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Biomedical subjects

J N Cunningham

Publications and source records attributed to J N Cunningham.

169 records · Page 10Linked to original sources
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Variations in total and ionized calcium during cardiac surgery.

Twenty patients undergoing cardiac surgery were studied to examine variations in total and ionized serum calcium and urine calcium during cardiopulmonary bypass. Serial samples of blood and urine were analyzed during bypass using a highly specific calcium electrode to determine the effects of hemodilution, various pharmacologic agents, and transfusions of citrated blood. Calcium chloride was routinely added to the crystalloid pump prime (400 mgs/L) and also administered when additional blood or crystalloid were infused. An average of 4.8 +/- .50 grams of calcium chloride was given per procedure. After induction of general anesthesia with nitrous oxide and Halothane, total serum calcium decreased from 10.0 +/- 0.3 to 8.5 +/- 0.8 mg% (p less than 0.05). Following heparinization, ionized calcium decreased from 4.2 +/- .08 to 3.9 +/- 12 mg% (p less than 0.05). Ionized calcium was not affected by reversal of heparin with Protamine. Following institution of cardiopulmonary bypass the ratio of ionized to total calcium declined about 13.4% (0.49 vs. 0.43). This ratio did not change during bypass but returned to normal immediately post-perfusion. Urinary calcium excretion averaged 1.9 +/- 0.6 mg/min and could not be implicated as a cause of hypocalcemia during bypass. Post-perfusion, ionized serum calcium rose 1.3 +/- .01 mg% for each gram of exogenously administered calcium chloride (p less than 0.05). From these observations, we conclude: (1) ionized and total serum calcium levels decreased significantly following institution of cardiopulmonary bypass alone, presumably as a result of hemodilution from the crystalloid pump prime and addition of citrated blood products; (2) induction of general anesthesia alone with nitrous oxide and Halothane is associated with a significant decrease in total serum calcium; (3) ionized calcium declined following heparinization but is unchanged by Protamine administration; (4) changes in total and ionized serum calcium are unaffected by urinary excretion during bypass; (5) exogenously administered calcium chloride significantly increases serum ionized calcium and these changes are inversely related to the circulating pool of calcium; (6) current protocols for administration of exogenous calcium chloride during bypass may result in insufficient levels of ionized calcium and we have adopted measures to correct these deficiencies, when indicated.

Calcium↗
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A simplified method for delivery of cold blood cardioplegia and aortic root venting during coronary artery bypass.

We present a simplified method for delivery of cold blood cardioplegia and left ventricular decompression during coronary artery bypass surgery when aortic occlusion is utilized. The system provides immediate delivery of the cardioplegic solution followed by continuous sump suction on the aortic root to decompress the left ventricle and to aspirate non-coronary collateral flow. This system has been utilized in over 200 consecutive cases of coronary revascularization without complication and is a safe, effective and inexpensive method of both delivery of the cardioplegic agent and maintenance of a dry quiet operative field.

Aorta↗
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An on-line system for delivery of blood cardioplegia.

A simplified system for delivery of cold blood potassium cardioplegia was tested in 12 experimental animals subjected to 180 minutes of aortic cross-clamping. This on-line system utilized blood drawn from the pump oxygenator which was volumetrically combined with a pre-mixed electrolyte solution (9 parts blood: 1 part drug). A separate heat exchanger was employed to deliver the cardioplegic infusate at 10-15 degrees C. Use of this system permits accurate regulation of infusate potassium concentration, pH, injection pressure and flow rate. Less than one minute is required to obtain an unlimited quantity of arrest solution at steady state values for these parameters. The efficacy of this method of delivery of blood cardioplegia was verified by biochemical and functional studies which revealed no significant changes in myocardial ATP, ultrastructure, compliance, or ventricular function after 3 hours of crossclamping. It is concluded that this system offers a safe and more simplified method of delivering blood cardioplegia than heretofore available.

Animals↗
PubMedDate not supplied

Release of particulate matter from extracorporeal tubing: ineffectiveness of standard arterial line filters during bypass.

Microemboli resulting from extracorporeal circulation have been considered to be a cause of organ dysfunction after cardiopulmonary bypass. A scanning electron microscopic study was carried out to quantitate the number of nonbiological particles which escape capture by the arterial line filter in a standard extracorporeal circulation circuit. Five different lots of polyvinylchloride (PVC) tubing from the same manufacturer were used in closed circuit extracorporeal pump set-ups consisting of a typical length of PVC tubing, a cardiotomy reservoir, and an arterial line filter (Pall 40 microns (mu)). A liter of Plasmalyte was circulated through this set-up for 15 minutes at 2 liters/minute with the pump head set at almost total occlusion. The circulated Plasmalyte from each pump line was then collected and passed through a 0.22 mu Millipore filter. Numerous particles ranging from 5-40 mu in diameter were observed on the surface of the filters. A mean of 51.2 particles/mm2 of filter was found after the first recirculation period. By extrapolation the mean total number of particles contained in the Plasmalyte was calculated to be 70,943. A second similar 15 minute rinse on the same pump set-ups revealed the release of a mean of 51.0 particles/mm2, or a mean total number of 70,665 particles. Analysis of variance showed no significant difference in the number of particles produced by the first compared with the second recirculation period but there were significant differences (P less than .05) between the numbers of particles produced by the different lots of tubing. This study demonstrates that commonly employed tubing packs and standard roller pump designs for extracorporeal circulation are associated with continuous release of particulate matter (5-40 mu) which is not removed by the arterial line filters most often employed. These particles seem to be released at a constant rate which makes an initial pre-bypass filtration run ineffective. Such particles can only be removed by continuous use of lower porosity filters in the pump circuit. The clinical significance of these large numbers of small particles is unknown, but they may contribute to the multi-organ failure often seen in prolonged (greater than 2 hour) periods of cardiopulmonary bypass.

Equipment Failure↗