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Perf Tech II (exam 2) > Myocardial Protection and Cardioplegia 11B > Flashcards

Myocardial Protection and Cardioplegia 11B Flashcards

1
Q

Four Main Objectives of Cardioplegia

A

•Immediate/sustained electromechanical arrest
•Rapid/sustained homogenous myocardial
cooling
•Maintenance of therapeutic additives in effective concentrations
•Periodic washout of metabolic inhibitors

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2
Q

Two Main Goals of Cardioplegia

A

I. Prevent myocardial ischemic damage (induction/maintenance)
II. Prevent/minimize injury (reperfusion)

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3
Q

3 Phases of Cardioplegia

A

I.Induction of arrest
II.Maintenance of arrest
III.Reperfusion

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4
Q

Pure Crystalloid Cardioplegia Induction Advantages (4)

A
  • History of use
  • Ease
  • Cheap
  • Low viscosity
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5
Q

Pure Crystalloid Cardioplegia Induction Disadvantage (6)

A 
-Cellular edema
•Low O2 capacity
•Left shift oxy-Hgb curve
•Activates platelets, leukocytes, and complement
•Impaired membrane stabilization
•Hemodilution
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6
Q

Cellular edema is a disadvantage of what cpg solution?

A

Pure crystalloid cpg

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7
Q

Low O2 capacityis a disadvantage of what cpg solution?

A

Pure crystalloid cpg

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8
Q

With a Lactated Ringer’s 1000mL cpg what do you add prior to use?

A

Add prior to use

Procaine 10% 2.7 mL

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9
Q

With a Normosol 1000 mL cpg what do you add prior to use? (3)

A

Add prior to use
Lidocaine 75mg
Ntg 500 mcg
Albumin 25% 12.5 g

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10
Q

Normosol 1000 mL is made of what? (3)

A

NaHCO2 35mEq
KCL 35mEq
Mannitol 25% 12.5 g

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11
Q

Lactated Ringer’s 1000mL is made of what? (4)

A

KCL20mEq
MgCl 32mEq
Mannitol 12.5 g
NaHCO2 6.5mEq

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12
Q

Cold Blood CPG Induction Advantages (4)

A
  • O2 carrying capacity
  • Reduced hemodilution
  • Buffering/oncotic effects
  • O2 radical scavengers present
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13
Q

Cold Blood CPG Induction Pitfalls if HCT high enough? (3)

A
  • Sludging
  • Oxy-Hgb curve disruption
  • Possible red cell damage
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14
Q

Warm Blood CPG Induction Advantages (3)

A
  • Improved aerobic metabolism
  • Improved LV function
  • Improves compromised hearts
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15
Q

Warm Blood CPG Induction Disadvantages

A

Expensive due to additives

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16
Q

Low Potassium Maintenance - how often ?

A

-Usually every 15 to 20 minutes

•Restores arrest post wash-out

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17
Q

Low Potassium Maintenance - what kinds?

A
  • Cold blood cardioplegia or crystalloid

* Restores arrest post wash-out

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18
Q

Hot Shot solutions?

A
  • Aspartate Glutamate
  • Tham
  • Dextrose
  • CPD
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19
Q

During “hot shots” warm blood may be substituted why?

A

cost

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20
Q

HTK stands for?

A

Histidine-Tryptophan-Ketoglutarate

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21
Q

HTK is what type of solution?

A

Intracellular cardioplegia solution

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22
Q

HTK solution

A

Low sodium concentration
Histidine
Tryptophan
Mannitol

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23
Q

HTK cardiac surgery Benefits?

A

Longer safe time of ischemia
During valve surgery
Minimally invasive procedures

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24
Q

HTK initial use ?

A

organ preservation

25
Q

Del Nido Solution (4:1) Additives ? (5) **

A 
Mannitol 20% 16.3 mL
MgSO4 50% 4 mL
NaHCO2 8.4% 13 mL 
KCL 2mEq/L 13 mL 
Lidocaine 1 % 13 mL
26
Q

Warm retrograde cardioplegia flow must be
what to minimize myocardial lactate
production?

A

> 100 mL/min **

27
Q

When do you use the single clamp technique ?

A

Used with calcified stiff aortas **

28
Q

Side biting technique benefits? ischemic time?

A

Ischemic time is only with fully clamped aorta

Shorter clamp times **

29
Q

Intermittent Crossclamp - clamp time sum of?

A

Clamp time is the sum of all fully ischemic times **

30
Q

Intermittent Crossclamp negatives?

A
  • Increased risk of stroke

* Not commonly used

31
Q

Fibrillatory Arrest

A

Creates a nearly motionless heart by placing an alternating current generator in contact with the left ventricle.

32
Q

Fibrillatory Arrest - what side of heart can be opened?

A

Left side of heart can be opened without the fear of ejecting air into the aorta

33
Q

Fibrillatory Arrest should be used in conjunction with what?

A

hypothermia

34
Q

What do you keep elevated during Fib Arrest?

A

KEEP MAP ELEVATED *

35
Q

Fibrillatory Arrest Advantages? (2)

A
  • Avoid cross clamp

* Quiescent heart with coronary perfusion

36
Q

Fibrillatory Arrest Disadvantages? (2)

A
  • Higher energy requirement than arrested heart

* Spontaneous ejection will result in air emboli

37
Q

Anesthetic agents do what for preconditioning?

A

↑ preconditioning

38
Q

Erythropoietin do what for myocardial injury?

A

↓myocardial injury

39
Q

Statins increase what?

A

↑NO release

40
Q

Neutrophil depletion decrease what?

A

↓V fib

41
Q

Goal of Perfusionist during CPG delivery?

especially?

A

GOAL: optimize uniformity and effectiveness of delivery (especially retrograde) ***

42
Q

What do you monitor during CPG delivery?

A

Temperature
pH
Electrical Activity

43
Q

Decrease TEMP what happens to ?

HOH >< H + OH = pH

A

^ HOH >< Decrease H + Decrease OH = ^ pH

44
Q

Increase TEMP what happens to ?

HOH >< H + OH = pH

A

Decrease HOH >< ^ H + ^ OH = decrease pH

45
Q

Failure to arrest look at what? (6)

A
  • Aortic insufficiency
  • Cross-clamp or cardioplegia needle malpositioned
  • Inadequate solution (low potassium)
  • Low flow?
  • Low pressure?
  • Temperature?
46
Q

Use of suction-based stabilizers is use when?

Reduces what?

A

-Used during OFF Pump surgery
-Has reduced the problem of working on a moving target
•Provide good exposure without excess compression of ventricle

47
Q

Ischemic Preconditioning ?

A

Brief period of vessel occlusion before occluding for construction of the anastomosis

Used during off pump procedures

48
Q

Off Pump Procedures keep systemic bld pressure at what ?

A

Keep normal to high systemic blood pressure
May increase flow through collaterals
vessels

49
Q

K+ does what for CPG?

A

electromechanical arrest

50
Q

Na+ does what for CPG?

A

↓ edema/intracelluar Ca++ buildup

51
Q

Ca++ does what for CPG?

A

Membrane stabilization

52
Q

NaHCO3 does what for CPG?

A

↑pH

53
Q

THAM does what for CPG?

A

↑pH

54
Q

Glucose does what for CPG?

A

Substrate, ↑Osmolarity, ↓ edema

55
Q

Mannitol does what for CPG?

A

↑ Osmolarity

56
Q

KCl high and low K doses concentrations?

A

100mmol/L

40 mmol/L

57
Q

THAM high and low K doses concentrations?

A

12mmol/L

12mmol/L

58
Q

MgSO4 high and low K doses concentrations?

A

9 mmol/L

9 mmol/L

59
Q

CPD high and low K doses concentrations?

A

20 mL

20 mL

Perf Tech II (exam 2) (6 decks)

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