Impact of temperature on the Narcotrend Index during hypothermic cardiopulmonary bypass in children with sevoflurane anesthesia

Perfusion ◽  
2017 ◽  
Vol 33 (4) ◽  
pp. 303-309 ◽  
Author(s):  
Nils Dennhardt ◽  
Christiane Beck ◽  
Dietmar Boethig ◽  
Sebastian Heiderich ◽  
Alexander Horke ◽  
...  
Keyword(s):  
Cardiopulmonary Bypass ◽  
Minimum Alveolar Concentration ◽  
Anesthesia Machine ◽  
Eeg Monitoring ◽  
Physiological Conditions ◽  
Heart Lung Machine ◽  
Processed Eeg ◽  
Independent Association ◽  
Narcotrend Index ◽  
Lung Machine

Background: During cardiopulmonary bypass (CPB) in children, anesthesia maintained by sevoflurane administered via the oxygenator is increasingly common. Anesthetic uptake and requirement may be influenced by the non-physiological conditions during hypothermic CPB. Narcotrend-processed EEG monitoring may, therefore, be useful to guide the administration of sevoflurane during this phase. Objective: The objective of this prospective, clinical, observational study was to assess the correlation between body temperature, Narcotrend Index (NI) and administered sevoflurane in children during CPB. Methods: Forty-four children aged 0 to 10 years undergoing hypothermic cardiac surgery were studied. On bypass, anesthesia was maintained with sevoflurane administered via the oxygenator of the heart-lung machine. Nasopharyngeal temperature, NI and minimum alveolar concentration (MAC) of sevoflurane were recorded in intervals of 10 minutes. Expiratory gas was sampled from the oxygenator’s sole expiratory port via a separate connecting line and the MAC was measured by the agent analyzer of the anesthesia machine. Results: Raw (r = 0.74) and corrected (r = 0.73) r-values show that narcosis depth (as indicated by NI) can primarily be explained by the interaction of MAC and temperature. The analysis of variance (without the interaction term) confirms the significant and independent association of both factors, MAC (p<0.004, 95%CI: 0.19 to 0.46) and temperature (p<0.0001, 95%CI: 0.68 to 0.78), with the NI. During hypothermia, sevoflurane had been reduced significantly (r = 0.41, p<0.0001, 95%CI: 0.33 to 0.48). Conclusion: Perfusionists and anesthetists should be aware of the results of processed electroencephalograph (EEG) monitoring during CPB. Sevoflurane requirements differ inter-individually; they may decrease during cooling and increase during rewarming. Therefore, it seems reasonable to include the results of processed EEG monitoring when administering sevoflurane during CPB in children, but further studies are necessary to confirm this thesis.

An Automatically Regulated Low Prime Heart-Lung Machine for Infants: A Rabbit Model

Perfusion ◽  
1987 ◽  
Vol 2 (2) ◽  
pp. 109-113
Author(s):  
Erik Wabeke ◽  
Piet H Mook ◽  
Jan M Elstrodt ◽  
Charles RH Wildevuur
Keyword(s):  
Cardiopulmonary Bypass ◽  
Negative Pressure ◽  
Rabbit Model ◽  
Gravity Drainage ◽  
Extracorporeal Circuit ◽  
Donor Blood ◽  
Minimal Volume ◽  
Priming Volume ◽  
Heart Lung Machine ◽  
Lung Machine

A new compact heart-lung machine for paediatric use was designed. The total volume of this system of only 90ml allows for priming without the use of donor blood. The priming volume could be kept small mainly by replacing gravity drainage with drainage by a negative pressure in the venous reservoir. To avoid volume shifts between the extracorporeal circuit and the infant's circulation and to safely operate this minimal volume circuit, the heart-lung machine was automatically controlled. In this study we show that the miniaturized system functioned reliably under various conditions during cardiopulmonary bypass in rabbits.

scholarly journals Application of blood salvaging technologies in cardiosurgical patients operated under cardiopulmonary bypass

2012 ◽  
Vol 93 (2) ◽  
pp. 354-356
Author(s):  
R K Dzhordzhikiya ◽  
I M Rakhimullin ◽  
R R Khamzin
Keyword(s):  
Cardiopulmonary Bypass ◽  
Fresh Frozen Plasma ◽  
Cell Saver ◽  
Intraoperative Bleeding ◽  
Heart Lung Machine ◽  
Mass Transfusion ◽  
Fresh Frozen ◽  
Hospital Days ◽  
Lung Machine ◽  
Frozen Plasma

Aim. To evaluate the effectiveness of blood salvaging technologies in cardiosurgical patients operated under cardiopulmonary circulation. Methods. Analysis of perfusion protocols and transfusion cards of cardiosurgical patients operated using cardiopulmonary bypass during the period 2010-2011. Two groups of patients were identified: the first group - with the application of blood salvaging technologies (906 patients), the second group - without the application of this technique (122 patients). Blood from the operative wound was collected during the operation, processed, filtered through the «Cell-saver» machine from «Fresenius» company and was then re-introduced into the patient’s bloodstream. After completion of cardiopulmonary bypass the blood remaining in the circuit of the cell-saver machine and blood that was discharged through the drainage tubes was returned to the patient after being processed. Results. In the first group at the end of the operation 314.6±28.6 ml of washed red blood cells were returned to the patient from the heart-lung machine, while during the first postoperative day, the amount of the returned autologous erythrocytes from the drainage tubes was 72.8±12.5 ml. In this group, only 45 (4.9%) patients required donor erythrocyte mass transfusion, its volume per patient amounted to 172.3±31.8 ml. In the first group 182 (20.1%) patients required transfusion of fresh frozen plasma with the aim of achieving hemostasis, its volume amounted to 425±51.3 ml. In the second group 51 (41.8%) patients received erythrocyte mass transfusion in the volume of 346.7±31.1 ml, and 86 (70.5%) - received fresh frozen plasma in the amount of 568.7±41.2 ml. Hemoglobin content and hematocrit at the end of the operation and on the first postoperative day were significantly higher in the first group compared to the second group (p 0.01). These changes were associated with both intraoperative bleeding and with the loss of blood through the drainage tubes on the first postoperative day in the second group of patients. Compensation for these losses required transfusion of blood components significantly more frequently (p 0.001) and in larger volumes (p 0.01) than in the first group. Conclusion. Blood salvaging technologies using the «Cell-saver» machine during cardiac surgery under cardiopulmonary bypass significantly reduce blood loss, reduce the number of postoperative hospital days and complications, and are less expensive.

Continuous perfusion without hemodilution in neonates—the experience at the Marie Lannelongue Hospital

1993 ◽  
Vol 3 (4) ◽  
pp. 340-346 ◽  
Author(s):  
François Lacour-Gayet ◽  
François Nicolas ◽  
José Coil ◽  
Jean Pierre Daniel ◽  
Michel Weiss ◽  
...  
Keyword(s):  
Cardiopulmonary Bypass ◽  
Heart Lung Machine ◽  
Lung Machine ◽  
Continuous Perfusion

Cardiopulmonary bypass in neonates is markedly different from the procedure used in children above 10 kg and in adults. There are two major reasons for this—first, the mismatch between the volume of the heart-lung machine circuit and that of the blood in the patient and second, the immaturity of tissues in the first three months of life.

Pericardiectomy for Constrictive Pericarditis: An Institution's 21 Years Experience

2017 ◽  
Vol 66 (08) ◽  
pp. 645-650 ◽  
Author(s):  
Leopold Rupprecht ◽  
Christina Putz ◽  
Bernhard Flörchinger ◽  
York Zausig ◽  
Daniele Camboni ◽  
...  
Keyword(s):  
Cardiopulmonary Bypass ◽  
Constrictive Pericarditis ◽  
Safe Procedure ◽  
Excellent Outcome ◽  
Concomitant Surgery ◽  
Heart Beating ◽  
Heart Lung Machine ◽  
Midline Sternotomy ◽  
Lung Machine ◽  
Post Cardiac Surgery

Background The aim of this retrospective study was to evaluate our experience with the surgical pericardiectomy procedure for patients suffering from isolated severe constrictive pericarditis. Methods From 1995 to 2016, 39 patients underwent isolated pericardiectomy for constrictive pericarditis. Fifteen patients were excluded because of concomitant surgery. There were 31 male (79.5%) patients and 8 female (20.5%) patients, 28 to 76 years old (mean, 56.6 ± 13.6 years). The underlying etiologies were idiopathic pericarditis (74.5%), infection (10%), rheumatic disorders (8%), status post cardiac surgery (2.5%), tuberculosis (2.5%), and status post mediastinal irradiation (2.5%). Results Pericardiectomy was performed through midline sternotomy in all cases. Sixteen patients (41%) underwent pericardiectomy electively employing cardiopulmonary bypass with the heart beating, and 23 patients (59%) had surgery without extracorporeal circulation (ECC). The overall 30-day mortality rate was 50% if cardiopulmonary bypass was used (13.8% since 2007). If surgery was performed without a heart–lung machine, mortality was 0%. On-pump patients had a significantly longer intensive care unit (ICU) stay (12 ± 9 vs. 4 ± 4 days, p = 0.013). Likewise, the duration of mechanical ventilation was much longer (171 ± 246 vs. 21 ± 40 hours, p = 0.04). The hospital stay was comparable with 28 ± 10 and 24 ± 18 days (p = 0.21). Conclusion The present study demonstrates that pericardiectomy, without the use of cardiopulmonary bypass as treatment for constrictive pericarditis, is a safe procedure with an excellent outcome in critically ill patients.

Kinetics of 51Cr-Labeled Thrombocytes During Cardiopulmonary Bypass Circulation

1975 ◽  
Author(s):  
J. M. Michiels ◽  
J. Lindemans ◽  
D. S. de Jong ◽  
E. Krenning-Douma
Keyword(s):  
Cardiopulmonary Bypass ◽  
Platelet Rich Plasma ◽  
Arterial Line ◽  
Extracorporeal Circuit ◽  
External Monitoring ◽  
Heart Lung Machine ◽  
Filter Area ◽  
Kinetics Of ◽  
Lung Machine

The decrease in number of circulating platelets during the use of cardiopulmonary bypass (C. P. B.) in cardiac surgery had been found to be larger than could be explained on the basis of hemoclilutions in the heart-lung machine (H. L. M.). It is demonstrated in seven experiments, that the radioactivity of 51Cr-labeled donor platelets, which had been transfused 24 hours prior to the operation, decrease at the same rate as the total number of platelets in the patient’s blood. It is known that many platelets adhere to the filters in the extracorporeal circuit, especially to the terminal filter in the arterial line. External monitoring over the filter area revealed that adherence of radioactive thrombocytes reached a maximum within a few minutes after complete mixing of the patient’s blood with the blood-Hemaccel® mixture in the H. L. M., and that the radioactivity remained fairly constant during the ensuing C. P. B. The disappearance rate of platelets appeared to be closely correlated with the accumulation of 51Cr-radioactivity on the filters of the H. L. M. During cardiopulmonary bypass circulation non-platelet bound radioactivity increased gradually, suggesting release of 51Cr from platelets. Irreversible A. D. P. aggregation in vitro of 51Cr-labeled platelets did not lead to release of radioactivity, but it was found after coagulation of recalcified platelet rich plasma. The results of this study indicate that during cardiopulmonary bypass circulation, platelets aggregate and adhere to the filters in the first minutes, and that subsequently platelets are damaged and/or consumed.

Weaning from cardiopulmonary bypass, decannulation, and closure

2021 ◽  
Keyword(s):  
Cardiopulmonary Bypass ◽  
Surgical Care ◽  
Cardiac Procedure ◽  
Heart Lung Machine ◽  
American College Of Surgeons ◽  
History Of ◽  
First John ◽  
Clinical Advances ◽  
Lung Machine

In 1952, John Gibbon performed the first successful cardiac procedure using cardiopulmonary bypass, which turned out to be one of the most important clinical advances of that year. Cardiopulmonary bypass has also been described as “One of the most impressive evidences of the role of investigative surgery in the history of medicine in the persevering efforts of Dr. Gibbon for more than 20 years, which finally culminated in a practical heart-lung machine,” at the first John H. Gibbon, Jr, Lecture at the annual meeting of the American College of Surgeons [1]. Due to the subsequent advancement of cardiopulmonary bypass, many patients with complex heart disease requiring surgical care undergo cardiac surgery while the other organs remain adequately oxygenated and perfused.

scholarly journals Cardiopulmonary bypass: development of John Gibbon's heart-lung machine

2015 ◽  
Author(s):  
Andréia Cristina Passaroni ◽  
Marcos Augusto de Moraes Silva ◽  
Winston Bonetti Yoshida
Keyword(s):  
Cardiopulmonary Bypass ◽  
Heart Lung Machine ◽  
Lung Machine

Development of an instrument to indirectly monitor arterial pCO2 during cardiopulmonary bypass

Perfusion ◽  
2006 ◽  
Vol 21 (1) ◽  
pp. 13-19 ◽  
Author(s):  
Jan Olav Høgetveit ◽  
Frode Kristiansen ◽  
Thore H Pedersen
Keyword(s):  
Carbon Dioxide ◽  
Cardiopulmonary Bypass ◽  
Temperature Sensor ◽  
Carbon Dioxide Tension ◽  
Temperature Correction ◽  
Blood Gas ◽  
Sensor Module ◽  
New Instrument ◽  
Heart Lung Machine ◽  
Lung Machine

Arterial blood carbon dioxide tension (PaCO2) during cardiopulmonary bypass (CBP) is important to the conduct of perfusion with alpha-stat or pH-stat strategy. Temperature changes during CBP complicate any attempts to monitor carbon dioxide tension in the exhaust outlet of an oxygenator (PexCO2) because CO2 becomes more soluble with decreasing temperatures. Normally, this would have been the obvious and easy choice of method to indirectly measure the patient’s PaCO2. Several tests have been performed with ordinary capnographs modified to measure pCO2 at the oxygenator exhaust gas port. These tests have shown varying degrees of precision ( Br J Anaesth 1999; 82(6): 843-46; J Extra-Corpor Technol 2003; 35(3): 218-23; Br J Anaesth 2000; 84: 536; J Extra-Corpor Technol 1994; 26: 64-67). Some of the best results have been achieved by Potger et al. ( J Extra-Corpor Technol 2003; 35(3): 218-23), who found a strong correlation between the arterial temperature-corrected PexCO2 when using a standard capnograph monitoring the PaCO2 measured from a blood gas analyser (PbCO2). Our group has developed a new instrument, especially designed for oxygenator gas exhaust monitoring. The new instrument has automatic temperature correction, enabling it to show both original and corrected pCO2 values, simultaneously. Ordinary capnograph functions, such as zeroing, flow control and calibration routines, are included. The solution consists of a pCO2 sensor module, a temperature sensor, a water trap and a dedicated PC mounted on a heart-lung machine. Since the heart-lung machine was already equipped with a computer for data logging and a temperature sensor, only a box containing the pCO2 sensor module and the water trap had to be added. The PC uses a specially written program designed to collect data, make the necessary calculations and display the results on the computer screen. A temperature correction was developed based on a linear regression analysis for a data-set of 15 patients, assuming that the deviation between the measured PexCO2 from the oxygenator exhaust outlet and the PbCO2 from the blood gas analyser was linearly dependent on arterial temperature alone. Eighty-six blood gas samples were compared to the corrected PexCO2 values. The final product displayed good qualities of stability and was accurate when temperature fluctuated from 32 to 388C, even during rewarming, which has been reported to be a problem for other PexCO2 investigations ( J Extra-Corpor Technol 2003; 35(3): 218-23).

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