Test 1 CPG

Question 0

Crystalloid based solutions

Answer 0

Custodial (7%)
St Thomas, Plegisol, Baxter (5%)
Customized (2%)

Question 1

Blood based solutions

Answer 1

Del Nido (38%)
Customized (32%)
St Thomas, Plegisol, Baxter (11%)
Microplegia (5%)

Question 2

CPG solutions with the longest effective intervals

Answer 2

Del Nido and Custodial

Question 3

Osmolarity, Dosing, and delivery of Del Nido

Answer 3

Osmolarity: 340 mosm/L
Dosing: 20ml/kg arrest, 10ml/kg maintenance
Delivery: 90-180 ml/min

Question 4

Components of custodial (Bretscneider) cpg and their purposes

Answer 4

Histidine: buffer against acidosis during XC
Tryptophan: stabilizes cell membrane
Ketogluterate: improves ATP production during reperfusion

Question 5

How does Mg provide a protective effect of hypoxy-ischemic hearts?

Answer 5

Antiarrhythmic
Prevents Ca entry into myocytes
Prevents Na uptake by myocytes
Mg exchanged for Ca during reperfusion

Question 6

Path of ultrafiltration while on bypass

Answer 6

ALF–>mannifold–> hemoconcentrator–> venous reservoir

Question 7

Path of MUF

Answer 7

Aorta–>cardioplegia pump–> hemoconcentrator–>right atrium

Question 8

7 things that happen in the hemoconcentrator

Answer 8

1. Raise HCT
2. Extravascular fluid crosses (large increase in COP and OSMO)
3. Removes inflammatory mediators
4. C-reactive proteins cross
5. Complement activation factors cross (C3a, C56-9, C3 bound)
6. Protein reactive cytokines cross
7. Pulmonary effect > systemic effect (IL6, IL8, TNF)

Question 9

Reasons MUF affects not sustained

Answer 9

Initiation of systemic inflammatory response is during rewarming, so it’s started before MUF is initiated
MUF unable to overcome ongoing affects of capillary leak

Question 10

Max blood flow through ultra filter

Answer 10

20ml/kg/min

Question 11

End points of ultrafiltration

Answer 11

10-20min

Or HCT reaches 40-50

Question 12

Benefits of MUF

Answer 12

Reduced total body water
Reduced edema
Reduced LOS
Reduced ventilation time
Reduced incidence of pleural and pericardial effusion

Question 13

Arguments against MUF

Answer 13

Possible air embolism
Air would enter venous side
Circuit complexity and cost
Prolonged exposure to foreign surface

Question 14

Clinically proven benefits of MUF

Answer 14

Increased ventricular systolic function
Improved CBF, cerebral metabolic activity, and oxygen delivery
Decreased ventilation
Decreased Postop bleeding