AW: AW: [HSF] Deairing the heart

[Dr. Roberto Battellini]

Prasanna,
do some oft hose papers include MRI?
Roberto

-----Ursprüngliche Nachricht-----
Von: openheart-l-bounces at lists.hsforum.com
[mailto:openheart-l-bounces at lists.hsforum.com] Im Auftrag von psimha
Gesendet: Freitag, 2. März 2007 15:45
An: OpenHeart-L at lists.hsforum.com
Betreff: Re: AW: [HSF] Deairing the heart

Every subtle neurodeficit need not necessarily be due to an embolic 
cause. In fact in CCML we had a literature swap of GA induced cognitive 
decline after noncardiac surgery in the elderly !!!
Prasanna
Ani Anyanwu wrote:
> But Hal I would question the relevance of subtle neurological changes that
require a battery of sophisticated tests to demonstrate. A lot of these
changes IMHO are integral to having artificial extracorporeal circulation
and indeed MRI studies show changes in many patients with no neurological
complications. Air and embolism are an integral part of CBP and in most
cases are likely of no or of minimal consequence. Obviously though we must
exclude gross air bubbles and our deairing approach, including CO2 and TEE
is very similar to yours. 
>
> However, I think to a great degree air is an invention of TEE and most of
what we see on TEE or strive to achieve with TEE is of little relevance
above that which can be determined clinically as in Novick's practice or in
the practice of the 1980s. Like you I vent the root up to 15 mins after
coming of bypass and I suspect in most patients this will be sufficient to
deal with any rogue bubbles that failed deairing - regardless of the
presence of TEE.
>
> I am not sure there is any direct evidence that the incidence of
neurological complication or neuropsychometric deficit has changed with the
advent of TEE or that the incidence is different in centers that routinely
use TEE and centers that don't. Those surgeons in life courses who don't
seem to deair properly may not necessarily be harming their patients. In my
previous center (Harefield with Yacoub) we generally ignored the snowstorms
seen on TEE and apparently (I know I know) to no consequence.
>
> Ani
>
>
> ----- Original Message ----- 
>   From: Hgrmd at aol.com<mailto:Hgrmd at aol.com> 
>   To: OpenHeart-L at lists.hsforum.com<mailto:OpenHeart-L at lists.hsforum.com> 
>   Sent: Friday, March 02, 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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