Anesthesiology and Intensive Care

Principles of Cardioplegic Solutions keywords:Cardioplegia, cardioplegic solution, myocardial protection, heart surgery, cardiac arrest, myocardial ischemia, reperfusion Energy conservation during myocardial ischemia can be achieved by inducing chemical arrest through two primary mechanisms: Preventing the conduction of the myocardial action potential by inhibiting the fast sodium current can be achieved through one or more of the following methods : a . Extracellular hyperkalemia  b . Sodium channel blockers (e.g., lidocaine)  c . KATP channel openers (e.g., adenosine) Preventing myocyte contraction by inhibiting calcium activation of myofilaments can be accomplished through one or more of the following approaches : a . Reducing extracellular calcium to zero  b . Using L-type calcium channel blockers (e.g., magnesium )  c . Directly inhibiting myofilaments with agents such as 2,3-butanedione monoxime (BDM) Cold Cardioplegia There are two types of solutions used...

Both β-adrenergic receptor blockers and calcium channel blockers, when used alongside other methods, have been incorporated into myocardial management strategies by various groups. Calcium channel blockers such as verapamil and diltiazem are particularly beneficial due to their ability to prevent calcium entry into cells and their coronary vasodilatory effects. However, these drugs are also strong negative inotropes and cause prolonged electromechanical inactivity, especially when used in cardioplegic solutions.

Moderately Hypothermic Intermittent Global Myocardial Ischemia Intermittent cardiac ischemia with moderate cardiac hypothermia requires performing cardiopulmonary bypass (CPB) with a perfusate temperature between 25°C and 30°C. During this method,

Continuous Normokalemic Coronary Perfusion: Empty Beating Heart Early intracardiac procedures were performed on normothermic, perfused, empty beating hearts. Experimental studies initially suggested that this method maintained "normal left ventricular function" for up to 3 hours of cardiopulmonary bypass (CPB) with the heart empty and