[HSF] I think therefore...(little ol' lady update)

[erdinç naseri]

Hal,Prasanna,
Thanks for the responses.I asked those questions because whenver our cross clamp and in paralle CPB time is > 100 and 300 minutes respectively we will have the following changes:
1. htc will drop below 17%
2.Hemolysis may appear  leading to Hb uria.
3.We will definitely need higher doses of inotropics and ...
PS: 1.I wondered whether you use centrifugal pump
2.modertae hypothemia + tepid ante+/_ retro blood cardiplegia+/- hot shut are my cardioprotective methods
3.>6 hrs cross clamp and low dose inotropic shows normal O2 supply/ demand ratio during Xclamp time which is very fascinating
erdinc> Date: Wed, 25 Jul 2007 22:06:59 +0530> From: prasannasimha at gmail.com> To: OpenHeart-L at lists.hsforum.com> Subject: Re: [HSF] I think therefore...(little ol' lady update)> CC: > > 1 Doesn't matter - we use Jostra or Sarns> 2 Oxygenator - Any available - we have a closed oxygenator Dideco at > present. It is very good.> 3 Avoid blood - we actually remove blood - RAP and dry venous line. and > shortened tubings.> 4 5No all cases receive intra op and postop diuretics. I usually start a > Lasix infusion next morning till shifting in the evening . Later they > get oral diuretics. Basically they have to reach their preop weight - > estimated failure fluid.> 6 Blood cardioplegia with St Thomas Ampoule's 2 Amps in 500 ml on a 1:4 > bridge with Adenosine , Esmolol and Insulin and 50 NTG. All Afib cases > and aortic valves have additional Cordarone in the pump. Antegrade and > retrograde with continuous cold during nonessential parts and warm > during closing phases of cross clamp.> 7 The best paramenter is that the patient should be weaned with minimal > Inotropes - 3mics dopa _ dobut and for RVOT issues (TOF/Infundibular PS) > 0.35 mics Milrinone. Anything more = inadequate protection based on the > near hit miss. Also release of X clamp must not result in Vtach / Vfib. > Also you can use> coronary sinus lactates , CS oxygen content/sats etc to establish > adequacy of protection or to help resuscitate shocked myocardium. > Presently adding coronary sinus Troponin levels - let us see what that > says !!> My longest case was a 6 1/2 hr cross clap time with patient weaned off > with 3 mics dop + dobut + ad lib SNP which had been discussed before.> Prasanna> > erdinç naseri wrote:> > Hal,> > Regarding very long clamp and hence long CPB times I would have some questions to be answered by you or any one interested:> > 1.What type of Heart-lung machine do you use?> > 2.What type of oxygenator do you use?> > 3.What is the average amount of blood ,if any,added to the circuit in these long cases?> > 4.What is the average upward shift in the extracellular fluid ( edema) in these caese and does it lead to any complication?> > 5.What is your diuretic protocol (if any) in these cases?> > 6.What are the exact details of your cardioplegia protocol in these cases( route,single or in combination,constituents of cardioplegia solution,..)?> > 7.What parameters do you follow for the monitorization of myocardial protection?(coronary sinus lactate,..)> > erdinc> From: Hgrmd at aol.com> Date: Tue, 24 Jul 2007 19:28:41 -0400> Subject: Re: [HSF] I think therefore...(little ol' lady update)> To: OpenHeart-L at lists.hsforum.com> CC: > > Ani,> I had resisted weighing in on the conduct of Brent's case until now. I'm > glad she got off the table, but I believe the operation was probably > inadequate for a good quality long term result. Being a partner of Ed Bender, > perhaps he should have let Ed assist or do the case. I'm saying this as > constructive criticism, and I'm glad that Brent let us debate his management of the > case. Today, I did 3 valves and a cryomaze on an 82 yo man today. The clamp > time was a little over 2 hours due to careful endarterectomies of the sinuses. > Like you, I've got no problem with much longer clamp times (a few over 4 > hours) with my current method of myocardial preservation. > > Hal> > > > ************************************** Get a sneak peek of the all-new AOL at > http://discover.aol.com/memed/aolco> > m30tour> _______________________________________________> OpenHeart-L mailing list> > Send postings to:> OpenHeart-L at lists.hsforum.com> > To UNSUBSCRIBE, to CHANGE email address, or to view archives:> http://mmp.cjp.com/mailman/listinfo/openheart-l> > All messages transmitted by the OpenHeart-L are subject to the policies and > disclaimers posted at:> http://www.hsforum.com/listdisclaim> -----------------------------------------> > _______________________________________________> > OpenHeart-L mailing list> >> > Send postings to:> > OpenHeart-L at lists.hsforum.com> >> > To UNSUBSCRIBE, to CHANGE email address, or to view archives:> > http://mmp.cjp.com/mailman/listinfo/openheart-l> >> > All messages transmitted by the OpenHeart-L are subject to the policies and > > disclaimers posted at:> > http://www.hsforum.com/listdisclaim> > -----------------------------------------> >> >> > > > > _______________________________________________> OpenHeart-L mailing list> > Send postings to:> OpenHeart-L at lists.hsforum.com> > To UNSUBSCRIBE, to CHANGE email address, or to view archives:> http://mmp.cjp.com/mailman/listinfo/openheart-l> > All messages transmitted by the OpenHeart-L are subject to the policies and > disclaimers posted at:> http://www.hsforum.com/listdisclaim> -----------------------------------------