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Neurological problems in ICR

Printed From: Perfusion.com
Category: Perfusion
Forum Name: Pediatric Perfusion
Forum Discription: This forum is for discussion of cadriovascular perfusion issues in pediatric patients.
URL: http://www.perfusion.com/cgi-bin/forum/forum_posts.asp?TID=37
Printed Date: Apr 23 2018 at 1:25pm


Topic: Neurological problems in ICR
Posted By: madwilli
Subject: Neurological problems in ICR
Date 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?



Replies:
Posted By: Guests
Date Posted: Nov 29 2006 at 11:26am
Whats in your prime?


Posted By: Guests
Date Posted: Nov 30 2006 at 11:04am
What is ICR?
How warm do you get?


Posted By: Guests
Date 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


Posted By: Guests
Date 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


Posted By: Guests
Date Posted: Dec 04 2006 at 5:06am
ICR - Intra Cardiac repair


Posted By: Guests
Date Posted: Dec 04 2006 at 5:25am
Ringer Lactate
NahCo3
Mannitol


Posted By: FlowisKing
Date 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.
 


Posted By: Guests
Date Posted: May 08 2007 at 8:17am

whats hemodynamic changes during this period



Posted By: Asmar
Date 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.


Posted By: Guests
Date 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.


Posted By: balibali_007
Date 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


Posted By: rajev76perf
Date 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


Posted By: stan80
Date Posted: Apr 06 2009 at 11:15am

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



Posted By: coleb
Date 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.


Posted By: thuhanip
Date Posted: Nov 13 2011 at 6:49pm
do you check blood coagulation post bypass?



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