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Neurological problems in ICR

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thuhanip View Drop Down
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  Quote thuhanip Quote  Post ReplyReply bullet Topic: Neurological problems in ICR
    Posted: Nov 13 2011 at 6:49pm
do you check blood coagulation post bypass?
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coleb View Drop Down
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  Quote coleb Quote  Post ReplyReply bullet Posted: Jun 09 2009 at 9:34pm
Have you tried using any kind of cerebral monitoring device while on pump and post surgery.  There are several out there these days.  We use one and we don't base all of decisions on its number but use it as a trending device.  The doctors are quit pleased with it and so are we the perfusionist.  As you go on pump you see a large drop in its readings but as temperature drops ,and pressure and flow increase the number trends upward. The best way to get a baseline number is to try to get the cerebral pad on before the baby is put to sleep.  Then use this number as a guide.  This will give you an idea of what kind of blood flow is going to the head.  Also if the svc cannul is placed wrong, you can see a drop in your cerebral sats.  Also it is great during antegrade or retro cerebral perfusion.  Try it out for a few cases. When you first get it you will be surprised at how much this will effect your case.  You can tell if you are flowing to low or the BP is to low. 
We like it. I hope you can try it.
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stan80 View Drop Down
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  Quote stan80 Quote  Post ReplyReply bullet Posted: Apr 06 2009 at 11:15am

I think think this problem is not your. Its possibly falls of number heparin that you order.

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  Quote rajev76perf Quote  Post ReplyReply bullet Posted: Jan 17 2009 at 2:26am
dear sir
 on perfusionist point of veiw i feel that problem can be resolved by due consideration towards
platlet count> 100000
Hb>10 
shift to alpha stat if use ph stat
and the most important keep the pt.neso temperature around 35*c 
ofcourse oncotic pressure is vital to maintain.
rajeev gupta
sr. perfusionist
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  Quote balibali_007 Quote  Post ReplyReply bullet Posted: Jan 14 2009 at 3:53pm
the most important aspect in such patients is to moniter their base line A.C.T,it is because of their high hb content.we perform a base line act ,then do a phlabotomy,then ffp is adminstered with relatively low dose of heprrin.another aspect is your dose of mannitol ,you should not exceed more than 2 ml perkr body weight
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  Quote ccped Quote  Post ReplyReply bullet Posted: Sep 09 2007 at 2:29am
You should also consider possibly using pentothal for cerebral protection for the time being. Of course you should consult with anesthesia and surgeon.
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Asmar View Drop Down
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  Quote Asmar Quote  Post ReplyReply bullet Posted: May 09 2007 at 7:16am
consider arterial cannula site , R U doing  circulatory arrest with antegrade cerebral perfusion !!! how about the mannitol dose! and what kind of crystalloid R U priming with?.all of the above can be a contributing factors.
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  Quote Guests Quote  Post ReplyReply bullet Posted: May 08 2007 at 8:17am

whats hemodynamic changes during this period

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  Quote FlowisKing Quote  Post ReplyReply bullet Posted: Apr 27 2007 at 12:54pm
Consider your plasma oncotic pressure. If it is too low capillary leak and possible brain bleeds. Consider 25% albumin. Decrease priming volume drastically. Consider using THAM instead of NaHCO3.
 
What kind of flows are you running? Too high of flow could be culprit
 
Directions of arterial cannula jet could be cause...
 
Do you MUF? Do use ultrafiltrate / ZBUF/DUF during procedure? Consider using all of these techniques. Stive to remove or run a lot of volume through the patient and out of your ultrafiltrator. Aggressively MUF to acheive very high hemaglobins.
 
What blood products are administered post CPB and in ICU? Look at these and increase or decrease use.
 
Steroids in patient or in pump? Consider solumedrol.
 
These are just suggestions. The more info you provide on your circuit and techniques them more support you will recieve.
 
Hope these help.
 
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willi View Drop Down
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  Quote willi Quote  Post ReplyReply bullet Posted: Dec 04 2006 at 5:25am
Ringer Lactate
NahCo3
Mannitol
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