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Neurological problems in ICR

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madwilli View Drop Down
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  Quote madwilli Quote  Post ReplyReply bullet Topic: Neurological problems in ICR
    Posted: Nov 28 2006 at 7:31am
We are facing a difficult problem with ICR babies, till extubation(after 24 hrs) after ICR correction - there is no sign of neurological problems etc., but soon after that within 10 hrs they are developing Cerebral hemorrhage. We used Haemofilter, SNP during rewarming and Mean arterial pressure was maintained about 35-45 for <15 kg patients. We cooled down to 28C. Haematocrit was maintained around 27. Can somebody explain this? Is there any problem in perfusion technique or anaesthetic problem?
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flando View Drop Down
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  Quote flando Quote  Post ReplyReply bullet Posted: Nov 29 2006 at 11:26am
Whats in your prime?
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Mary View Drop Down
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  Quote Mary Quote  Post ReplyReply bullet Posted: Nov 30 2006 at 11:04am
What is ICR?
How warm do you get?
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Larry Frounfelkner View Drop Down
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  Quote Larry Frounfelkner Quote  Post ReplyReply bullet Posted: Dec 01 2006 at 9:33am
I agree with Randy that you should consider hypernatremia. NaHCO3 increases serum osmolarity and sodium levels and can result in brain damage and intracranial bleeding from changes in the cerebral spinal fluid.
Giving 3 mEq./kg. of NaHCO3 results in an increase of 7.5 mOsm./kg in serum osmolarity. Hope this helps.
Larry Frounfelkner, CCP
CPMC, San Francisco
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  Quote tanny klasna Quote  Post ReplyReply bullet Posted: Dec 01 2006 at 1:53pm
Please forgive my ignorance, but what does ICR stand for.  I am an adult perfusionist and former neonatal nurse, but have never heard that abbreviation.
 
I'm sorry for your situation, maybe if I understand it better I can help.
 
Thank you.
 
Tanny Klasna, RN, BSN, CCP
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willi View Drop Down
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  Quote willi Quote  Post ReplyReply bullet Posted: Dec 04 2006 at 5:06am
ICR - Intra Cardiac repair
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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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FlowisKing View Drop Down
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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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  Quote Guests Quote  Post ReplyReply bullet Posted: May 08 2007 at 8:17am

whats hemodynamic changes during this period

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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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