Abstract
Identification of factors responsible for the development of reduced sensitivity to heparin have important implications for cardiac surgery with cardiopulmonary bypass, because inadequate anticoagulation during this procedure can have profound thrombotic and haemorrhagic consequences. Recently, it was noted [1,2] that preoperative platelet levels are higher in heparin-resistant patients than in those who are heparin sensitive. In the present study, a possible relationship between preoperative platelet levels and heparin response was investigated.
Highlights
Jugular bulb oxyhaemoglobin desaturation (SjO2 ≤ 50%) during the rewarming phase of cardiopulmonary bypass (CPB) is associated with postoperative cognitive deficits [1]
The incidence of desaturation during rewarming was significantly reduced by isoflurane. This suggests the balance between cerebral blood flow and Acknowledgement: Funded by Wellcome Trust grant 050190
Leucocyte depleting filters may be capable of selectively removing activated white cells [3], but this has not been proved in vivo
Summary
Jugular bulb oxyhaemoglobin desaturation (SjO2 ≤ 50%) during the rewarming phase of cardiopulmonary bypass (CPB) is associated with postoperative cognitive deficits [1]. Cardiopulmonary bypass (CPB) has been shown to induce a systemic inflammatory response similar to the local reaction seen after tissue damage [1] This leads to the release of toxic substances, such as elastase, which cause endothelial damage and may adversely affect outcome [2]. Identification of factors responsible for the development of reduced sensitivity to heparin have important implications for cardiac surgery with cardiopulmonary bypass, because inadequate anticoagulation during this procedure can have profound thrombotic and haemorrhagic consequences. It was noted [1,2] that preoperative platelet levels are higher in heparin-resistant patients than in those who are heparin sensitive. In the present study we investigated the efficacy of clomethiazole in improving neuropsychological outcome after coronary artery bypass surgery
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