Off pump vs. on pump?

Started by GoodmanBrown
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GoodmanBrown

GoodmanBrown

is walking down the path.
10+ Year Member
Just curious how anesthesia responsibilities change with on-pump cardiac bypass (or any other cardiac surgery). With off pump, the MD focused his energy on making sure the heart kept beating properly even while being manipulated by the surgeon, watched the pulse ox, and kept BP steady. On pump, how the the anesth. make sure the patient is still doing okay? Do you adjust the blood flow speed or anything like that? How is BP regulated when the heart's not pushing anything? Are you watching all the canulas or is the surgeon making sure they're all in place? Just curious. Thanks!
 
GoodmanBrown said:
Just curious how anesthesia responsibilities change with on-pump cardiac bypass (or any other cardiac surgery). With off pump, the MD focused his energy on making sure the heart kept beating properly even while being manipulated by the surgeon, watched the pulse ox, and kept BP steady. On pump, how the the anesth. make sure the patient is still doing okay? Do you adjust the blood flow speed or anything like that? How is BP regulated when the heart's not pushing anything? Are you watching all the canulas or is the surgeon making sure they're all in place? Just curious. Thanks!
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On pump the perfusionist (the pump operator for lack of a better term) is doing all the driving. He/she is maintaining oxygenation, blood flow, blood pressure, heart inactivity, as well as the anesthesia -- he has a vaporizer which inserts anesthesia med directly into the blood flow going back to the body. I'm taking a few moments to relax, then get ready to come off pump in an organized manner (paperwork all caught up, fresh/full IV bags hanging on all lines, coming-off-pump meds and drips ready and given at the proper time, constantly listening to the talk between surgeon and perfusionist to clue me in). Generally the only thing I directly do for the surgeon while on-pump is adjust the level of the operating table if asked.

Off pump bypasses have me working like a dog, sweating bullets because the room is kept very warm. I'm watching the arterial line reading (constant real-time BP measurement) to warn the surgeon if it drops too low as he "mugs" the heart (turns it sideways to access a particular spot). I've got two IV flow controllers in my hands: a vasodilator in one hand, and a vasoconstrictor in the other. Lots o' fun.
 
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