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Файл:Ординатура / Хирургия / Библиотека им академика М.И. Перельмана / Книга_3901_Библиотеки_им_академика_М_И_Перельмана
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myocardial protection (cont.)
myocardial oxygen demand,
103–104
non-cardioplegic methods, 110
cyclosporine, 111
intermittent cross-clamping/
fibrillation, 110
ischemic preconditioning, 102,
110–111
off-pump surgery, 110
remote ischemic preconditioning,
111
sodium hydrogen exchanger
isoform-1, 111
volatile anesthetic agents, 111
in pediatric patients, 151
reperfusion injury role in, 102–103
near infrared spectroscopy (NIRS), 84,
88, 177–180
nephrotoxic agents, 190–192
neurological complications, 175, 183
blood pressure control, 175–177
cerebral oxygen saturation, 177–180
epiaortic ultrasound of ascending
aorta, 183
pharmacological protection,
178–182
risk factors, 175–176
temperature management, 182–183
neuromonitoring, 175
cerebral oxygen saturation, 30,
177–180
during DHCA, 88–90
neuroprotection, 178–182
during DHCA, 86
hypothermia alone, 86–88
intermittent cerebral perfusion,
86–87
pharmacological, 86,
181
retrograde cerebral perfusion,
87–88
selective antegrade cerebral
perfusion, 87–88
spinal cord, 88–90
newborns, 150. See also pediatric
patients
nimodipine, 181
nitric oxide (NO), 121
nitrous oxide, 98
NMDA receptor antagonists, 179–181
non-cardiac surgical functions of CPB.
See mechanical circulatory
support
non-pulsatile flow, 92–93, 173,
185–187, 190
nonsteroidal anti-inflammatory drugs
(NSAIDs), 191–192
nontechnical skill (NTS), 7
noradrenaline (norepinephrine), 121
normothermic regional perfusion
(NRP), 129
novel oral anticoagulants (NOACs),
158
obesity, 92–93
occlusion
blood path, 197
pumps, 14–16, 35
off-pump coronary artery bypass graft
(OPCABG), 110, 173, 190
one lung ventilation (OLV), 132–133
opioids, 99
optimized extracorporeal circulation
(opECC), 77–78
organ damage during CPB, 166–167,
173
endothelial lining effects in, 167–168
gastrointestinal dysfunction,
168–170
myocardial dysfunction, 171
pulmonary dysfunction, 170–171
therapeutic strategies, 171–173
organ perfusion pressure, 175
organ transplantation
heart, 129–132
heart-lung, 132
liver, 133
lung, 129–133
osmolarity, priming solution, 46
over-pressurization, during
cardioplegia, 203
oxidative stress, in pediatric patients,
153
oxygen consumption (VO
2
), 95–96
oxygen delivery (DO
2
)
AKI risk, 186–187
CPB changes to, 166–167
goal-directed perfusion parameters,
95–96
hemodilution, 42–43
kidney, 187–190
monitoring, 30
optimization, 64–65
for pediatric patients, 152
oxygen extraction ratio (O
2
ER), 96
oxygen saturation, 29–30, 88, 177–180.
See also cerebral oxygen
saturation
oxygenators, 19–20, 35, 195–197
P
2
Y
12
-blockers, 157–158
pacing, during weaning from CPB, 114
pancreatitis, 170
paraplegia, 88–90
partial CPB, 127
patient concerns, pre-CPB review of,
38, 40
pediatric patients, 150, 154
conduct of CPB, 152–153
DHCA and regional cerebral
perfusion, 151–152
differences between adult cardiac
patients, 150
myocardial protection in, 151
pathophysiology of CPB in, 153–154
pathophysiology specific to, 150–151
percutaneous temporary ventricular
assist devices (VADs), 145–146
perfusion pumps. See pumps
perfusion record, 31–33
peripheral arterial cannulation, 60
peripheral venous cannulation, 62–63
peristaltic pump. See roller pumps
pH. See acid-base management
pharmacokinetics, 43, 98–99
pharmacological neuroprotection, 86,
178–182
phenylephrine, 93–94
phosphate, 97
phosphodiesterase-III (PDE III)
inhibitors, 119–121
pH-stat management, 85, 100
physiological perfusion, 76
platelet dysfunction, 156
platelet factor 4 (PF4), 51
platelet inhibition, 54
platelet transfusions, 159
point-of-care tests, 52, 158–161
polymethylpentene (PMP)
oxygenators, 19
polypropylene (PPL) oxygenators, 19
polyvinylchloride (PVC) tubing, 11
porcelain aorta, 58
postoperative cognitive dysfunction,
176–177
postoperative debriefing, 7
potassium, 46, 96–97, 102–105, 115
prasugrel, 157–158
pre-bypass filtration, 36–37
pre-CPB checklist, 37–40
preoperative briefing, 7
pressure
management, 64–68
monitoring, 27–28, 64–68, 80–81
priming, 36–37
autologous blood, 42–44, 154
hemodilution with, 42–44, 162
minimally invasive extracorporeal
circulation, 43
for pediatric patients, 153–154
solutions, 42, 44, 47
colloids, 45
crystalloids, 43
–45
electrolyte management, 45–47
volume, 42–43, 153–154
propofol, 99, 181, 191–192
Index
210
protamine, 53–54, 118, 156
protamine titration, 52
prothrombin complex concentrate
(FPCC), 157–158, 161
pulmonary artery catheter (PAC), 31
pulmonary artery (PA) perfusion, 173
pulmonary artery (PA) pressure, 65
pulmonary dysfunction, 170–171
pulmonary embolism, 90
pulmonary (thrombo) endarterectomy
(PTE), 86–87, 90
pulmonary hypertension, 90
pulsatile flow, 92–93, 173, 185–187, 190
pumps, 9, 14, 35. See also flow rates
centrifugal, 16–18, 73–74, 123–125
roller, 14–16
RAS blockers, 191–192
regional cerebral perfusion, 151–152
remote ischemic preconditioning
(RIPC), 111, 190
renal morbidity. See acute kidney
injury
renal replacement therapy (RRT), 136,
184–187, 190, 192
reno-visceral perfusion, 127–129
reperfusion, weaning from CPB, 113
reperfusion injury. See ischemia-
reperfusion injury
reservoirs, 18–19, 35
levels for weaning from CPB, 116
monitoring, 28–29
residual blood management, 118
resonance technology, 158–159
respiratory failure, postoperative,
170–171
respiratory quotient (RQ), 96
retrograde autologous prime (RAP),
43–44, 154
retrograde cardioplegia, 109
retrograde cerebral perfusion (RCP),
59–60, 87–88
rewarming, 63–64, 112, 200–201
AKI risk, 186–187
cerebral temperature during,
182–183
from DHCA, 85
metabolic management, 100–101
right atrial cannulation, 61–62,
65–67
right atrial (RA) tumors, 126
right ventricular assist device (RVAD),
146–148
right ventricular (RV) failure, 147, 149
rivaroxaban, 158
roller pumps, 14–16
Safety 1 and Safety 2, 1
–2
safety culture, 194–195, 198–199
selective antegrade cerebral perfusion
(SACP), 87–88
selective spinal and reno-visceral
perfusion, 127–129
shunts, in pediatric patients, 150–151
sickle cell anemia, 163–164
Sieving coefficient, 23–24
silicone rubber tubing, 11
siphon effect, 61
sodium bicarbonate (NaHCO
3
)
as cardioplegia solution additive, 107
priming solution, 46–47
during weaning from CPB, 116
sodium hydrogen exchanger isoform-1
(NHE-1), 111
somatosensory evoked potentials
(SSEPs), 89–90
spallation, 11
spinal cord perfusion pressure (SCPP),
89
spinal cord protection, 88–90
splanchnic circulation, 168–170
St Thomas’ Solution, 105–107
standardized conversations, 5
statins, 172, 181
“sterile cockpit” concept, 4
steroids, 47, 172, 181
stroke, 175
blood pressure control, 176–177
detection, 178, 180
risk factors, 175–176
subclavian cannulation, 13–14
sucker bypass, 22, 66
suckers, 22, 36
cardiotomy suction with, 66–68, 162
suction blood, reservoir segregation of,
19
superior vena cava (SVC), cannulation
of, 62
systemic inflammatory response, 166,
171–173
endothelial lining effects in, 167–168
gastrointestinal effects, 168
–169
in pediatric patients, 153
systemic to pulmonary shunts,
150–151
Systems Engineering Initiative to
Patient Safety (SIEPS), 2–3
TandemHeart, 138–139, 145–146
teamwork
communication, 1, 3–6
human factors in, 1–3, 37
leadership, 5
mental workload, 4–5
during MiECC, 73
anesthesiologist perspective, 73
perfusionist perspective, 73–74
surgeon perspective, 73
nontechnical skills, 7
repair, recovery and resilience, 5
solutions to improve, 5
preoperative briefing and
postoperative debriefing, 7
standardized conversations, 5
team creation and training, 7–8
temperature, 26–27, 65, 80–81, 85. See
also hypothermia
bleeding management with, 159
management, 63–65
cardioplegia, 110
cerebral, 182–183
during DHCA, 84–85
metabolic management, 99–101
weaning from CPB, 112
temperature coefficient (Q
10
), 99
thiopental, 86, 181
thoracic surgery, 125–126
thoracoabdominal aortic aneurysm
(TAAA), 81–82, 126–129
thrombin, 49–50, 156, 161–162
thrombocytopenia. See heparin-
induced thrombocytopenia
thromboelastography, 158–159
ticagrelor, 157–158
time-out phase, 37
tirofiban, 157–158
tranexamic acid (TA), 161–162
transactional leaders, 5
transcranial Doppler (TCD), 88, 178,
180
transducer levels, weaning from CPB,
116
transesophageal echocardiography
(TEE)
monitoring with, 31, 65–68
in weaning from CPB, 114, 118
transformational leaders, 5
transition of care, 5–6
Transmedics Organ Care System, 129,
131
trauma patients, 135–136
tris (hydroxymethyl) aminomethane
(THAM), 107
tubing, 9–12
biocompatible coatings, 11–12, 172
preparation and setup,
35–36
size, 12
tumor resection, 126
ultrafiltration, 23–24, 154, 162, 172
unfractionated heparin (UFH), 49, 54.
See also heparin
uninterruptible power supply (UPS), 35
urine output (UO), 65, 93, 95
vacuum-assisted venous drainage
(VAVD), 18–19, 28, 62
Index
211
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vasodilators, during weaning from
CPB, 115
vasoplegic shock, 202–203
vasopressin, 121
vasopressors, 93–94
failure to wean from CPB, 119–121
side effects, 121
during weaning from CPB, 115,
117–118
vein grafts, cardioplegia delivery
through, 109
veno-arterial extracorporeal membrane
oxygenation (VA ECMO), 123
failure to wean from CPB, 122
MCS with, 138–140, 143–144
circuit designs, 140–146
complications, 143
contraindications to, 141–143
emergent or bail-out applications,
133–136
indications, 141, 143
weaning from, 144
venous autologous prime (VAP), 43–44
venous blood path obstruction, 197
venous cannula, 14–15
venous cannulation, 61
complications, 63
connection, 61–62
DHCA, 81
MiECC, 73–74
pediatric patients, 152
peripheral, 62–63
TEE monitoring, 65–67
venous drainage, 92, 150–151
venous saturation, 29–30, 93–95
veno-venous extracorporeal membrane
oxygenation (VV ECMO), 123,
140
ventilation, 115, 169, 173
ventricular assist devices (VADs), 18,
146–148
failure to wean from CPB, 122
MCS with, 138–139, 144–145
complications, 146, 149
patient management, 148
perioperative management, 148
postoperative management,
148–149
types, 145–148
percutaneous temporary, 145–146
vents, 22, 36, 68–69
viscoelastic tests (VET), 158–161
vitamin K antagonists, 157–158
volatile anesthetic agents
AKI prevention, 191–192
gas scavenging system, 35
heart-lung machine monitoring,
25–26
metabolism, 98–99
myocardial protection, 111
neuroprotection, 179
warfarin, 157–158
weaning from CPB, 112
checklists, 112–113
alarms,
115
anesthesia, 115
de-airing, 112–113
electrolytes and acid-base balance,
115–116
inotropes, 115
levels, 116
pacing, 114
rate/rhythm/contractility, 113–114
reperfusion, 113
temperature, 112
ventilation, 115
failure, 119–122
pediatric patients, 153
prediction of difficulty, 117
residual blood management, 118
reversal of anticoagulation, 118
separation mechanics, 117–118
TEE in, 114, 118
weaning from ECMO, 144
whole blood clotting time (WBCT),
50–51
Index
212
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