Cardiopulmonary Bypass and the Anesthesiologist

Mora-Mangano, Christina; Chow, J. L.; Kanevsky, Max

doi:10.1016/b978-141603786-6.10022-1

Cited by 4 publications

(4 citation statements)

References 17 publications

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“…Cardiopulmonary bypass is normally conducted during open heart surgery allowing the surgeon to evaluate the heart chambers (4, 5). The machine and the patient are connected through synthetic lines and tubes.…”

Section: Introductionmentioning

confidence: 99%

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Cardiopulmonary Bypass Alone Does Not Cause Postoperative Cognitive Dysfunction Following Open Heart Surgery

et al. 2018

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BackgroundPostoperative cognitive dysfunction (POCD) is commonly observed following cardiac surgery. The utilization of cardiopulmonary bypass (CPB) is associated with many possible mechanisms to cause POCD. However, there is no evidence confirming that CPB alone is the cause of POCD.ObjectivesThe current study aimed at evaluating several factors suspected to cause POCD following cardiac surgery in Cipto Mangunkusumo Hospital, Jakarta, Indonesia.MethodsThe current prospective cohort study was conducted on 54 patients who were candidates for cardiac surgery. The assessment of memory, attention, and executive functions was performed by neuropsychological tests, before and after the surgery. Cognitive decline was defined as a 20% decrease in cognitive function in at least one of the tests. Inclusion criteria were adults spokeing Bahasa Indonesia fluently, literate, and giving consent to participate in the study. The analyzed risk factors included age, diabetes, educational level, duration of aortic cross clamp, and duration of cardio-pulmonary bypass.ResultsPOCD occured in 40.7% of subjects that underwent cardiac surgery using cardiopulmonary bypass. Age was the only influential factor through bivariate test and logistic regression analysis (P = 0.001). The current study conducted a logistic regression test on age variable; the obtained result indicated an increasing trend of POCD in accordance with age group.ConclusionsDurations of CPB, cross clamp, diabetes, and educational level were not the main risks of POCD. Old age was a significant predictor to POCD.

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Section: Introductionmentioning

confidence: 99%

“…The machine and the patient are connected through synthetic lines and tubes. The blood from the heart is delivered to the machine to undergo oxygen and carbondioxide diffusion (5, 6). However, this machine may cause many undesirable side effects due to the alteration in normal circulation and perfusion.…”

Section: Introductionmentioning

confidence: 99%

Cardiopulmonary Bypass Alone Does Not Cause Postoperative Cognitive Dysfunction Following Open Heart Surgery

et al. 2018

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“…1,3,4 The TP is incorporated with the cessation of pump flow as a common CPB protocol. 1,5,6 Investigations have described procedures with TP as having a slight benefit in reducing air emboli from the cerebral network, yet TP is not always fully considered. 3,4,7 For instance, Borger et al 8 compared distal aortic arch to central cannulation with patients placed in TP and concluded that a significantly lower embolic load occurred, but the contribution of TP was not analysed.…”

Section: Introductionmentioning

confidence: 99%

Improving Trendelenburg position effectiveness by varying cardiopulmonary bypass flow

McDonald

Pauls

et al. 2022

Perfusion

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Introduction Trendelenburg position (TP) is used to transport gaseous emboli away from the cerebral region during cardiac surgery. However, TP effectiveness has not been fully considered when combined with varying the cardiopulmonary bypass (CPB) flow. This study simulated the supine and TP at different pump flows and assessed the trapped emboli and embolic load entering the aortic arch branch arteries (AABA). Methods A computational fluid dynamics (CFD) approach used a centrally cannulated adult patient-specific aorta model replicating a CPB circuit. Air emboli of 0.1 mm, 0.5 mm, and 1.0 mm ( n = 700 each) were injected into the aorta placed in the supine position (0°) and the TP (−20°) at 2 L/min and 5 L/min. The number of emboli entering the AABA were compared. An aortic phantom flow experiment was performed to validate air bubble behaviour. Results TP at 5 L/min had the lowest 0.1 mm mean (±SD) embolic load compared to the supine 2 L/min (55.3 ± 30.8 vs 64.3 ± 35.4). For both the supine and TP, the lower flow of 2 L/min had the highest number of simulated trapped emboli in higher elevated regions than at 5 L/min (541 ± 185 and 548 ± 191 vs 520 ± 159 and 512 ± 174), respectively. The flow experiment demonstrated that 2 L/min promoted bubble coalescence and high amounts of trapped emboli and 5 L/min transported air emboli away from the AABA. Conclusions TP effectiveness was improved by using CPB flow to manage air emboli. These results provide insights for predicting emboli behaviour and improving emboli de-airing procedures.

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“…From the first successful use of cardiopulmonary bypass (CPB) on May 6, 1953, to treat a woman with atrial septal defect, the technology of CPB has evolved to support the ever-widening range of cardiac surgery. [1] The successful conduct of CPB involves close communication between cardiac surgeon, perfusion technologist (often referred as clinical perfusionists) and anesthesiologist. Cardiac anesthesiologists play a key role in decision-making during various complex procedures during the conduct of CPB.…”

Section: Introductionmentioning

confidence: 99%

A survey of practices during cardiopulmonary bypass in India: An Indian association of cardiovascular and thoracic anesthesiologist endeavor

et al. 2019

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Context: Cardiac anesthesiologists play a key role during the conduct of cardiopulmonary bypass (CPB). There are variations in the practice of CPB among extracorporeal technologists in India. Aims: The aim of this survey is to gather information on variations during the conduct of CPB in India. Settings and Design: This was an online conducted survey by Indian College of Cardiac Anaesthesia, which is the research and academic wing of the Indian Association of Cardiovascular Thoracic Anaesthesiologists. Subjects and Methods: Senior consultants heading cardiac anesthesia departments in both teaching and nonteaching centers (performing at least 15 cases a month) were contacted using an online questionnaire fielded using SurveyMonkey™ software. There were 33 questions focusing on institute information, perfusion practices, blood conservation on CPB; monitoring and anesthesia practices. Results: The response rate was 74.2% (187/252). Fifty-one (26%) centers were teaching centers; 18% centers performed more than 1000 cases annually. Crystalloid solution was the most common priming solution used. Twenty-three percent centers used corticosteroids routinely; methylprednisone was the most commonly used agent. The cardioplegia solution used by most responders was the one available commercially containing high potassium St. Thomas solution (55%), followed by Del Nido cardioplegia (33%). Majority of the responders used nasopharyngeal site to monitor intraoperative patient temperature. Antifibrinolytics were commonly used only in patients who were at high risk for bleeding by 51% of responders, while yet, another 39% used them routinely, and 11% never did. About 59% of the centers insist on only fresh blood (<7 days old) when blood transfusion was indicated. The facility to use vaporizer on CPB was available in 62% of the centers. All the teaching centers or high volume centers in India had access to transesophageal echocardiography probe and echo machine, with 51% using them routinely and 38% using them at least sometimes. Conclusions: There is a wide heterogeneity in CPB management protocols among various Indian cardiac surgery centers. The survey suggests that adherence to evidence-based and internationally accepted practices appears to be more prevalent in centers that have ongoing teaching programs and/or have high volumes, strengthening the need to devise guidelines by appropriate body to help bring in uniformity in CPB management to ensure patient safety and high quality of clinical care for best outcomes.

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Cardiopulmonary Bypass and the Anesthesiologist

Cited by 4 publications

References 17 publications

Cardiopulmonary Bypass Alone Does Not Cause Postoperative Cognitive Dysfunction Following Open Heart Surgery

Cardiopulmonary Bypass Alone Does Not Cause Postoperative Cognitive Dysfunction Following Open Heart Surgery

Improving Trendelenburg position effectiveness by varying cardiopulmonary bypass flow

A survey of practices during cardiopulmonary bypass in India: An Indian association of cardiovascular and thoracic anesthesiologist endeavor

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