Cardiopulmonary Bypass Prime Solution Additives.
- Use of an osmotic diuretic may be advisable. Mannitol (≈0.5 g · kg−1), a pure osmotic diuretic, can be included as part of the prime. Mannitol also has the advantage of being an effective agent against oxygen free radicals generated during CPB.
- Incorporating furosemide in the pump prime is practiced by many groups. It may be more advantageous to give it as a bolus in a dose of 1 to 2 mg · kg−1 at the start of rewarming, either after an interval of circulatory arrest or moderately or deeply hypothermic CPB.
- The short-acting adrenergic α-receptor blocking agent phentolamine is capable of antagonizing the vasoconstriction produced by catecholamines and has been shown to produce more uniform body cooling and rewarming and improved tissue perfusion when given during CPB.B52 A bolus of 0.2 mg· kg−1 is administered just after the start of CPB and the initiation of cooling.
- Methylprednisolone in a single dose of 30 mg · kg−1 or dexamethasone in a single doseof 1 mg · kg−1 given at the onset of CPB and not repeated may be advantageous. These agents do not appear to reduce complement activation, but there is evidence to support the hypothesis that they attenuate complement-mediated leukocyte activation, particularly that associated with reperfusion of the heart and lungs in the latter part of CPB.
- The powerful antifibrinolytic agent aprotinin is a biological product that acts as a serine proteinase inhibitor. It may have a favorable effect on some platelet membranespecific receptors, specifically GPIb. Aprotinin has been shown in several randomized studies to reduce bleeding after CPB by about 50%.
- ε-Aminocaproic acid (EACA) and tranexamic acid are two other antifibrinolytic agents that can be administered before, during, and after CPB to reduce bleeding and the need for allogeneic blood transfusions. EACA is administered using an empirical dose of 10 g before the skin incision, 10 g during the procedure, and 10 g early postoperatively. Tranexamic acid is given at a dose of 1 g before the skin incision, 500 mg in the pump prime, and 400 mg · h−1 during the procedure
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