Optical Quantification of Cerebral Hemodynamics During Deep Hypothermic Cardiopulmonary Bypass with Selective Cerebral Perfusion

2020 ◽  
Author(s):  
Tiffany S. Ko ◽  
Constantine D. Mavroudis ◽  
Wesley B. Baker ◽  
Timothy W. Boorady ◽  
Vincent C. Morano ◽  
...  
Keyword(s):  
Cardiopulmonary Bypass ◽  
Cerebral Perfusion ◽  
Cerebral Hemodynamics ◽  
Selective Cerebral Perfusion ◽  
Hypothermic Cardiopulmonary Bypass

Acid-base Management in Cardiopulmonary Bypass

2021 ◽  
Vol 13 (2) ◽  
pp. 134-143
Author(s):  
Sonny Lesmana Surya ◽  
Yudi Hadinata
Keyword(s):  
Cardiopulmonary Bypass ◽  
Cerebral Perfusion ◽  
Circulatory Arrest ◽  
Deep Hypothermic Circulatory Arrest ◽  
Selective Cerebral Perfusion ◽  
Acid Base ◽  
Cerebral Dysfunction ◽  
Base Management ◽  
Ph Stat

Cardiopulmonary bypass (CPB) merupakan alat penunjang fungsi sirkulasi dan pernapasan pasien yang biasa digunakan ketika menjalani pembedahan jantung atau pembuluh darah besar. Selama prosedur CPB, kondisi hipotermia dipertahankan untuk menurunkan kebutuhan oksigen dan laju metabolisme. Kondisi hipotermia akan mempengaruhi keseimbangan asam-basa pada tubuh. Manajemen asam-basa selama prosedur CPB dicapai dengan menggunakan metode a-stat atau pH-stat. Pada metode a-stat, manajemen asam-basa dilakukan dengan menjaga pHa 7.4 dan PaCO2 40 mmHg pada suhu 37oC tanpa penambahan CO2 oksigen untuk menjaga total CO2 tetap konstan. Sedangkan, pada metode pH-stat, diberikan CO2 oksigen untuk menjaga PaCO2 40 mmHg dan pHa 7.4 secara in vivo. Masih banyak perdebatan terkait waktu penerapan masing-masing metode. Pada level mikrosirkulasi, manajemen a-stat terbukti memberikan keuntungan pada otak dan mengurangi insidensi postoperative cerebral dysfunction. Sedangkan, metode pH-stat dilaporkan meningkatkan risiko emboli otak, sehingga tidak disarankan untuk pasien yang memiliki risiko tinggi gangguan aliran darah otak. Namun, terdapat pula laporan yang menyatakan pH-stat bermanfaat pada operasi bedah jantung anak. Berdasarkan hal itu, usia pasien dapat menentukan waktu penggunaan metode a-stat dan pH-stat. Satu indikasi primer penggunaan pH-stat adalah selama proses pendinginan saat deep hypothermic circulatory arrest (DHCA), sedangkan metode a-stat lebih baik digunakan selama selective cerebral perfusion (SCP) dan rewarming.

Effect of hemodilution on the adequacy of cerebral perfusion under hypothermic cardiopulmonary bypass

2001 ◽  
Vol 49 (10) ◽  
pp. 595-601 ◽  
Author(s):  
Hiroaki Kawata ◽  
Shigeaki Ohtake ◽  
Yoshiki Sawa ◽  
Toshihiro Ohata ◽  
Hikaru Matsuda
Keyword(s):  
Cardiopulmonary Bypass ◽  
Cerebral Perfusion ◽  
Hypothermic Cardiopulmonary Bypass

A simplified technique for antegrade selective cerebral perfusion

Perfusion ◽  
2002 ◽  
Vol 17 (3) ◽  
pp. 187-189 ◽  
Author(s):  
N Colangelo ◽  
S Benussi ◽  
G Piazza ◽  
O Alfieri
Keyword(s):  
Blood Flow ◽  
Cardiopulmonary Bypass ◽  
Aortic Arch ◽  
Cerebral Perfusion ◽  
Extracorporeal Circuit ◽  
Selective Cerebral Perfusion ◽  
Modified Technique ◽  
Roller Pump ◽  
Set Up ◽  
Antegrade Selective Cerebral Perfusion

Various methods of cerebral protection have been used during aortic arch surgery. We reviewed our experience with a modified technique for selective cerebral perfusion (SCP) administration during surgery on the thoracic aorta from October 1999. Conventionally, this technique requires an additional roller pump on the cardiopulmonary bypass (CPB) console. In order to simplify the extracorporeal circuit (ECC), the paediatric double-roller pump used for the administration of cardioplegia was utilized by adding a ‘Y-connection’ on the blood line of the cardioplegia circuit, upstream of the cardioplegia reservoir, to provide SCP blood flow. SCP administration with a Y-connection is both easy and fast to set up on the ECC circuit and does not create additional difficulties to the surgeon. It simplifies SCP delivery by allowing the perfusionist to use a standard ECC system set-up.

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