Flashcards in Cardioplegia and MUF: Topic 4 Deck (48)
What do we want in our cardioplegia system in pediatrics? (4)
Good heat exchange
Air handling capabilities
A versatile system
Cardioplegia Circuits may include: (6)
What two components of the cardioplegia circuit may be combined?
What is the most common heat exchanger in peds? How much prime does it use?
Actually uses 28 cc's of prime
What are the two functional sizes for retrograde cardioplegia cannulas?
What is the standard size for the aortic root CP cannula? What kg weight range does it cover?
What is the smallest size vent cannula you'll see/
What is the ml/kg for antegrade delivery in peds?
30 mL/kg in pediatric patients.
What does line pressure depend on in antegrade cpg delivery in peds?What is the goal?
Pressure drop across the cpg system (goal is to maintain root pressure approx 70 mmHg)
*Look at your pre-op pressures
Flow in antegrade cpg delivery in peds is dependent on what?
In retrograde cpg in peds, balloon is inflated and provides what two functions?
1. Prevents backflow
2. Holds cannula in place
Retrograde cpg delivery in peds, flow should be titrated to maintain a coronary sinus pressure of what?
** Do not exceed 40 mmHg on kidlets
What is used to halt the mechanical contractions of the heart and to allow intracardiac procedures to be performed in a motionless, bloodless field?
Myocardial-protection strategies (aka cpg)
Myocardial-protection strategy is designed to sufficiently reduce ________, so that myocardial function can resume at the end of the procedure with minimal dysfunction.
Myocardial oxygen consumption
Blood cpg solution in peds is usually what mixture?
4 parts blood and 1 part crystalloid
The addition of blood to the cardioplegic solution in peds enchances what?
Oxygen delivery, especially at the microcirculation level
What percent of cpg peditratic solutions are blood based?
What percent of cpg pediatric solutions are cystalloid based?
What are the 3 conclusions of the peditratic cpg solutions study?
1. Myocardial protection techniques still remained highly variable among congenital heart surgeons
2. Perception that del nido and custodial solutions can offer appropriate myocardial protection for longer intervals w/ decreased repeat dosing
3.observational study should be considered
Whats the Del Nido Solution dose in peds to maintain arrest
Whats the Del Nido solution dose in peds for maintainance
What should you deliver Del Nido solution at?
Never give custodial more than how long?
up to 2 hours
Histidine Tryptophan Ketoglutarate
The addition of _______ may provide a protective effect on the hypoxic- ischemic immature heart.
What effect does magnesium have?
Antiarrythmic, inhibited entry of calcium into the myocytes, and decreased uptake of sodium by myocytes during ischemia
Magnesium is exchanged for __________ during reperfusion.
What development has significantly altered blood usage and post op care in pediatrics?
What is the purpose of MUF?
Allow recovery of the pump blood for the patient while allowing the patient to be in a hemodynamic state to accept the volume is the significant advance for pediatric perfusionists