Cardiopulmonary bypass surgery

Hetastarch 6% has comparable plasma expansion to 5% albumin solution but is usually less expensive, which accounts for much of its use. Hetastarch should be avoided in situations in which short-term impairments in hemostasis could have adverse consequences (e.g., cardiopulmonary bypass surgery, intracranial hemorrhage), because it may aggravate bleeding due to mechanisms such as decreased factor VIII activity. 

CEO, Stephen Hoffman and VP for clinical studies, Michael Gerber of Alios Therapeutics guided RSR 13 through a series of phase-one and phase-two clinical trials for radiation treatment of brain tumors and for potential use in cardiopulmonary bypass surgery [46, 51-55]. Considering the cost of running a phase-three clinical trial, only one was possible. The very positive phase-two results for use of RSR 13 to treat metastatic brain cancer provided the impetus for selecting that indication for a phase-three trial. 

Unlabeled Uses Cardiopulmonary bypass surgery hemodialysis pulmonary hypertension associated with acute respiratory distress syndrome, systemic lupus erythematosus, or congenital heart disease refractory CHF severe community-acquired pneumonia... 

Schoen P, Everts H, de Boer T, van Oeveren W (2003) Serum carnosinase activity in plasma and serum validation of a method and values in cardiopulmonary bypass surgery. Clin Chem 49 1930-1932... 

CO improves cardiac energetics and safeguards the heart during reperfusion after cardiopulmonary bypass surgery [17]. 

However, rewarming has to be considered as the critical phase of hypothermic therapy. This rebound intracranial hypertension after rewarming might be due to a proposed hypermetabolic response after induced hypothermia, as it was described after cardiopulmonary bypass surgery (40). 

Albumin-h Albutein (Alpha Therapeutics) Hypovolemic shock hemodialysis cardiopulmonary bypass surgery... 

Surgeons are concerned with brain blood flow to patients undergoing cardiopulmonary bypass surgery. An intensive study by Chow et al. was conducted where blood flows were restricted to patients from age 2 weeks to over 20 years [48]. Near-IR was used to correlate blood flow rate with NIR spectra of the brain. Flows of 0.6, 1.2, and 2.4 L/mVmin-1 were used. Their results showed that flow was related to mean arterial pressure, but did not correspond to pulsatility. This was interesting in that pulse rate is often used as a diagnostic to assure sufficient blood flow to the brain during surgery. 

In the Henderson-Hasselbalch equation, pK and a are used as constants for a temperature of 37 °C. The temperature-controlled sample chamber of an instrument is specified to be 37 °C 0.1 C, and it is at that temperature that all measurements of pH and partial pressure of gases are made. The body temperature of a febrile patient may be elevated to 40 °C to 41 °C, or a patient may be made hypothermic for cardiopulmonary bypass surgery and have a temperature as low as 23 °C. Most blood gas instruments, on keyboard entry of a patient s actual temperature, can calculate and present... 

Mann SW, Buckley BM, Roberts KD, Green A. Changes in plasma ionized calcium concentration during pediatric cardiopulmonary bypass surgery. Ann Clin Biochem 1988 25 226-7. 

Cardiopulmonary bypass surgery hemoperfusion for kidney patients peripheral vascular disease, preinfarction angina, and stroke... 

Hetastarch, an amylopectin derivative and plasma volume expander (500 to 1000 ml IV), is used in shock and cardiopulmonary bypass surgery. 

A fluorosensor for monitoring blood gases and pH in an extracorporal loop is commercially available [125]. Arterial or venous oxygen and carbon dioxide pressure, pH, and temperature can be determined continuously during cardiopulmonary bypass surgery. The system consists of a microprocessor-based instrument, bifurcated fiber-optic cables, and a disposable sensor head with fluorescent spots sensitive to the respective analytes. 

P2. Paramo, J., Rifon, J., Llornes, R., Casares, J., Paloma, M. J., and Rocha, E., Intra- and postoperative fibrinolysis in patients undergoing cardiopulmonary bypass surgery. Haemostasis 21, 58-64 (1991). 

The finding that hemoperfusion through the polymeric BetaSorb column effectively removes several middle-molecular-weight toxic proteins and that such toxins and cytokines are heavily involved in the systemic inflammatory response syndrome (SIRS) have stimulated extensive preclinical studies to demonstrate the wider utility of the hemoperfusion procedure. Winchester et al. [365] list 24 cytokines and other protein and glycoprotein molecules in the molecular weight range of 4—llOkDa that are implicated in SIRS. In addition to ESRD, SIRS is caused by various other health problems, such as acute renal failure (350,000 cases per year in the USA), cardiopulmonary bypass surgery (1.5 million/year), and sepsis. 

Extracorporeal monitoring has also been found to be possible during cardiopulmonary bypass surgery. The blood of the patient is withdrawn by a pump at a low flow rate (a few milliliters per... 

In 14 clinical trials of prothrombin complex concentrates for reversal of oral anticoagulation therapy, seven of 460 patients (1.5%) had thrombotic events, three thrombotic strokes, two cases of deep venous thrombosis, and two non-Q-wave myocardial infarctions [31 ]. However, in 40 patients taking oral anticoagulants, who needed cardiopulmonary bypass surgery, and of whom 20 were treated with prothrombin complex concentrates, no thrombotic events occurred [35 ]. 

Demeyere R, Gillardin S, Amout J, Strengers PF. Comparison of fresh frozen plasma and prothrombin complex concentrate for the reversal of oral anticoagulants in patients undergoing cardiopulmonary bypass surgery a randomized study. Vox Sang 2010 99(3) 251-60. 

There are two main medical applications of defoaming. The first concerns the treatment of symptoms associated with excessive gas in the gastrointestinal tract. The second concerns the treatment of blood during cardiopulmonary bypass surgery. 

Despite use of these defoamer/fllters, the presence of lipids, PDMS antifoam particles, and microbubbles of air conspire to make cardiotomy blood the major canse of emboli in modem cardiopulmonary bypass surgery when nsing membrane oxygenators [67]. Superior outcomes can often be achieved by simply discarding that blood [67], although this is not usnally a practical option. 

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