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• W2023943730 abstract "Acid-base and electrolyte changes are reported in 11 infants undergoing profound hypothermia for cardiac surgery by the technique of initial surface cooling followed by further bypass cooling and rewarming. Seven patients (group 1) underwent initial surface cooling to a mean oesophageal temperature of 26.6° C and four (group 2) to a mean oesophageal temperature of 32° C. During initial surface cooling, Pco2 was maintained close to 40 mm Hg by the addition of CO2 to the inspired gas mixture and there were no significant mean changes in pH or calculated base excess values in either group. The most significant electrolyte change was the decrease in plasma K+ in group 1. The possible relationship between the decrease in plasma K+ and the incidence of ventricular fibrillation was discussed. Although a slight but not statistically significant decrease in plasma total calcium was observed, the physiologically active ionic calcium level remained completely within the normal range. There were no changes in plasma Na+ or magnesium during surface cooling in either group. During bypass cooling any potential changes which might have resulted from the further drop in temperature were modified or overshadowed by the effects of the composition of the priming solution. Five per cent CO2 was found to be insufficient to maintain Pco2 levels during cooling bypass and at least 10 per cent CO2 is now recommended. Administration of NaHCO3 to correct the metabolic acidosis observed early during bypass rewarming resulted in post-operative metabolic alkalosis. Correction of the acidosis was found to occur spontaneously by the time of chest closure, hence treatment is usually unnecessary. Calcium ion activity is maintained during bypass and in the post-operative period by the addition of 2 ml of 10 per cent CaCl2 to each unit of heparinized blood used in the prime or as replacement during bypass. Plasma K+ concentrations were normal during bypass cooling and early rewarming but decreased to low normal values by the time of chest closure. They remained low in both groups during the first 24 post-operative hours, half the values being in the hypokalaemic range despite the administration of potassium (2 mEq/kg/24 h). The post-operative dosage of potassium in these infants should be increased to 3-4 mEq/kg/24 h for 1 or 2 days depending on adequacy of renal function and plasma potassium levels. The plasma magnesium concentrations were maintained in the normal range during bypass in both groups. Nevertheless, the patients in group 1 were hypomagnesaemic postoperatively. A magnesium supplement administered postoperatively to the patients of group 2 in a dose of 1 mEq/kg/24 h was sufficient to maintain plasma magnesium levels in the high normal range." @default.
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• W2023943730 date "1974-01-01" @default.
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• W2023943730 title "Acid-base and electrolyte changes in infants undergoing profound hypothermia for surgical correction of congenital heart defects" @default.
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• W2023943730 doi "https://doi.org/10.1007/bf03004577" @default.
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