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Canadian Journal of Anesthesia, Vol 8, 468-476, Copyright © 1961 by Canadian Anesthesiologists' Society

The Prevention of Shock following Extracorporeal Circulation and Hypothermia

WALTER ZINGG M.D.1

1 Department of Surgery, University of Manitoba, Faculty of Medicine and Clinical Investigation Unit, Children's Hospital, Winnipeg, Manitoba.; Supported by a grant from the Manitoba Heart Foundation and by a General Public Health Grant (No. 606-9-132) of the National Health Grants Programme, to Dr. C. C. Ferguson

The current thinking regarding the management of patients on the heart-lung machine, with or without hypothermia, has been reviewed. The following points appear to be of importance for a smooth postoperative phase and the prevention of shock: adequate flow; slight hypervolemia during and after by-pass and hypothermia; minimal use of coronary sinus suction; possible temporary acidosis during hypothermia. Some of our theories are based On facts, others are based on fantasies and will have to be reviewed again. The rflain problem is to provide enough oxygen to the living cells and to remove CO2 Without upsetting the acidy base balance and other physiological'equilibria. The trouble is that we do not know what is physiological for a patient on total by-Jpass whose lungs are not perfused, whose major organs are at 25° C. and the rest of the body somewhere between 27° C. and 34° C.

Many problems have not been discussed, such as the value of the EEG, which usually shows severe changes at the beginning of partial by-pass. These problems are actively investigated in many centres and as time goes on we shall get a better understanding. I would like to close by quoting a remark which a member of the audience made to me some time ago following a similar presentation: "If you know so little about your subject it is surprising how much you can do."

Note:

Presented at the Sixteenth Annual Meeting, Canadian Anaesthetists Society Western Division, Winnipeg, Manitoba, March 8–11, 1961.






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Copyright © 1961 by the Canadian Anesthesiologists' Society.