Purfusion lecture ppt Flashcards
notes from fuck face who keeps calling us ANESTHESIOLOGIST b/c hes too fucking stupid to realize who he is giving a lecture to
A’s of anesthesiology
anesthesia
analgesia
Amnesia
A’s of anesthetist
Ability
amiability
Availability
P’s of perfusion
preparation
Prime and pump
persistence
Pandering
Perfusion Equipment
heart-lung machine Cell saver Heater-cooler bloodgas machine ACT machine thrombelastagraph inline bloodgass analyzer cerebral oximeter Disposable invetory -oxygenators -hemoconcentrators -tubing packs -cardioplegia delivery systems -Cannulas
Prime:
Est adult blood volume
Adult
neonate
Adult:6 liters
Neonate: 400 ml
Prime:
adult prime
Neonate prime
Adult: 1.5 L (25% dilution)
Neonate: 500mL (125% dilution)
Prime:
what is the prime made up of?
- plasmalyte (1000mL or less)
- Albumin (200mL 25% 50G) for COP (avoid edema) and coating of circuit
- Heparin 1000-10000 Units
- Ca++ 300-700mg
- Blood
- FFP
- Bicarb (25-50mEq) and/or THAM
Prime:
what is the crystaloid of choice
Plasmalyte
Prime:
blood is usually added if predicted HCT is what?
<16
Ultrafiltration:
what are the 3 types
PBUF (Pre-bypass Ultrafiltration)
ZBUF (Zero Balance Ultrafiltration)
MUF (modified Ultrafiltration)
Cardioplegia:
what is it used for?
- arrest the heart so surgeon can have a bloodless field (this fag bag talks way too much about making the god damn surgeon happy, it like the fagget has no balls)
- Preserve the tissue
Cardioplegia:
what must you worry about following termination of cardioplegia?
reperfusion injury
Cardioplegia:
Myocardial O2 demand drops ___% for every 10 degrees celsius of cooling?
50%
Cardioplegia:
Body O2 demand drops 50% for every ___ degrees celsius of cooling?
6
CARDIOPLEGIA:
what are the ingredients
Blood (4-1) K+ (20 mEq/L) Adenosine Mannitol/Albumin Glucose-insulin Glutamate/Aspirtate (buckberg AA ) Steroids CCB CA chelator (CPD) Allopurinol Buffers Lidocaine/Mg++ O2
CARDIOPLEGIA:
what type of blood is best used?
Leukocyte depleted
CARDIOPLEGIA:
how much K+ is used?
20 mEq/L
CARDIOPLEGIA:
why is mannitol/albumin used?
osmolarity
CARDIOPLEGIA:
what CCB is usually used?
diltazem
CARDIOPLEGIA:
why is allopurinal used?
O2 free radical scavengers
CARDIOPLEGIA:
what are buffers used?
Bicarb
THAM
CARDIOPLEGIA:
why is lidocaine/Mg++ used?
membrane stabilization
CARDIOPLEGIA:
some studies have shown that uses what blood shown benefits? Arterial or Veneous?
Venous
Bypass causes what throughout the body?
Systemic Inflammatory response
CPB inflammatory response:
Material dependent causes?
- exposure of blood to non-physiologicl surfaces (PVC tubing)
- exposure of blood to non-physiological conditions (blood-air interface
CPB inflammatory response:
Material independent cause?
- surgical trauma
- ischemia-reperfusion of organs
- changes in body temp
- release of endotoxin
CPB inflammatory response: (SIRS)
Complications
leukocytosis Histamine release (from C3a/C5a) Increased capillary permeability Accumulation of interstitial fluid Organ dysfunction (primarily Lungs) late depression of inflammatory response (day 5)
How to prevent SIRS
coated circuit puslsatile perfusion Leukocyte depleted filters (rewarming) continuous blood flow to lungs Eliminate blood Air interface use of a hemoconcentrator (washed cells) Meds -preop steroids -aprotinin -CCB -IIb, IIIa platelet blockers Viagra
Complications of perfusion
blood exposure pulmonary renal Neuro major organ hypoperfusion Bleeding infection Cardiac length of stay
ECMO:
2 types of partial support
Veno Veno
Veno Arterial
I duno thats it i guess!!!!!
this was a shitty lecture
