Perioperative Considerations in Cardiac Surgery by C. Narin

By C. Narin

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Propofol decreases systemic blood pressure with corresponding changes in cardiac output and systemic vascular resistance. The blood pressure effects may be overt in hypovolemic patients, elderly patients and also patients with coronary artery disease compromising the left ventricle. Adequate hydration is often recommended to offset this effect of propofol. Unlike the effect of thiopental on blood pressure compansated by the increase in heart rate, propofol does not change heart rate. Furthermore, bradycardia and asystoli may also occur most probably because of the reduction in sympathetic outflow more than parasympathetic.

In the clinical setting, increasing pump flows, increasing hematocrit concentrations (transfusion of PRBCs or use of ultrafiltration for hemoconcentration), or increasing hemoglobin saturation and the amount of dissolved oxygen (increasing the inspired oxygen concentration [FIO2]) can improve delivery of oxygen (Lango&Mrozinski,2010). Delivery of oxygen during CPB is typically less than that measured in the awake and anesthetized subjects. This is primarily caused by the decrease in the arterial oxygen content that occurs from hemodilution at the onset of bypass.

Nasopharynx, esophagus) (Grogan et al,2008). Jugular bulb (JB) is the most reliable site to detect the accurate cerebral temperature, because it receives 99% of the CBF; however it takes time and money with risks associated with placing the device. Nasopharyngeal site and arterial inflow (arterial outlet of membrane oxygenator) temperatures are the closest ones to JB with a gradient of 1-2 C (Grigore et al,2009). Mild hypothermia (32-34 C), slow-rewarming during CPB (maintaining inflow temperature and nasopharyngeal temperature at or below 37 C as the maximum allowable) and avoidance of hyperthermia are the current recommendations (Grigore et al,2009;Grogan et al,2008).

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