TY - CHAP M1 - Book, Section TI - Cardiopulmonary Bypass: Anticoagulation A1 - Choi, Hanwool Ryan A1 - Lewis, Choy A2 - Freeman, Brian S. A2 - Berger, Jeffrey S. Y1 - 2016 N1 - T2 - Anesthesiology Core Review: Part Two Advanced Exam AB - The utilization of cardiopulmonary bypass (CPB) offers a dichotomy in the need for complete anticoagulation in preparation for and while on CPB and for hemostasis at the end of CPB. The surgical process itself stimulates the release of thrombogenic substances such as tissue factor. Furthermore, blood has a natural tendency to clot when it encounters foreign surfaces and in addition, the presence of a foreign substance incites an inflammatory response that further increases the propensity of the blood to clot. Because of this, the blood circulating through the cardiopulmonary bypass circuit is at high risk for clotting if special anticoagulation strategies are not employed. Such strategies include but are not limited to anticoagulation of the patient’s blood and the bypass circuit priming solution prior to placement of cannulas in the patient, as well as the use of heparin bonded bypass circuits. Patients are generally kept anticoagulated for the duration of the bypass period. At the completion of the bypass period, the heparin effect is reversed, usually with protamine. This is done to achieve hemostasis in an effort to stave off or limit postoperative bleeding. In this chapter, we will review anticoagulation in preparation for and during CPB and strategies to achieve hemostasis after the bypass period. SN - PB - McGraw-Hill Education CY - New York, NY Y2 - 2024/10/03 UR - accessanesthesiology.mhmedical.com/content.aspx?aid=1135739967 ER -