Introduction and Maintenance of Cardioprotective
Anesthesia by Arno P. Nierich, M.D.
General Induction
The following is a suggested protocol for general induction:14
- Propofol 1Ü2mg/kg
- Pancuronium 0.1mg/kg
- Sufentanil 0.25mg/kg
- Continuation with air/oxygen and propofol 2Ü3mg/kg/hr Heparinization
- Maintain ACTs greater than 250 seconds. Less heparin (100Ü200
units/kg as opposed to the standard 300 units/kg) is required,
and protamine reversal is thereby reduced to 2/3dose.15
Heparinization
Maintain ACTs greater than 250 seconds. Less heparin (100Ü200
units/kg as opposed to the standard 300 units/kg) is required,
and protamine reversal is thereby reduced to 2/3 dose.15
Normothermia
Use the following techniques to keep the patient normothermic:
- Warm IV fluids
- A heating mattress or warm air under the drapes
- A humidified airway
- A warm OR
Monitoring Hemodynamic Stability
- Arterial line and/or CV line
- SvO2 - When oxygenation and hemoglobin
are constant, SvO2 is a good indicator
of hemodynamic performance.
- EKG - Used to monitor rhythm and analyze ST segment
trends
- TEE - Used to monitor regional wall motion and status
of ventricular volume
Maintaining Hemodynamic Stability
Hemodynamic stability is easily maintained with the use of the
simple techniques described below:
- Trendelenburg position- Increases preload and allows
gravity to assist in supporting the heart in the vertically
displaced position
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