RT Book, Section
A1 Choi, Hanwool Ryan
A1 Lewis, Choy
A2 Freeman, Brian S.
A2 Berger, Jeffrey S.
SR Print(0)
ID 1135739967
T1 Cardiopulmonary Bypass: Anticoagulation
T2 Anesthesiology Core Review: Part Two Advanced Exam
YR 2016
FD 2016
PB McGraw-Hill Education
PP New York, NY
SN 9781259641770
LK accessanesthesiology.mhmedical.com/content.aspx?aid=1135739967
RD 2024/04/19
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.