Term
| Why is an LV vent placed? |
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Definition
| LV distension occurs because AO regurg may occur or blood flows through the bronchial and thebesian veins; myocardial wall tension can lead to ischemia and tension causes poor distribution of cardioplegia in subendocardial vessels |
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Term
| What must you ensure before CPB initiation? |
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Definition
| adequate arterial flow of oxygenated blood, adequate venous return to reservoir, ACT of at least 400 seconds, core temp in place (bladder), baseline pupil assessment for size and symmetry, adequate depth of anesthesia |
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Term
| On initiation of CBP what happens to the BP? What will the aline look like during bypass? |
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Definition
The BP will drop as a reflexive response to nonpulsatile flow and hemodiluation
The aline will be flat and only read a MAP |
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Term
| What may the patient require as CBP is initiated and why? |
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Definition
| Hemodilution due to the bypass machine will also dilute medications and the patient may require more opioid, amnestic, and NDMR |
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Term
| Describe characteristics associated with rewarming |
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Definition
Time of high recall
Head must be down for separation from CPB to prevent air entrainment
AOX will be removed and replaced with partial occlusion clamp for proximal anastamosis to aorta
After heart is beating, may start dobutamine infusion |
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Term
| What does the EKG initally look like after coming off pump? |
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Definition
| Wide QRS due to air and washout of cardioplegia |
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Term
| What is your anesthetic checklist before coming off pump? |
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Definition
Check ABGs, Hct, lytes, platelets
Ascertain systemic rewarming
Calibrate pressure transducers
Adequate HR? Need to pace?
Check for arrhythmias and ST seg. change
Initiate ventilation when requested
Protamine when requested |
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Term
| What should we do during sternal wire placement/closure? |
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Definition
| Give postop antibiotics, check CO, give cell saver blood, transfuse - PRBCs, FFP, Platelets; |
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