[HSF] Deairing the heart

[hgrmd at aol.com]

Bill,
  Thanks for clarifying your previous post.  I wonder why you guys have been resistant to using CO2, since it's a relatively benign adjunct.  Other than acidosis with overuse, I really can't think of any down side.  To be honest, I've always thought peds cardiac surgery required a lot more brains and technical ability than the stuff I do.  Why then, won't you consider using such a simple tool?
Hal 
 
-----Original Message-----
From: ichfno at aol.com
To: OpenHeart-L at lists.hsforum.com
Sent: Fri, 2 Mar 2007 11:26 AM
Subject: Re: [HSF] Deairing the heart


Hal;
 
There is actually no data in the peds perfusion or post op neuro comps regarding 
CO2 that is why I posted it. Also, we (peds CTS) do think that certain perfusion 
protocols do lead to neuro injury that is unseen in gross exams, I was 
specifically referring to the fixed strokes that were mentioned. 
William M Novick MD
Paul Nemir Professor
International Child Health
University of Tennessee Health Sciences Center
Founder/Medical Director
International Children's Heart Foundation
www.babyheart.org
 
 
-----Original Message-----
From: Hgrmd at aol.com
To: OpenHeart-L at lists.hsforum.com
Sent: Fri, 2 Mar 2007 7:33 AM
Subject: Re: AW: [HSF] Deairing the heart


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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