AW: [HSF] Deairing the heart

[Hgrmd at aol.com]

Bill,
  I'm somewhat surprised that you don't use CO2, because it definitely  does 
reduce or eliminate air emboli.  Your stroke rate is laudible.   However, I 
assume you are talking about fixed deficits only.  Air emboli  often present as 
a diffuse encephalopathy with no focal deficits. Unless you are  having a 
battery of neurologic exams done on your postop patients, I wouldn't  place too 
much credence in the amount of brain damage you currently think is  being 
inflicted on your patients. As we all know in adult cardiac surgery,  subtle 
permanent personality changes may be the only manifestation of  perioperative 
neurologic injury. Those usually aren't factored into the postop  stroke rate. 
Perhaps your kids would do better in the 1st grade if you  considered adding this to 
your technique.  I know that you can't really  monitor its effect since I 
presume you don't have a TEE scope small enough to  acommodate an infant.  For 
your larger patients, I would definitely  consider using a pediatric scope.
Hal
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