Guest guest Posted August 14, 2006 Report Share Posted August 14, 2006 Dear All and , Well I made a Tutorial on this. I will post it here and in total on the overflow site at: 2 Try a folder on USP 797 where I will place some links to the FDA warning about the CAPS products that is causing so much alarm. But a simple answer to your question Karin is: a high potassium solution with some other electrolytes. Here is the tutorial I made just for YOU! Tutorial - Cardioplegia What is cardioplegia? Cardioplegia is the willful or intentional temporary cessation of cardiac activity, used mainly in cardiac bypass surgeries, and typically using drugs. The solution MUST be filtered and use a special delivery set. The solution is usually mixed with blood. Temperature and rate of reperfusion is critical. The end of surgery is a critical time: problems usually occur after cross clamp removal during the surgery (near the end of surgery). (putting things back the way they were). Types of Solution: The four types are: cold crystalloid cardioplegia, cold blood cardioplegia, hyperkalemic warm blood cardioplegia or simple oxygenated blood perfusion. The standard has been a Crystalloid Cardioplegia Delivery System would continually cool the solution during surgery. Warm Cardioplegia is becoming widely accepted with a better post bypass end-systolic pressure-volume relationship; which translates to: improved preservation of the left ventricular systolic function after the cardiac bypass surgery{ CABG surgery} which means it keeps the left lower part of the heart functional. The 37° C substrate-enriched warm cardioplegia consists of : glutamate (13 mM/L), aspartate (13 mM/L)], hyperkalemic (25 mEQ/L) anterograde and retrograde blood cardioplegic solution. Temperature and Delivery Systems: Photo of Temp Control device http://www.medtronic.com/cardsurgery/arrested_heart/biocal.html Photo of Cardioplegia delivery system/lines; http://www.blmarket.com/cardioplegia-delivery-system.html What is in this stuff? Cardioplegia usually contains magnesium and potassium which stop the heart beating and minimize the energy requirements of the heart during surgery. In addition it contains procaine which protects the heart muscle and helps stop the heart beating during the surgery. Procaine also helps prevent disturbances in heart rhythm straight after the surgery. Blood cardioplegia formula consists of KCl 20 mmol/L, MgCl2 16 mmol/L, CaCl2 1.2 mmol/L, Procaine 0.9 mmol/L, pH 6.9, osmoality 340 mOsm/L. Another formula: High potassium " Rivero " cardioplegia solution, 60meq/L concentration. Specific ingredients: 1. Potassium – main chemical that causes the cardioplegia and prevents repolarization or `Diastolic arrest " BELIEVE it or NOT! 2. Procaine Membrane stabilisation – antidysrhythmicm Na+ channel blocker [Class I] and as a vasodilator 3. Slow calcium channel blocker 4. Calcium to reverse excess Slow Ca++ blocker action. 5. Bicarbonate for buffering and blocking metabolic acidosis secondary which occurs due to anaerobic metabolism. Tham can also be used. 6. Mannitol to lessen the injury caused by cardiac reperfusion; also counteracts the edema which causes impairment due to hypothermia & ischemia. 7. Dextrose, electrolytes in specific amounts. 8. Adenosine and Propofol can help aid energy and be free radical scavengers Allergies to watch out for: If the pt has allergies to any anesthetic ( `caine' ending) OR to PABA a sunscreen agent aka: para-aminobenzoic acid. Anaphylactic shock or PCN like reactions occur. Disease State Contraindications are: 1. Myasthenia gravis (severe weakness of the muscles) 2. An electrical or heartbeat conduction impairment 3. Liver Disease 4. Kidney Disease 5. Abnormally high temps during anesthesia Drug Interactions include: 1. anticholinesterases drugs that block the enzyme that destroys cholinester. So in effect a drug that blocks the bodies normal or abnormal ability to destroy the PSNS response so that the PSNS response will continue. (example: pyridostigmine) 2. Sulfa antibiotics (examples are sulfonamides Septra, Bactrim, sulfamethoxazole) and possibly antifungals. Video of the Surgery and use of Cardioplegia: Cold Crystalloid Cardioplegia used in Open heart Surgery http://mmcts.ctsnetjournals.org/cgi/content/full/mmcts.2004.001040/DC1 Video 1 or 2 I could not get sound on it maybe you can. Other Images: http://www.visibleheart.com/objectives.html http://www.visibleheart.com/videoclips.html Addition of blood to cardioplegia solution: The heart muscle (myocardium) that is perfused with blood cardioplegic solution demonstrated a more rapid establishment of cardiac rhythm (about 60%) compared to the crystalloid solution (45%). This is why blood, particularly warm blood cardioplegia has gained ground. Filtering the blood in cardioplegia: Also the white blood cells or leukocytes can cause more myocardium damage than when the blood has been filtered so that it contains less or none. This is called " leukocyte filtered blood cardioplegia " (LCBC). Image of the Pall Filter we used on the job: http://www.pall.com/images/ds_pho_Cardioplegia_Plus.jpg http://www.pall.com/datasheet_medical_6426.asp Crystalloid + Chinese Herb works well: I did some digging and found that a Chinese herb had been added to the Crystalloid Cardioplegia and the study concluded that it may significantly reduce `myocardial metabolism and reduce postoperative myocardial enzymes and the damage of the myocardial ultrastructure (mitochondria) following ischemia and reperfusion is also lessened. " The name of the herb is: Puerarin. Timing : Intermittent profusion is better than antegrade. Complications of the surgery and cardioplegia are: 1. Heart block (due to too much K+) 2. Air emboli (air clot in line then in heart) 3. Want more technical: Here is a good link: http://www.uspharmacist.com/oldformat.asp?url=newlook/files/Feat/Cardioplegic.ht\ m & pub_id=8 & article_id=873 Or go to the overflow site to this site and the folder marked USP 797 Hope this helps you … and leads you all to appreicate USP 797. " We techs " in pharmacy back in l995, did NOT make the solution. But we did supply the OR with the ingredients. We had to pack the box with the vials and such the night before all surgeries. Then a pharmacist went to the surgery in the early AM and I never knew if he/she or he/she in conjunction with the surgeon or ??? made the cardioplegia. But sometimes our pharmacist made it on graveyard in our hoods at about 4 am. The tutorial has more sites for reference and also powerpoint slides I found. Enjoy! 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