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Perf Tech II (exam 2) > Myocardial Protection and Cardioplegia 11B > Flashcards

Myocardial Protection and Cardioplegia 11B Flashcards

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1
Q

Four Main Objectives of Cardioplegia

A

•Immediate/sustained electromechanical arrest
•Rapid/sustained homogenous myocardial
cooling
•Maintenance of therapeutic additives in effective concentrations
•Periodic washout of metabolic inhibitors

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2
Q

Two Main Goals of Cardioplegia

A

I. Prevent myocardial ischemic damage (induction/maintenance)
II. Prevent/minimize injury (reperfusion)

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3
Q

3 Phases of Cardioplegia

A

I.Induction of arrest
II.Maintenance of arrest
III.Reperfusion

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4
Q

Pure Crystalloid Cardioplegia Induction Advantages (4)

A
  • History of use
  • Ease
  • Cheap
  • Low viscosity
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5
Q

Pure Crystalloid Cardioplegia Induction Disadvantage (6)

A 
-Cellular edema
•Low O2 capacity
•Left shift oxy-Hgb curve
•Activates platelets, leukocytes, and complement
•Impaired membrane stabilization
•Hemodilution
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6
Q

Cellular edema is a disadvantage of what cpg solution?

A

Pure crystalloid cpg

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7
Q

Low O2 capacityis a disadvantage of what cpg solution?

A

Pure crystalloid cpg

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8
Q

With a Lactated Ringer’s 1000mL cpg what do you add prior to use?

A

Add prior to use

Procaine 10% 2.7 mL

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9
Q

With a Normosol 1000 mL cpg what do you add prior to use? (3)

A

Add prior to use
Lidocaine 75mg
Ntg 500 mcg
Albumin 25% 12.5 g

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10
Q

Normosol 1000 mL is made of what? (3)

A

NaHCO2 35mEq
KCL 35mEq
Mannitol 25% 12.5 g

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11
Q

Lactated Ringer’s 1000mL is made of what? (4)

A

KCL20mEq
MgCl 32mEq
Mannitol 12.5 g
NaHCO2 6.5mEq

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12
Q

Cold Blood CPG Induction Advantages (4)

A
  • O2 carrying capacity
  • Reduced hemodilution
  • Buffering/oncotic effects
  • O2 radical scavengers present
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13
Q

Cold Blood CPG Induction Pitfalls if HCT high enough? (3)

A
  • Sludging
  • Oxy-Hgb curve disruption
  • Possible red cell damage
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14
Q

Warm Blood CPG Induction Advantages (3)

A
  • Improved aerobic metabolism
  • Improved LV function
  • Improves compromised hearts
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15
Q

Warm Blood CPG Induction Disadvantages

A

Expensive due to additives

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16
Q

Low Potassium Maintenance - how often ?

A

-Usually every 15 to 20 minutes

•Restores arrest post wash-out

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17
Q

Low Potassium Maintenance - what kinds?

A
  • Cold blood cardioplegia or crystalloid

* Restores arrest post wash-out

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18
Q

Hot Shot solutions?

A
  • Aspartate Glutamate
  • Tham
  • Dextrose
  • CPD
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19
Q

During “hot shots” warm blood may be substituted why?

A

cost

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20
Q

HTK stands for?

A

Histidine-Tryptophan-Ketoglutarate

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21
Q

HTK is what type of solution?

A

Intracellular cardioplegia solution

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22
Q

HTK solution

A

Low sodium concentration
Histidine
Tryptophan
Mannitol

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23
Q

HTK cardiac surgery Benefits?

A

Longer safe time of ischemia
During valve surgery
Minimally invasive procedures

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24
Q

HTK initial use ?

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A

organ preservation

25
Del Nido Solution (4:1) Additives ? (5) **
``` Mannitol 20% 16.3 mL MgSO4 50% 4 mL NaHCO2 8.4% 13 mL KCL 2mEq/L 13 mL Lidocaine 1 % 13 mL ```
26
Warm retrograde cardioplegia flow must be what to minimize myocardial lactate production?
>100 mL/min **
27
When do you use the single clamp technique ?
Used with calcified stiff aortas **
28
Side biting technique benefits? ischemic time?
Ischemic time is only with fully clamped aorta | Shorter clamp times **
29
Intermittent Crossclamp - clamp time sum of?
Clamp time is the sum of all fully ischemic times **
30
Intermittent Crossclamp negatives?
* Increased risk of stroke | * Not commonly used
31
Fibrillatory Arrest
Creates a nearly motionless heart by placing an alternating current generator in contact with the left ventricle.
32
Fibrillatory Arrest - what side of heart can be opened?
Left side of heart can be opened without the fear of ejecting air into the aorta
33
Fibrillatory Arrest should be used in conjunction with what?
hypothermia
34
What do you keep elevated during Fib Arrest?
KEEP MAP ELEVATED *
35
Fibrillatory Arrest Advantages? (2)
* Avoid cross clamp | * Quiescent heart with coronary perfusion
36
Fibrillatory Arrest Disadvantages? (2)
* Higher energy requirement than arrested heart | * Spontaneous ejection will result in air emboli
37
Anesthetic agents do what for preconditioning?
↑ preconditioning
38
Erythropoietin do what for myocardial injury?
↓myocardial injury
39
Statins increase what?
↑NO release
40
Neutrophil depletion decrease what?
↓V fib
41
Goal of Perfusionist during CPG delivery? | especially?
GOAL: optimize uniformity and effectiveness of delivery (especially retrograde) ***
42
What do you monitor during CPG delivery?
Temperature pH Electrical Activity
43
Decrease TEMP what happens to ? | HOH >< H + OH = pH
^ HOH >< Decrease H + Decrease OH = ^ pH
44
Increase TEMP what happens to ? | HOH >< H + OH = pH
Decrease HOH >< ^ H + ^ OH = decrease pH
45
Failure to arrest look at what? (6)
* Aortic insufficiency * Cross-clamp or cardioplegia needle malpositioned * Inadequate solution (low potassium) * Low flow? * Low pressure? * Temperature?
46
Use of suction-based stabilizers is use when? | Reduces what?
-Used during OFF Pump surgery -Has reduced the problem of working on a moving target •Provide good exposure without excess compression of ventricle
47
Ischemic Preconditioning ?
Brief period of vessel occlusion before occluding for construction of the anastomosis Used during off pump procedures
48
Off Pump Procedures keep systemic bld pressure at what ?
Keep normal to high systemic blood pressure May increase flow through collaterals vessels
49
K+ does what for CPG?
electromechanical arrest
50
Na+ does what for CPG?
↓ edema/intracelluar Ca++ buildup
51
Ca++ does what for CPG?
Membrane stabilization
52
NaHCO3 does what for CPG?
↑pH
53
THAM does what for CPG?
↑pH
54
Glucose does what for CPG?
Substrate, ↑Osmolarity, ↓ edema
55
Mannitol does what for CPG?
↑ Osmolarity
56
KCl high and low K doses concentrations?
100mmol/L | 40 mmol/L
57
THAM high and low K doses concentrations?
12mmol/L | 12mmol/L
58
MgSO4 high and low K doses concentrations?
9 mmol/L | 9 mmol/L
59
CPD high and low K doses concentrations?
20 mL | 20 mL

Perf Tech II (exam 2) (6 decks)

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