Endocrine/Metabolic/Electrolyte Response to CPB

Question 1

Vasopressin (ADH)

Answer 1

• Responds to
  1. HIGH osmolarity (conc.)
  2. LOW BP and Volume (ON CPB)
  3. Hypoglycemia
  4. Angiotensin
  5. Stress and Pain
  6. Surgery and Anes.
  7. ACE Inhibitors
• Action
  1. Increased SVR
  2. Increased Renal Resistance (decrease flow)
  3. Decreased Heart Contractility
  4. Decreased Coronary flow

-Prevention
1. Anesthesia
Fentanyl
2. Regional Anesthesia
3. Pulsatile flow

Question 2

Catecholamines (Norepinephrine and Epinephrine)

Answer 2

-Sympathetic Response

-Action
1. Vasoconstrictor
Epinephrine 10 fold
Norepinephrine 4 fold
Epi peaks @low temp
Norepi peaks @XC and Rewarm

• Prevention
  1. Anesthesia
• Fentanyl
• propofol
  2. Pulsatile Flow