min.
• PaO2 to be maintained between 100-
300mmHg and PaCO2 between 30-40mmHg.
• Blood Glucose and Haematocrit measured
every 30-60 min.
• DEPTH OF ANAESTHESIA IS MAINTAINED BY
adding anaesthetic agents and muscle
relaxants directly into the circuit and adding
volatile agents by connecting vapourizer to
oxygenator of bypass machine.
27. • PUMP FLOW RATE is to be maintained
@50-70 ml/kg/min.
• Urine Output to be atleast 0.5ml/kg/hr.
• Core temperature to be monitored at
Nasopharynx or Tympanic membrane.
• DE-AIRING OF HEART TO BE DONE BEFORE
WEANING FROM CPB by increasing venous
pressure by inflating lungs and tapping of
tubings .
28. WEANING FROM BYPASS
• BEFORE TERMINATION ,PATIENT SHOULD BE
REWARMED ,HEART IS DE-AIRED, REGULAR
CARDIAC ELECTRICAL ACTIVITY CONFIRMED OR
SUPPORTED BY PACE MAKER, LAB VALUES
CONFIRMED AND CORRECTED
• VENTILATION OF LUNGS IS ESTABLISHED BY
CONNECTING TO WORKSTATION WHEN PA
BLOOD FLOW IS RESTORED.
• VENOUS DRAINAGE IS SLOWLY REDUCED AND
CARDIAC FILLING VOLUME IS GRADUALLY
INCREASED.
• VASOPRESSORS OR INOTROPIC SUPPORT MAY BE
NEEDED
29. •WHEN PT. BECOMES HEMODYNAMICALLY STABLE
PROTAMINE SULPHATE IS ADMINISTERED
1-1.3mg protamine per 100 units of HEPARIN slowly
over 10-15 mins
• ACT should be brought to baseline
•WHEN PRE-LOADING IS OPTIMAL AND
CONTRACTILITY IS ADEQUATE, AORTIC INFLOW LINE
IS CLAMPED TO SEPERATE FROM BYPASS MACHINE.
•VISUALISATION OF HEART BY TEE TO SEE
CONTRACTILITY.
•VOLUME EXPANSION TO BE DONE IF NEEDED.
30. POST BYPASS
• PATIENT IS SHIFTED TO CARDIAC ICU BEING
INTUBATED AND ON MECHANICAL
VENTILATION FOR 2-12 hrs WITH SEADTION
AND ANALGESIA TO BE CONTINUED
• EXTUBATION IS CONSIDERED WHEN-pt.
become conscious,muscle paralysis gone,ABG
acceptable, surgical hemostasis is adequate
and the patient is hemodynamically stable
31. BYPASS COMPLICATIONS
• ISCHEMIA AND INFARCTION
• LV DYSFUNCTION
• RV DYSFUNCTION
• RV FAILURE
• HYPOTENSION
• DYSRYTHMIAS (AF MOST COMMON, VF,
BRADYCARDIAS AND HEART BLOCK)
• BLEEDING AND COAGULOPATHY
• ATELECTASIS,HEMOTHORAX/
PNEUMOTHORAX, PULMONARY EDEMA
33. OFF PUMP CABG
• OFF PUMP OR BEATING HEART CABG IS SURGERY
WITHOUT CARDIOPULMONARY BYPASS and REQUIRED
IN
1. patients with anterior lesions,single or double vessel disease
2. Pts. With high risk of stroke, renal failure, pulmonary
dysfunction and severe valvular disease.
• Hypothermia is avoided throughout sx.
• Goal of heparin anticoagulation is >2 times of baseline ACT
or >300sec or sometimes >400
• Only focal area of heart is stabilized with epicardial
stablizers.SBPkept< 100mm hg
• HEMODYNAMIC DISTURBANCES AND ARRYTHMIAS ARE
MORE FREQUENT