This document provides information on cardiopulmonary bypass, including:
1. The history of cardiopulmonary bypass, beginning with the first operation using bypass in 1951 and the first successful open heart procedure using bypass in 1953.
2. The basic components of a bypass system, including how blood is drained, oxygenated, and returned to the body via cannulas in major veins and arteries.
3. Additional details on venous and arterial cannulation techniques and potential complications. Venting of the heart is also discussed to prevent ventricular distension during bypass.
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
Central Venous Access and Catheters. Their indications and contraindications, Different types of central catheters and their advantages and disadvantages, Technique of insertion, and Complications related to central venous lines.
central venous pressure and intra-arterial blood pressure monitoring. invasiv...prateek gupta
central venous pressure and intra-arterial blood pressure monitoring. various sites for cvp and Ibp insertion. working principle for cvp and ibp. indication and complication. various waveform of cvp and ibp
Short term MCS as the parachute... non RCTs in support... but try to launch out of the plane without it ;-)
Slides from the first hospital meeting On the use of MCS systems.
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Knee anatomy and clinical tests 2024.pdfvimalpl1234
This includes all relevant anatomy and clinical tests compiled from standard textbooks, Campbell,netter etc..It is comprehensive and best suited for orthopaedicians and orthopaedic residents.
These lecture slides, by Dr Sidra Arshad, offer a quick overview of physiological basis of a normal electrocardiogram.
Learning objectives:
1. Define an electrocardiogram (ECG) and electrocardiography
2. Describe how dipoles generated by the heart produce the waveforms of the ECG
3. Describe the components of a normal electrocardiogram of a typical bipolar leads (limb II)
4. Differentiate between intervals and segments
5. Enlist some common indications for obtaining an ECG
Study Resources:
1. Chapter 11, Guyton and Hall Textbook of Medical Physiology, 14th edition
2. Chapter 9, Human Physiology - From Cells to Systems, Lauralee Sherwood, 9th edition
3. Chapter 29, Ganong’s Review of Medical Physiology, 26th edition
4. Electrocardiogram, StatPearls - https://www.ncbi.nlm.nih.gov/books/NBK549803/
5. ECG in Medical Practice by ABM Abdullah, 4th edition
6. ECG Basics, http://www.nataliescasebook.com/tag/e-c-g-basics
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
NVBDCP.pptx Nation vector borne disease control programSapna Thakur
NVBDCP was launched in 2003-2004 . Vector-Borne Disease: Disease that results from an infection transmitted to humans and other animals by blood-feeding arthropods, such as mosquitoes, ticks, and fleas. Examples of vector-borne diseases include Dengue fever, West Nile Virus, Lyme disease, and malaria.
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
- 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
Acute scrotum is a general term referring to an emergency condition affecting the contents or the wall of the scrotum.
There are a number of conditions that present acutely, predominantly with pain and/or swelling
A careful and detailed history and examination, and in some cases, investigations allow differentiation between these diagnoses. A prompt diagnosis is essential as the patient may require urgent surgical intervention
Testicular torsion refers to twisting of the spermatic cord, causing ischaemia of the testicle.
Testicular torsion results from inadequate fixation of the testis to the tunica vaginalis producing ischemia from reduced arterial inflow and venous outflow obstruction.
The prevalence of testicular torsion in adult patients hospitalized with acute scrotal pain is approximately 25 to 50 percent
Explore natural remedies for syphilis treatment in Singapore. Discover alternative therapies, herbal remedies, and lifestyle changes that may complement conventional treatments. Learn about holistic approaches to managing syphilis symptoms and supporting overall health.
Pulmonary Thromboembolism - etilogy, types, medical- Surgical and nursing man...VarunMahajani
Disruption of blood supply to lung alveoli due to blockage of one or more pulmonary blood vessels is called as Pulmonary thromboembolism. In this presentation we will discuss its causes, types and its management in depth.
Tom Selleck Health: A Comprehensive Look at the Iconic Actor’s Wellness Journeygreendigital
Tom Selleck, an enduring figure in Hollywood. has captivated audiences for decades with his rugged charm, iconic moustache. and memorable roles in television and film. From his breakout role as Thomas Magnum in Magnum P.I. to his current portrayal of Frank Reagan in Blue Bloods. Selleck's career has spanned over 50 years. But beyond his professional achievements. fans have often been curious about Tom Selleck Health. especially as he has aged in the public eye.
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Introduction
Many have been interested in Tom Selleck health. not only because of his enduring presence on screen but also because of the challenges. and lifestyle choices he has faced and made over the years. This article delves into the various aspects of Tom Selleck health. exploring his fitness regimen, diet, mental health. and the challenges he has encountered as he ages. We'll look at how he maintains his well-being. the health issues he has faced, and his approach to ageing .
Early Life and Career
Childhood and Athletic Beginnings
Tom Selleck was born on January 29, 1945, in Detroit, Michigan, and grew up in Sherman Oaks, California. From an early age, he was involved in sports, particularly basketball. which played a significant role in his physical development. His athletic pursuits continued into college. where he attended the University of Southern California (USC) on a basketball scholarship. This early involvement in sports laid a strong foundation for his physical health and disciplined lifestyle.
Transition to Acting
Selleck's transition from an athlete to an actor came with its physical demands. His first significant role in "Magnum P.I." required him to perform various stunts and maintain a fit appearance. This role, which he played from 1980 to 1988. necessitated a rigorous fitness routine to meet the show's demands. setting the stage for his long-term commitment to health and wellness.
Fitness Regimen
Workout Routine
Tom Selleck health and fitness regimen has evolved. adapting to his changing roles and age. During his "Magnum, P.I." days. Selleck's workouts were intense and focused on building and maintaining muscle mass. His routine included weightlifting, cardiovascular exercises. and specific training for the stunts he performed on the show.
Selleck adjusted his fitness routine as he aged to suit his body's needs. Today, his workouts focus on maintaining flexibility, strength, and cardiovascular health. He incorporates low-impact exercises such as swimming, walking, and light weightlifting. This balanced approach helps him stay fit without putting undue strain on his joints and muscles.
Importance of Flexibility and Mobility
In recent years, Selleck has emphasized the importance of flexibility and mobility in his fitness regimen. Understanding the natural decline in muscle mass and joint flexibility with age. he includes stretching and yoga in his routine. These practices help prevent injuries, improve posture, and maintain mobilit
2. History The first operation performed using cardiopulmonary bypass and open cardiotomy was on April 5, 1951 by Dr. Clarence Dennis at the University of Minnesota. This was following four years of experiments with dogs.
3. History The first successful open heart procedure on a human using bypass machine was performed by John Gibbon on May 6, 1953 in Philadelphia. The operation was correction of an ASD on an 18 year-old girl.
4. Cardiopulmonary Bypass Basic Bypass System : Blood drained from the venous system utilizing gravity through : Cannulas in SVC and IVC Single cannula in right atrium into the venous reservoir It is pumped into the membrane oxygenator Returned to the system via a cannula usually placed in distal ascending aorta
5. Cardiopulmonary Bypass Complete Bypass System (many additional components): Consolidation of: Membrane oxygenator Venous reservoir Heat exchanger In one unit Added microfilter bubble trap to arterial line Blood suctions depending on the operation from : Surgical field Cardiac chambers +/- Aortic root Optionally, but increasingly recommended field blood is washed in a cell saver system and returned to the perfusate as packed cells Partial and occluding clamps on venous and arterial lines in addition to adjusting pump flow to direct and regulate flow. Sites for obtaining blood samples Sensors for monitoring: Pressures Temperatures O2 Sats Blood Gases pH Various safety devices Cardioplegic system to administer cardioplegic solutions at controlled: Coposition Rate Temperature A haemoconcentrator system
6. Cardiopulmonary Bypass Complete Bypass System (Stages): Blood drained from a single “two-stage” catheter into the reservoir Blood is pumped through : First the heat exchanger Then the membrane oxygenator Arterilized blood passes through a filter/bubble trap to the aortic cannula Blood aspirated from vents and suction systems enters a separate cardiotomy reservoir (contains a microfilter) before joining the venous reservoir Cardioplegic System: Fed by a spur from the arterial line Cardioplegic solution added Pumped through a separate heat exchanger into the : Antegrade Retrograde catheters
8. Venous Drainage Venous blood enters the circuit by gravity or siphonage into a reservoir placed 40-70 cm below the level of the heart. The amount of blood drained is determined by: CVP Intravascular volume Venous compliance Medications Sympathetic tone Anaesthesia ∆ H Resistance in cannulas, tubing, and connectors Absence of air within the system Chattering / Fluttering : Inadequate blood volume Excessive siphon pressure Compliant venous or atrial walls collapse against cannular intake openings. Corrected by adding vlume to the patient.
9. Venous Cannulation Venous Cannulas : Made out of flexible plastic +/- wire reinforcement. Tips: Straight or angled From rigid plastic or metal Determining Size: Patient size Anticipated flow rate Index of catheter flow indices For and average adult : 30 F SVC + 34 F IVC / Single 42 F Single Cavoatrial Insertion : Through a purse string Right atrial appendage / lateral atrial wall / directly in IVC and SVC
10. Venous Cannulation Venous Cannulation Techniques: Bicaval + caval tourniquets to prevent bleeding and air entry when entering right heart. Caval tourniquet should not be tightened before decompressing the atrium because of coronary sinus return. - caval tapes if working on left atrium and mitral valve Single Atrial Cavo-atrial
11. Venous Cannulation Bicaval + caval tourniquets to prevent bleeding and air entry when entering right heart. - caval tapes if working on left atrium and mitral valve
12. Venous Cannulation Atrial (“Single Cannula”) Suffices for most of the: Aortic Valve Coronary Artery Surgery Elevation of the heart might partially kink the junction of the SVC and the right atrium Cavo-atrial (“two-stage”) is the method of choice for most of the operations Entered through right atrial appendage More stable and better drainage than a single cannula Proper positioning is critical
13. Venous Cannulation Other approaches: Femoral / Iliac Open / Percutaneous Indications: Emergency closed cardiopulmonary assist Support of particularly ill patients before anaesthesia induction Prevention of management of bleeding complications during sternotomy Reoperations Certain aortic and thoracic surgery Application of CPB without sternotomy Special cannulas : Long Ultra thin Wire-reinforced For adequate flow rates : Large cannulas TOE-guided advancing into the right atrium
14. Venous Drainage Augmented or Assisted Venous Drainage : Negative pressure using a roller pump or centrifugal pump / regulated vacuum to a closed hard-shell venous reservoir. Allows use of smaller diameter catheters Helpful when long, peripheral catheters are used Negative pressure risks : Aspiration of gross or microscopic air and causing cerebral injury Hemolysis Air aspiration into the blood compartment of membrane oxygenators Positive pressure in the venous reservoir: Air entry into the venous lines and right heart These risks require : Safety monitoring devices Adherence to detailed protocols
15. Venous Return Low Venous Return: Low venous pressure Hypovolemia Drug-induced venous dilatation Inadequate ∆ H Small Cannula Cannula obstruction Air Locks Excessive Flow Resistance Partial obstruction of the venous return causes right ventricular distension and impairment of later contractility.
16. Venous Cannulation and Drainage Complications Atrial arrhythmias Atrial / Caval tears and bleeding Air embolization Injury or obstruction due to catheter malposition Reversing arterial and venous lines Unexpected decannulation Placing tapes around the cavae may lacerate: Branches Nearby vessels (right pulmonary artery) Cava itself Catheters may compromise venous return to the right atrium before or after the CPB Venous catheters and/or caval tapes may displace or compromise : CV monitoring PA monitoring Catheters (as do these catheters to the function of venous catheters and / or caval tapes) Entrapment of the intra-cardiac catheter by a suture Improper purse suture placement obstructing the cava when tied
17. Arterial Cannulation Arterial Cannulas: The tip is the narrowest part. Hence, the high pressure differentials, jets, turbulence, and cavitation. High velocity jets : Damage aortic wall Dislodge atheroemboli Produce dissections Disturb flow to nearby vessels Cause cavitation and haemolysis (pressure differences > 100 mmHg cause excessive haemolysis and protein denaturation)
18. Arterial Cannulation Stroke: Increased left-sided stroke following cardiac surgery, due to sand-blasting effect of end-hole aortic cannulas directing debris into the left CCA. Prevention : Aortic cannulas with only side ports are designed to minimize jet effects and better distribute arch vessel perfusion and pressure and may be associated with fewer strokes. Dual-stream aortic perfusion catheter featuring an inflatable horizontal streaming baffle? Protecting arch vessels from any kind of emboli and allowing selective cerebral hypothermia A new type with side-port that deploys a 120-µm mesh filter to remove particulate emboli beyond the ascending aorta. Despite the increased pressure gradient by 50%, this catheter has removed an average of 8 emboli in almost all the patients in the study utilizing this catheter.
22. Arterial Cannulation Sites : Proximal Aorta Innominate Artery Distal Aortic Arch Femoral External Iliac Axillary Subclavian The choice is influenced by : The planned operation The Distribution of atherosclerotic disease
23. Ascending Aortic Cannulation Cannulation: 2 purse strings (1.0 – 1.3 cm diameter) partially through the aortic wall. MAP of 60-80 mm Hg. 4-5 mm full0thickness stab wound Insert the cannula under a finger Position the cannula to direct the flow to the mid transverse aorta Proper placement is confirmed by noting pulsatile pressure in the aortic line monitor and equivalent pressure in the radial artery.
24. Complications Difficult Insertion Bleeding Tear in the Aortic Wall Intramural or Malposition of the Cannula Tip Atheromatous Emboli Failure to Remove All Air From the Arterial Line After Connection Injury to the Aortic Back Wall Inadequate or Excessive Cerebral Blood Flow Inadvertent Decannulation Aortic Dissection
25. Complications Detection: Monitoring the aortic line and radial artery pressures Asymmetric cooling of the face or neck may suggest a problem with cerebral blood flow Late Complication: Late Bleeding Infected or Non-infected false aneurysms
27. Other Parts Pumps Filters and Bubble Traps Tubing and Connectors Cardiotomy Reservoir and Field Suction Venting the Heart Cardioplegia Delivery Systems Haemoconcentrators Perfusion Monitors and Safety Devices
28. Venting the Heart Concept: Avoiding distension of either ventricles during the arrest. Distension is detrimental to subsequent contractility. The distension and fibrillation in right ventricle is not as important as it is in the left side. Blood enters the left ventricle via: Pulmonary venous return from the blood: Escaping the atrial and venous drainage system Coming from the coronary sinus and thebesian veins Bronchial venous blood Blood regurgitating through the aortic valve Blood from undiagnosed interventricular or interatrial defects Volume of blood which might be entering left ventricle from: Bronchial venous blood : 140 ± 182 mL/min Noncoronary collateral flow : 48 ± 74 mL/min
29. Venting the Heart Method : Direct left ventricular venting through apex : now is nearly an obsolete method and rarely used Most often utilizing a multihole, soft-tip catheter placed in: Junction of the right superior pulmonary vein and left atrium Left atrial appendage ± Passage into the left ventricle Other : Placing a suction in pulmonary artery Passing a catheter retrograde through the aortic valve while working on the mitral valve Using cardioplegia line as a venting system while not being used as the delivery system Drainage: Drained to cardiotomy reservoir Roller pump, vacuum source, gravity drainage Monitoring is essential for malfunction: Inspection and palpation to detect distension TOE Direct measurement of left atrial and pulmonary arterial pressures CABG : No need for venting If the heart can not remain docompressed during distal anastomosesa vent should be inserted.
30. Cardioplegia Delivery System Solution : 8 to 20 mEq/L potassium Magnesium Carrier : Crystalloid Blood (Preferred) Types: Normothermic : must be transfused continuously Hypothermic : intermittent infusion Delivery: Antegrade: Small cannula in the aortic root Hand-held cannulas directly into the coronary ostia when the aortic valve is exposed Retrograde: Blindly inserted cuffed catheter into the coronary sinus Proper placement is critical Complications: Rupture or perforation of the sinus Haematoma Rupture of the catheter cuff
31. Assembly of Heart-Lung Machine Who assembles the machine? The perfusionist is responsible for setting up and preparing the CPB machine and all the components necessary. Stages : Dry assembly: Use of readily available commercial packs. Takes 10-15 minutes. Can be kept in stand-by for 7 days Priming with fluids: Takes up to 15 minutes Should be used in 8 hours Pre-bypass check list: Conducted by the perfusionist A safety inspection Completing a written pre-bypass checklist Priming: Adult extracorporeal perfusion circuits: 1.5-2.0 litres (30-35% of patient’s blood volume) Balanced electrolyte solution: Hartmann’s Normosol-A Plasma-Lyte Because of the adverse neurological effects: addition of glucose and/or lactate to the prime is avoided Before connection : recirculated through the filter to remove the particulate and air emboli Issues: Haemodilution: Priming volume is about 30-35% of patient’s blood volume Reducing Hct to about 2/3 of the pre-op value Addition of crystalloid cardioplegia further reduces the Hct So what to do? Add a unit of banked blood (with added heparin 2000 units/unit) What is the best hct? No consensus The most common hct value for a perfusate is a 20-25% with moderate hypothermia (25°C-32°C) What is the problem with haemodilution? Reduced viscosity is not a problem Reduced oxygen-carrying capacity Mixed venous O2 Sat < 60% Transfuse Increase the pump flow Other : Sometimes 12.5-50 g of mannitol is added to stimulate the diuresis to reduce the post-operative renal dysfunction Use of autologous blood prime Use of minimal perfusate Smaller and shorter tubes Colloids for priming: controversial Albumin (no proven benefit and definite risks), gelatins, dextrans, and hetastarches (increases the risk of bleeding)
32. Anticoagulation and Reversal Heparin: How much? 300-400 u/kg IV When? Before arterial or venous cannulation. Confirmation? ACT Hepcon Test When? 3 minutes after the administration of heparin. How high is high enough? Minimum ACT : 400 s Recommended ACT : 480 sbecause heparin only partially inhibits thrombin formation Inadequate ACT: Insufficient heparin Up to 500 units / kg Anti-thrombin deficiency If 500 units / kg of heparin fails Then: FFP, Recombinant anti-thrombin During CPB: 1/3 of bolus heparin Q1h ACT Check Q30min If ACT < Target Level : give more heparin Reversal: What? Protamine How much? 1 mg / 100 unit of initial heparin dose Not to exceed 3mg / kg What to expect? Hypotension : due to activation of complement system by protamine-heparin complex. To counteract this, calcium 2 mg / 1 mg protamine is added. Anaphylactic reaction : in patients allergic to protamine insulin After 1/3 of protamine dose avoid returning blood to cardiotomy reservoir Heparin Rebound: Supplemental Protamine
33. Starting Bypass Surgeon requests. Perfusionist and anaesthesiologist start increasing the arterial blood flow while monitoring the patient’s blood pressure and volume levels in all reservoirs. 6 observations: Adequate venous drainagefor the desired flow Acceptable pressure in the arterial line Adequate oxygenation of arterial blood Acceptable systemic arterial pressure Acceptable systemic venous pressure Adequate decompression of the heart. When all of these stable for at least 2 minutes: Lung ventilation may be stopped Perfusion cooling may begin X-Clamp the aorta for arresting the heart.
34. Cardioplegia Antegrade: Blood or crystalloid cardioplegia is delivered: At the aortic root proximal to the aortic x-clamp With the pressure of 60-100 mm Hg By a dedicated roller pump Coronary sinus blood: Captured by the right atrial or unsnaredcaval catheter Arrest time : usually after 30-60 seconds Delay in arrest: Problems with the delivery system Unrecognized AR Retrograde: Cardioplegia solution is delivered: At coronay sinus Flow rate of 200-400 mL/min With the pressure of 30-50 mm Hg Higher pressures injure the coronary sinus Lower pressures indicate: Malposition of the catheter Leakage around the catheter cuff A tear in the coronary sinus Arrest time: slower than the antegrade. 2-4 minutes May provide incomplete protection of right ventricle
35. Cardioplegia Solution Solution 1 (Hypertonic): Na+: 110 mmol / L K+: 72 mmol / L Ca+ +: 1.2 mmol / L Mg+ + : 72 mmol / L Cl- : 332 mmol / L Procaine : 3.5 mg pH : 3.8 Osmolarity : 589 Solution 2 (Isotonic): Na+ : 110 mmol / L K+ : 36 mmol / L Ca+ + : 1.2 mmol / L Mg+ + : 16 mmol/ L Cl- : 180 mmol / L Lidocaine: 0.7 mg pH : 3.8 Osmolarity : 344 Preparation: Add Sodium-Bicarbonate to alkalinize the solution: 18 mLs of 8.4% Sodium-Bicarbonate to 500 mLs bag