The body's venous supply of blood is oxygenated and then pumped back into the arterial system.
The bypass machine also provides intracardiac suction, filtration, and temperature control.
Some of the more important components of these machines include pumps, oxygenators, temperature regulators, and filters. (UMDNS, 1999) www.nlm.nih.gov/cgi/mesh/...
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Once the surgeon closes the PDA the pressures are likely to improve, and if large doses of vasopressor have been given the pressures after closing the PDA may be a little too generous.
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In larger children this can generally be avoided as the dilution of their haemaglobin by the priming fluid is less significant.
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1. What are the haemodynamic goals for this cardiac condition?
2. What blood products will I need to organise ( Blood, FFP, Platelets)?
3. Will a blood in-motion-bag be needed in theatre at induction ( eg redo sternotomy)?
4. Is the patient too high risk to undergo induction in the induction room?
5. Nasal (infant) vs oral (older child) ETT?
6. Is this a redo sternotomy with all its necessary precautions?
7. Will you need tranexamic acid or aprotinin (low vs high pressure sutures) or should you avoid tranexamic acid (eg insertion of small shunt)?
8. Can the arterial line be placed in either arm (is there a BTS)?
9. Do we need to avoid putting lines the femoral artery in case they are required for emergent suction bypass (eg Redo sternotomy)
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#IS
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Aortic cross clamping will result in loss of the femoral pressure trace.
#DM
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Consider a slow administration in this older age group.
#safety #ref
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Below is a NIRS reading in a clear prime for an ASD repair related to HCT. #anzcaasm2012 #JS
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This means that in the event they require emergent bypass, the patient is already positioned, and lines and pressure areas are taken care of.
Once the drapes are on it is very difficult to do this after the fact.
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1. ketamine 10mg/kg plus
2. 0.25mg/kg midazolam in 50ml Syringe.
Running this at 10ml/hr gives an infusion of 2mg/kg/hr ketamine and
50mcg/kg/hr of midazolam
For the child < 1yr old -
Run midazolam 1mcg/kg/min.
#DM
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#AS
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#ref
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Ensure patient has been transferred to ICU monitoring and ventilator, and is stable before performing handover then :
1. 10,000 ft one sentence overview eg "This is a 4yr old with HLHS who has undergone a fairly uncomplicated fontan completion and LP plasty"
2. Overview of patient's history
3. Description of surgical procedure
4. Intraoperative complications
5. Outline cardiac function and support
6. Outline respiratory function and support
7. Haematology, blood products
8. Urine output
9. Lines
10. Other
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1. Is the heating blanket switched off?
2. What inotropes or vasodilators do you need to prepare for coming off bypass.
3. When are antibiotics next due?
4. What blood products are likely to be required coming off bypass that need to be ordered?
5. Will the lines with inotropes or vasodilators you're likely to need coming off bypass be sufficiently primed by the time they're needed?
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