A Randomized Study of Carbon Dioxide Management during Hypothermic Cardiopulmonary Bypass

Bashein, G.; Townes, Brenda D.; Nessly, Michael L.; Bledsoe, Stephen W.; Hornbein, Thomas F.; Davis, Kathryn; Goldstein, Donald E.; Coppel, David B.

doi:10.1097/00000542-199001000-00003

Cited by 101 publications

(28 citation statements)

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“…t76 Therefore, many centres have changed to alphastat management of arterial blood gases. However, a randomized study in adults by Bashein et al 177 was unable to find a difference in neuropsychological testing after seven months of follow up, between patients managed by alpha or pH-stat. There remains much controversy over which method to use.…”

Section: Monitoring Of Cardiopulmonary Bypass and Its Effectsmentioning

confidence: 95%

Monitoring during paediatric cardiac anaesthesia

Purday

1994

Can J Anaesth

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Monitoring of paediatric anaesthesia has become increasingly more complex in recent years (precordial, oesophageal or paratracheal). Specialized monitoring includes the monitoring of mixed venous oxygenation saturation (S~O2) which is being increasingly used within the critical care area. Transoesophageal echocardiography (TOE) has become accepted in adult cardiac surgery particularly in the fields of mitral valve repair and aortic root surgery, where it allows immediate assessment of the adequacy of repair. The place of TOE in congenital heart disease is now becoming more clearly defined. Cerebral function monitoring is an area of a great deal of research and several new monitoring methods are under review. The use of the thromboelastogram in monitoring coagulation has been found to decrease blood and fluid replacement during liver transplantation and its use during cardiac surgery is increasing. Other end organs that are affected by cardiopulmonary bypass (CPB) include the gut; liver and immune system, possibly leading to multi-organ failure in some cases, and interest is being shown in their monitoring.The purpose of this review is to present the recent publications relating to specific areas of both standard and specialized monitoring and indicate areas where these monitors may prove particularly useful to the practitioner involved in the care of paediatric cardiac patients. Routine monitoring ElectrocardiogramThe ECG displays the electrical activity of the heart. Abnormalities in the ECG can reflect alterations in rate or rhythm and changes in the ST segment may incidate underlying ischaemia. The normal ECG in childhood changes with age and shows several differences from the adult, particularly in the first few years of life where the right ventrical mass is dominant. There are several general changes that occur with increasing age (Table I). Heart rate (HR), frontal plane QRS vector (axis), PR interval, R wave heights and T waves are some of the factors that alter with age (Table II) and the reader is referred to a more specialized review for further information. 1,2 In adult cardiac surgery there has been investigation of perioperative myocardial ischaemia, its prognosis, and the best way of detecting it. 3,4 In children, however, there has been little work looking at the ST segment. Bell et al. ~ reported three cases of ST changes in neonates consistent with myocardial ischaemia. The first case involved a child of 26 wk who developed ST changes during awake laryngoscopy and lung retraction that were presumed to be related to myocardial hypoxia, although pulse oximetry readings were not mentioned. In the second case, ST changes improved on starting trinitroglycerine, isoproterenol and dopamine and in the third were related to ectiocardiographic changes. Cherian and Rao 6 associate the ST segment with the adequacy of coronary blood flow during the arterial switch operation for transposition. Observing leads I and V 5 for the left coronary and lead II for the right, greater than 1 mm elevation for more tha...

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Section: Monitoring Of Cardiopulmonary Bypass and Its Effectsmentioning

confidence: 95%

Monitoring during paediatric cardiac anaesthesia

Purday

1994

Can J Anaesth

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“…1 Da die Exspirationsluft bei Nebenstromgeräten vor der Analyse getrocknet werden, das Gasgemisch in den Alveolen jedoch wasserdampfgesättigt ist, muss vor einem Vergleich von p et CO 2 und p a CO 2 der Messwert von p et CO 2 auf BTPS-Bedingungen ("body temperature, pressure, saturated"), sog.Körperbedingungen, umgerechnet werden: …”

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“…In einer umfangreichen Studie von Bashein et al [1] konnte zwischen der "pH-stat"-und "alpha-stat"-Methode bei Temperaturerniedrigungen bis 28°C kein signifikanter Unterschied bezüglich des "Outcome" von Patienten nach kardiopulmonalem Bypass gefunden werden.…”

Section: Temperaturkorrektur Der Blutgasanalyseergebnisse?unclassified

Blutgasanalyse

2004

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Blood gas analysis provides valuable information about both the extracellular acid-base status and gas exchange. A blood gas analyzer measures pH, partial pressure of oxygen(pO(2)), partial pressure of carbon dioxide (pCO(2)), O(2) saturation, and hemoglobin concentration. A number of calculated parameters can be derived from these direct measurements such as bicarbonate concentration, base excess, oxygen content, etc. This contribution introduces the basic technical aspects of a blood gas analyzer and then describes some of the parameters that facilitate evaluation of the acid-base status and the oxygenation status of the blood. Finally, proper sampling and handling of blood gas samples is addressed.

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“…Nevin et al 21 have shown that hypocapnia during CPB also results in neurological 38 injury while others have been unable to confirm that either acid-base strategy for hypothermic perfusion resulted in significant differences. 22 Fullerton et al 23 have recently shown that a respiratory acidaemia in patients with pulmonary hypertension from mitral valve stenosis results in exacerbation of the pulmonary vascular hypertension, and that a hypocarbic state may benefit these patients.…”

Section: Monitoring and Patient Outcomesmentioning

confidence: 99%

Monitoring controversies during cardiopulmonary bypass: how far have we come?

Stammers

1998

Perfusion

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A Randomized Study of Carbon Dioxide Management during Hypothermic Cardiopulmonary Bypass

Cited by 101 publications

References 0 publications

Monitoring during paediatric cardiac anaesthesia

Monitoring during paediatric cardiac anaesthesia

Blutgasanalyse

Monitoring controversies during cardiopulmonary bypass: how far have we come?

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