Effects oftwo kinds of crystals priming on levels of glucose and lactic acidin pediatrics withcardiopul-monary bypass during congenital heart surgery / 实用医学杂志

Objective To compare the effect of Acetate Sodium Potassium Magnesium Calcium and lactate ringers′ as priming solution in pediatrics with cardiopulmonary bypass (CPB) during congenital heart surgery. Methods Sixty children, aged 1-6 years, weighting 8 to 20 kg, with ASA Ⅱ to Ⅲ class and with ventricular or atrial septal defect elective , received heart surgery with CPB. They were randomly divided into two groups: the lactate ringers′ group (R) and the sodium acetate, potassium, magnesium and calcium glucose injection pre-filled group (L). Levels of artery blood gas, lactic, gluclose, electrolytes were detected at the time points of induction of anesthesia (T1), aortic cross damping (T2), stopping before (T3), and closing chest later (T4). Results Levels of the blood glucose and lactic acid in the two groups post-CPB were increased (P 0.05). Conclusion Sodium, potassium , magnesium , calcium and glucose injection as children CPB priming crystalloid fluid could provide energy substrate, reduce lactic acid concentration, with little effect on electrolyte and blood gas.

The Effect of Leukocyte Depletion from the Cardiopulmonary Bypass Priming Solution / 대한마취과학회지

BACKGROUND: Cardiopulmonary bypass provokes a vigorous inflammatory response and gut mucosal ischemia, which have important implications on the morbidity of cardiac surgery. The purpose of this study was to investigate the effect of a leukocyte-depleted priming solution on inflammatory response and tissue perfusion during cardiopulmonary bypass (CPB). METHODS: Twenty mongrel dogs received hypothermic (28degress C) partial CPB for 2 hours with blood-containing (C group, n = 10), or leukocyte-filtered (LD group, n = 10) priming solution. Gastric intramucosal PCO2 (PrCO2), pHi (pHi), IL-8, blood gas analysis and hemodynamic parameters were measured; 1) before CPB, 2) 1 hour into CPB, 2) 2 hours into CPB, 3) 2 hours after CPB, and 4) 4 hours after CPB. The ratio of wet to dry weight of lungs was measured. Statistical verification was performed using repeated measures ANOVA and unpaired t-test. RESULTS: All baseline data were comparable in the groups. Gastric intramucosal PCO2 increased and pHi decreased during the experiment ithout significant difference between the groups. IL-8 increased in both groups, however, it was lower in the LD group. The difference between PaCO2 and end-tidal CO2 increased during CPB in both groups, and was lower in the LD group. The ratio of wet to dry lung weight was significantly lower in the LD group. CONCLUSIONS: We conclude that the leukocyte depletion from the priming solution attenuates the inflammatory reaction and pulmonary edema induced by hypothermic CPB. The impairment of splanchnic perfusion during CPB may not be related to leukocyte in priming solution.

The Effect of Blood Transfusion on the Tissue Perfusion and Lung Injury during Cardiopulmonary Bypass / 대한구급학회지

BACKGROUND: The blood components of priming solution for cardiopulmonary bypass (CPB) may have opposite roles for tissue perfusion, which are the activation of inflammatory reaction and the improvement of oxygen carrying capacity. This study is aimed to investigate the effect of blood transfusion of priming solution on inflammatory response and tissue perfusion. METHODS: Twenty mongrel dogs randomly allocated and received hypothermic CPB with blood- containing (H group, n=10), or non-hemic (NH group, n=10) priming solution. Gastric intramucosal CO2 concentration (PrCO2), intramucosal pH (pHi), interleukin-8 (IL-8), blood gas and hemodynamic parameters were measured at 1) before CPB, 2) 1 hour during CPB, 3) the end of CPB, 4) 2 hours after CPB, 5) 4 hours after CPB. The ratio of wet to dried lung weight was measured. Statistical verification was performed using repeated measures ANOVA and unpaired t-test. RESULTS: PrCO2 increased and pHi decreased during the study without significant difference between the groups. IL-8 increased in both groups and IL-8 of H group increased higher than that of NH group during the study. The difference between PaCO2 and end-tidal CO2 of NH group was higher than that of H group at 4 hours after CPB. The ratio of wet to dried lung weight was not significantly different between the groups. CONCLUSIONS: We conclude that the allogenic blood in priming solution aggravates the CPB- induced inflammatory reaction, however, the CPB-induced impairment of gastric mucosal perfusion and the pulmonary edema are not significantly affected, compared to non-hemic solution.

The Change of Colloid Osmotic Pressure during Pediatric Open Heart Surgery / 대한마취과학회지

To evaluate the change of colloid osmotic pressure(COP) and the correlation between COP and other parameters during pediatric open heart surgery at Seoul National University Children's Hospital, COP, protein, albumin, hemoglobin, and hematocrit, were measured immediately after induction(T1), before cardiopulmonary bypass(CPB)(T3), duringT4, T5), and after bypass(T.6, T7) and immediately after(T8) and 24 hour after(T9) arrival at intensive care unit (ICU) in l0 pediatric patients aged from l year to 13 years. Above parameters of priming solution(T2) were also measured. The results were as followings; l) The good correlation between COP and protein(r=0.87), albumin(r=0.86), hemoglobin(r=0. 80), hematocrit(r=0.77) were showed. 2) The COP of priming solution was 9.42.6 mmHg and this was definitely lower than normal value. 3) The COP during CPB was in the range from 11 to 12 mmHg(mean values) and this value was also significantly lower than normal value. 4) The COP increased from the time of weaning from CPB, but the COP at the arrival at ICU was 18.0+/-1.2 mmHg and this value was still significantly lower than normal value. 5) The COP at 24 hours after arrival at ICU was 21.7+/-1.2 mmHg and this value was not significantly different fron normal value. Thus, the results suggest that the priming solution shuold be improved to maintain COP during and immediatelt after CPB.