query: where are the cannula most commonly placed for cardiopulmonary bypass procedures

pos: Cardiopulmonary bypass femoral vein to withdraw blood from the body. The cannula is connected to tubing filled with isotonic crystalloid solution. Venous blood which is removed from the body by the cannula is filtered, cooled or warmed, oxygenated, and then returned to the body. The cannula used to return oxygenated blood is usually inserted in the ascending aorta, but it may be inserted in the femoral artery. The patient is administered heparin to prevent clotting, and protamine sulfate is given after to reverse effects of heparin. During the procedure, hypothermia may be maintained; body temperature is usually kept at 28 °C to

pos: Extracorporeal membrane oxygenation the iliac artery. In adults, accessing the femoral artery is preferred because the insertion is simpler. Central VA ECMO may be used if cardiopulmonary bypass has already been established or emergency re-sternotomy has been performed (with cannulae in the right atrium(or SVC/IVC for tricuspid repair) and ascending aorta). VA ECMO is typically reserved when native cardiac function is minimal to mitigate increased cardiac stroke work associated with pumping against retrograde flow delivered by the aortic cannula. In veno-venous (VV) ECMO, cannulae are usually placed in the right common femoral vein for drainage and right internal jugular vein for infusion. Alternatively,

pos: Cardiopulmonary bypass femoral vein to withdraw blood from the body. The cannula is connected to tubing filled with isotonic crystalloid solution. Venous blood which is removed from the body by the cannula is filtered, cooled or warmed, oxygenated, and then returned to the body. The cannula used to return oxygenated blood is usually inserted in the ascending aorta, but it may be inserted in the femoral artery. The patient is administered heparin to prevent clotting, and protamine sulfate is given after to reverse effects of heparin. During the procedure, hypothermia may be maintained; body temperature is usually kept at 28 °C to

pos: Arterial switch operation The cardiopulmonary bypass is then initiated by inserting a cannula into the ascending aorta as distally from the aortic root as possible while still supplying all arterial branches, another cannula is inserted into the right atrium, and a vent is created for the left ventricle via catheterization of the right superior pulmonary vein. The HLM is started at a low-flow and the patient's body is cooled to a rectal temperature of 20 °C (68 °F), which prevents the brain damage otherwise associated with the temporary circulatory arrest necessary during the procedure; the patient must be cooled for a minimum of

pos: Cardioplegia for accomplishing asystole is infusing cold cardioplegic solution into the coronary circulation. This process protects the myocardium, or heart muscle, from damage during the period of ischemia. To achieve this, the patient is first placed on cardiopulmonary bypass. This device, otherwise known as the heart-lung machine, takes over the functions of gas exchange by the lung and blood circulation by the heart. Subsequently, the heart is isolated from the rest of the blood circulation by means of an occlusive cross-clamp placed on the ascending aorta proximal to the innominate artery. During this period of heart isolation, the heart is not

neg: Cardiopulmonary bypass oxygenator which is believed to produce less systemic inflammation and decrease the propensity for blood to clot in the CPB circuit. Multiple cannulae are sewn into the patient's body in a variety of locations, depending on the type of surgery. A venous cannula removes oxygen depleted venous blood from a patient's body. An arterial cannula infuses oxygen-rich blood into the arterial system. A cardioplegia cannula delivers a cardioplegia solution to cause the heart to stop beating. Some commonly used cannulation sites: A CPB circuit consists of a systemic circuit for oxygenating blood and reinfusing blood into a patient's body (bypassing

neg: Cannula (extubation), especially of a tracheostomy cannula, once a physician determines it is no longer needed for breathing. Cannulae normally come with a trocar inside. The trocar is a needle, which punctures the body in order to get into the intended space. Many types of cannulae exist: Intravenous cannulae are the most common in hospital use. A variety of cannulae are used to establish cardiopulmonary bypass in cardiac surgery. A nasal cannula is a piece of plastic tubing that runs under the nose and is used to administer oxygen. A venous cannula is inserted into a vein, primarily for the administration

neg: Cardiothoracic anesthesiology sternotomy, a surgical retractor is placed by the surgeon to optimize exposure of the heart. At this time, heparin is given to thin the blood to prevent thrombus from forming while on CPB. The surgeon places a cannula in the right atrium, vena cava, or femoral vein to withdraw blood from the venous circulation. The perfusionist uses gravity to drain the venous blood into the CPB machine, and a separate cannula, usually placed in the aorta or femoral artery, is used to return blood to the arterial circulation. The process of preparation, initiation, and separation of cardiopulmonary bypass is a

neg: Minimaze procedure microwave energy was used to make the lesions that had previously been performed by the surgeon's scalpel. Shortly thereafter, Randall K. Wolf, MD and others developed a procedure using radiofrequency energy rather than microwave, and different, slightly larger incisions. In 2005, he published his results in the first 27 patients. This came to be known as the Wolf minimaze procedure. Today, the terms “minimaze”, "mini-maze", and "mini maze" are still sometimes used to describe open heart procedures requiring cardiopulmonary bypass and median sternotomy, but more commonly they refer to minimally invasive, epicardial procedures not requiring cardiopulmonary bypass, such as those

neg: Thromboelastography by the TEG-ACT value which is measured in seconds rather than in minutes. The remainder of the TEG parameters do not differ between a standard and RapidTEG. A heparinase TEG is used to assess for heparin-associated anticoagulation as the cause of hemorrhage. It is used most commonly following cardiopulmonary bypass procedures where heparin is reversed using protamine intraoperatively. In instances where a patient develops bleeding due to recurrent coagulopathy (usually shortly after arrival to the ICU), the heparinase TEG can help quickly discern patients who can be treated with additional dosing of protamine versus those who need to be taken

neg: Cardiopulmonary bypass Cardiopulmonary bypass Cardiopulmonary bypass (CPB) is a technique that temporarily takes over the function of the heart and lungs during surgery, maintaining the circulation of blood and the oxygen content of the patient's body. The CPB pump itself is often referred to as a heart–lung machine or "the pump". Cardiopulmonary bypass pumps are operated by perfusionists. CPB is a form of extracorporeal circulation. Extracorporeal membrane oxygenation is generally used for longer-term treatment. Cardiopulmonary bypass is commonly used in coronary bypass heart surgery because of the difficulty of operating on the beating heart. Operations requiring the opening of the chambers of

neg: Cardiac surgery surgeon also may open the heart. Dr. Wilfred G. Bigelow of the University of Toronto found that procedures involving opening the patient's heart could be performed better in a bloodless and motionless environment. Therefore, during such surgery, the heart is temporarily stopped, and the patient is placed on cardiopulmonary bypass, meaning a machine pumps their blood and oxygen. Because the machine cannot function the same way as the heart, surgeons try to minimize the time a patient spends on it. Cardiopulmonary bypass was developed after surgeons realized the limitations of hypothermia in cardiac surgery: Complex intracardiac repairs take time, and

neg: Cardiothoracic anesthesiology Cardiothoracic anesthesiology Cardiothoracic anesthesiology is a subspeciality of the medical practice of anesthesiology devoted to the preoperative, intraoperative, and postoperative care of adult and pediatric patients undergoing cardiothoracic surgery and related invasive procedures. It deals with the anesthesia aspects of care related to surgical cases such as open heart surgery, lung surgery, and other operations of the human chest. These aspects include perioperative care with expert manipulation of patient cardiopulmonary physiology through precise and advanced application of pharmacology, resuscitative techniques, critical care medicine, and invasive procedures. This also includes management of the cardiopulmonary bypass (heart-lung) machine, which most cardiac procedures

neg: Cardiopulmonary bypass the heart); and a separate circuit for infusing a solution into the heart itself to produce cardioplegia (i.e. to stop the heart from beating), therefore providing myocardial protection (i.e. to prevent the death of heart tissue). A CPB circuit must be primed with fluid and all air expunged from the arterial line/cannula before connection to the patient. The circuit is primed with a crystalloid solution and sometimes blood products are also added. The patient must be fully anticoagulated with an anticoagulant such as heparin to prevent massive clotting of blood in the circuit. CPB is not benign and there are

neg: Acute kidney injury valve and bypass procedures, emergency surgery, and preoperative intraaortic balloon pump are risk factors most strongly correlated with post-cardiopulmonary bypass acute kidney injury. Other well-known minor risk factors include: female gender, congestive heart failure, chronic obstructive pulmonary disease, insulin-requiring diabetes, and depressed left ventricular ejection fraction. "Prerenal" causes of AKI ("pre-renal azotemia") are those that decrease effective blood flow to the kidney and cause a decrease in the glomerular filtration rate (GFR). Both kidneys need to be affected as one kidney is still more than adequate for normal kidney function. Notable causes of prerenal AKI include low blood volume (e.g.,

neg: Perfusionist Perfusionist A perfusionist, also known as a Clinical Perfusionist, Cardiovascular Perfusionist, Clinical Perfusion Scientist, or Medical Perfusionist, is a healthcare professional who uses the cardiopulmonary bypass machine (heart–lung machine) during cardiac surgery and other surgeries that require cardiopulmonary bypass to manage the patient's physiological status. Perfusionists form part of the wider cardiothoracic surgical team which includes cardiac surgeons, anesthesiologists and physician assistants. The perfusionist shares responsibility with the cardiac surgeon and anesthesiologist for the management of the physiological and metabolic needs of the cardiac surgical patient, so that the surgeon may operate on a still,or unbeating heart during certain procedures.

neg: Hemiazygos vein directly into the right atrium (3, 10). An incidental finding of this condition during venous cannulation for cardiopulmonary bypass complicates the procedure, since no solid IVC trunk for placing the cannula is present. Separate cannulation of the SVC and the right atrium should be used in this case. The name for this vein is derived from that of the azygos vein. "Azygos" means 'unpaired', and "hemi" means half. This vein mirrors the bottom half of the azygos vein. Hemiazygos vein The hemiazygos vein (vena azygos minor inferior) is a vein running superiorly in the lower thoracic region, just to the

neg: Management of atrial fibrillation not require a median sternotomy (vertical incision in the breastbone) or cardiopulmonary bypass (heart-lung machine). They use laser, cryothermy, radiofrequency, or acoustic energy to ablate atrial tissue near the pulmonary veins and make other required ablations to mimic the maze. Minimally invasive surgical (endoscopic) maze procedures are now routinely conducted at hospitals around the US. This approach was developed in the early 2000s. The Ex-Maze is a minimally invasive procedure, first reported in 2007, that also creates a lesion pattern across both atria epicardially on the beating heart. As with other procedures off-bypass, the surgeon can confirm that AF corrects

neg: Cardiopulmonary bypass death may follow shortly afterward. Similarly, CPB can be used to rewarm individuals suffering from hypothermia. Extracorporeal membrane oxygenation (ECMO) is a form of CPB sometimes used as life-support for newborns with serious birth defects, or to oxygenate and maintain recipients for organ transplantation until new organs can be found. CPB mechanically circulates and oxygenates blood for the body while bypassing the heart and lungs. It uses a heart–lung machine to maintain perfusion to other body organs and tissues while the surgeon works in a bloodless surgical field. The surgeon places a cannula in the right atrium, vena cava, or

neg: Redmond Burke interventions in the operating room. Many of these procedures utilized the video assisted thoracoscopic techniques Burke developed in Boston. Burke and associate surgeon Robert Hannan worked with their Director of Perfusion, Jorge W. Ojito, to develop a less traumatic cardiopulmonary bypass technique. They also designed a miniaturized Cardiopulmonary Support circuit, allowing critically ill patients to be transported by plane, helicopter or ambulance over great distances on full heart lung bypass. In 2007, Burke and Zahn, at Miami Children's partnered with cardiac teams in Boston and New York in the first US trial of the Medtronic Melody Transcatheter Pulmonary Valve, which

neg: Cardiac surgery an intensive care unit, where heart rate, blood pressure, and oxygen levels are closely monitored. Chest tubes are inserted to drain blood around the heart and lungs. After discharge from the hospital, compression socks may be recommended in order to regulate blood flow. The advancement of cardiac surgery and cardiopulmonary bypass techniques has greatly reduced the mortality rates of these procedures. For instance, repairs of congenital heart defects are currently estimated to have 4–6% mortality rates. A major concern with cardiac surgery is neurological damage. Stroke occurs in 2–3% of all people undergoing cardiac surgery, and the rate is higher

neg: Cardiology cardiothoracic surgery. For example, coronary artery bypass surgery (CABG), cardiopulmonary bypass and valve replacement are surgical procedures performed by surgeons, not cardiologists. However the insertion of stents and pacemakers are performed by cardiologists Cardiology is a specialty of internal medicine. To be a cardiologist in the United States, a three-year residency in internal medicine is followed by a three-year fellowship in cardiology. It is possible to specialize further in a sub-specialty. Recognized sub-specialties in the United States by the ACGME are cardiac electrophysiology, echocardiography, interventional cardiology, and nuclear cardiology. Recognized subspecialties in the United States by the American Osteopathic Association

neg: Perfusionist (i. e. AIIMS Delhi, SMSMC Jaipur) Recently the Board of Cardiovascular Perfusion of India introduced certification. Perfusionists can be involved in a number of cardiac surgical procedures, select vascular procedures and a few other surgical procedures in an ancillary role. In the realm of cardiac surgery, perfusionists perform cardiopulmonary bypass in adult and pediatric surgical procedures, which constitute the majority of procedures that perfusionists perform. Perfusionists may participate in curative or staged palliative procedures to treat the following pediatric pathologies: Adult surgical procedures may include: Select ancillary procedures in which perfusion techniques and/or perfusionists may be involved include isolated limb

neg: Karman cannula of incomplete abortion, and in endometrial biopsy. In 2010, a Sri Lankan physician named Geeth Silva was the first physician to use the Karman cannula in the removal of impacted faeces from a patient, this was done in Columbo at the Sri Jayawardenepura General Hospital. Physicians and other health care providers sometimes use a Karman cannula in "menstrual regulation" vacuum aspiration procedures in developing countries where abortion is illegal (e.g. Bangladesh). Karman cannula The Karman cannula is a soft, flexible cannula (or curette) popularized by Harvey Karman in the early 1970s. The flexibility of the Karman cannula was claimed to

neg: Plateletpheresis given recombinant human factor VIIa since the underlying cause are antibodies to platelet glycoproteins IIb/IIIa. Cardiopulmonary bypass surgery can result in destruction of a large proportion of the patient's platelets and may render the remaining viable platelets to be dysfunctional. The indications for transfusion in such patients is controversial. General guidelines recommend not transfusing patients prophylactically but only when they are bleeding excessively, while also giving desmopressin. The most common of these is aspirin, and its similar drug class, the NSAIDs. Other antiplatelet drugs are commonly prescribed for patients with acute coronary syndromes such as clopidogrel and ticlopidine. When surgery

neg: Oxygenator Carmeda Bioactive Surface and Duraflo II coatings. The researchers concluded that: Statistics and conclusions from more studies are available here. Clearly, heparin-coated blood oxygenators exhibit some advantages over non-coated oxygenators. Some hospitals use heparin-coated oxygenators for the large majority of their cases requiring cardiopulmonary bypass. It is unclear whether most surgeons actually reduce the amount of systemic heparin used when their patients are being perfused with heparin-coated oxygenators. Ultimately, each surgeon makes this decision based upon the needs of individual patient. Although they offer advantages, these oxygenators are not widely regarded by surgeons as revolutionary breakthroughs in cardiopulmonary bypass. This

neg: Management of atrial fibrillation procedure required an extensive series of endocardial (from the inside of the heart) incisions through both atria, a median sternotomy (vertical incision through the breastbone) and cardiopulmonary bypass (heart-lung machine). A series of improvements were made, culminating in 1992 in the Cox maze III procedure, which is now considered to be the "gold standard" for effective surgical cure of AF. The Cox maze III is sometimes referred to as the "traditional maze", the "cut and sew maze", or simply the "maze". Minimaze procedures are minimally invasive versions of the original Cox maze procedure but without cardiac incisions. These procedures do

neg: Renal angina the developed world occurs most commonly as a secondary injury to numerous disease processes. Sepsis and cardiopulmonary bypass (CPB) are the most oft recognized and reported “causative” injuries leading to AKI. The pathophysiology of AKI can be broadly categorized into four main categories: ischemic injury – manifest by low glomerular blood flow or perfusion pressure to the renal capillary system, hypoxic injury to the renal interstitium, inflammation of the renal tubules, or necrosis and apoptosis of the renal parenchyma. There is increasing recognition that people are not just dying "with" AKI, but "from" AKI. The epidemiology of AKI has changed

neg: Oxygenator units by nurses. For most cardiac operations such as coronary artery bypass grafting, the cardiopulmonary bypass is performed using a heart-lung machine (or cardiopulmonary bypass machine). The heart-lung machine serves to replace the work of the heart during the open bypass surgery. The machine replaces both the heart's pumping action and the lungs' gas exchange function. Since the heart is stopped during the operation, this permits the surgeon to operate on a bloodless, stationary heart. One component of the heart-lung machine is the oxygenator. The oxygenator component serves as the lung, and is designed to expose the blood to oxygen

neg: Cannula are: A nasal cannula or an oral–nasal cannula consists of a flexible tube, usually with multiple short, open-ended branches for comfortable insertion into the nostrils and/or mouth, and may be used for the delivery of a gas (such as pure oxygen), a gas mixture (as, for example, during anesthesia), or to measure airflow into and out of the nose and/or mouth. The removal of a tracheotomy tube is referred to as decannulation. A cannula is used in an emergency procedure to relieve pressure and bloating in cattle and sheep with ruminal tympany, due most commonly to their accidentally grazing wilted

neg: Median sternotomy a cardiopulmonary bypass, also known as a heart-lung machine. Should this procedure be performed upon an individual more than once, each subsequent sternotomy may be referred to as a "resternotomy". <BR> Median sternotomy Median sternotomy is a type of surgical procedure in which a vertical inline incision is made along the sternum, after which the sternum itself is divided, or "cracked". This procedure provides access to the heart and lungs for surgical procedures such as heart transplant, corrective surgery for congenital heart defects, or coronary artery bypass surgery. Median sternotomy is often mistakenly referred to as open heart surgery, in

neg: Impella output and forward flow from the left ventricle has secondary benefits related to right ventricular function. Impella support decreases pulmonary capillary wedge pressure and reduces right ventricular afterload. In June 2008, the Impella 2.5 heart pump received FDA 510(k) clearance for partial circulatory support for periods of up to 6 hours during cardiac procedures not requiring cardiopulmonary bypass. In March 2015, the Impella 2.5 heart pump received FDA Premarket Approval (PMA) for elective and urgent high-risk PCI procedures, and in December 2016, the FDA PMA was expanded to include the Impella CP heart pump. In April 2009, the Impella 5.0

neg: Laparoscopy or 10 mm cannula or trocar. The abdomen is usually insufflated with carbon dioxide gas. This elevates the abdominal wall above the internal organs to create a working and viewing space. CO is used because it is common to the human body and can be absorbed by tissue and removed by the respiratory system. It is also non-flammable, which is important because electrosurgical devices are commonly used in laparoscopic procedures. Laparoscopic cholecystectomy is the most common laparoscopic procedure performed. In this procedure, 5–10 mm diameter instruments (graspers, scissors, clip applier) can be introduced by the surgeon into the abdomen through

neg: Off-pump coronary artery bypass Off-pump coronary artery bypass Off-pump coronary artery bypass or "beating heart" surgery is a form of coronary artery bypass graft (CABG) surgery performed without cardiopulmonary bypass (heart-lung machine) as a treatment for coronary heart disease. It was primarily developed in the early 1990s by Dr. Amano Atsushi. During most bypass surgeries, the heart is stopped and a heart-lung machine takes over the work of the heart and lungs. When a cardiac surgeon chooses to perform the CABG procedure off-pump, also known as OPCAB (Off-pump Coronary Artery Bypass), the heart is still beating while the graft attachments are made to bypass

neg: Persistent truncus arteriosus will be placed on cardiopulmonary bypass to allow the surgeon to work on a still heart. The heart is opened and the ventricular septal defect is closed with a patch. The pulmonary arteries are then detached from the common artery (truncus arteriosus) and connected to the right ventricle using a tube (a conduit or tunnel). The common artery, now separated from the pulmonary circulation, functions as the aorta with the truncal valve operating as the aortic valve. Most babies survive this surgical repair, but may require further surgery as they grow up. For example, the conduit does not grow with

neg: Extracorporeal cardiopulmonary resuscitation the cardiac catheterisation laboratory for coronary angiogram or to radiology for thrombectomy. In an effort to avoid limb ischaemia, in some centres a third cannula is inserted. This third cannula, is extended distally into the femoral artery to ensure perfusion of the lower limb. It has been well established that maintenance of therapeutic hypothermia is arrest scenarios is beneficial. In view of this, a target temperature of 33° is maintained for the first 24 hours following commencement of ECMO, with gradual rewarming occurring thereafter. The current trend of increasing use of ECPR is very promising. However the pool of available

neg: Blood pump 1934, and application of this pump in one of the first heart-lung machines constructed by Gibbon, DeBakey's name became inseparably attached to this type of pump. For perfusion experiments, an electrically powered roller pump was first used by Fleisch in 1935. Today, the roller pump is the most frequently used blood pump for cardiopulmonary bypass worldwide, having prevailed against the early pulsatile tube compression pumps and ventricular pumps. In recent years, centrifugal pumps have increasingly competed with roller pumps as systemic blood pumps for cardiopulmonary bypass and have become the preferred arterial pump in a variety of centers. Application of

neg: Extracorporeal cardiopulmonary resuscitation patient is intubated for ventilatory support, whilst they continue to be managed. On confirming the appropriateness of the patient as a candidate for ECPR and once the complete ECPR has been assembled the process of cannulation begins. With a brief pause in chest compressions, a Modified Seldinger technique is used to access both the femoral artery and femoral vein with the assistance of ultrasound. In the CHEER trial 15Fr arterial cannulae and 17Fr venous cannulae (Medtronic, Minneapolis, MN USA) were used. The Arterial cannula is advanced to the descending aorta, whilst the venous cannula is extended to the inferior vena

neg: Acute kidney injury AKI can be caused by systemic disease (such as a manifestation of an autoimmune disease, e.g. lupus nephritis), crush injury, contrast agents, some antibiotics, and more. AKI often occurs due to multiple processes. The most common cause is dehydration and sepsis combined with nephrotoxic drugs, especially following surgery or contrast agents. The causes of acute kidney injury are commonly categorized into "prerenal", "intrinsic", and "postrenal". Acute kidney injury occurs in up to 30% of patients following cardiac surgery. Mortality increases by 60-80% in post-cardiopulmonary bypass patients who go on to require renal replacement therapy. Preoperative creatinine greater than 1.2mg/dL, combined

neg: Cardiopulmonary bypass a heart transplant. CPB may contribute to immediate cognitive decline. The heart-lung blood circulation system and the connection surgery itself release a variety of debris into the bloodstream, including bits of blood cells, tubing, and plaque. For example, when surgeons clamp and connect the aorta to tubing, resulting emboli may block blood flow and cause mini strokes. Other heart surgery factors related to mental damage may be events of hypoxia, high or low body temperature, abnormal blood pressure, irregular heart rhythms, and fever after surgery. Cardiopulmonary bypass Cardiopulmonary bypass (CPB) is a technique that temporarily takes over the function of

neg: Minimally invasive cardiac surgery solution. Off-pump is also known as beating heart surgery. Minimally invasive heart surgery has been used as an alternative to traditional surgery for the following procedures: A cannula with a pump and vacuum action is fed up through an artery in the groin to reduce the stress on the heart so that it may still function during the operation. This pump flows at 2-3L per minute to support circulation and eliminates the need for cardioplegia to arrest the heart. Hybrid coronary revascularization is a common procedure that takes advantage of coronary stenting in combination with CABG. Hybrid coronary bypass is

neg: Peristaltic pump in the United States by Rufus Porter and J.D. Bradley in 1855 (U.S. Patent number 12753) as a well pump, and later by Eugene Allen in 1881 (U.S. Patent number 249285) for blood transfusions. It was developed by heart surgeon Dr. Michael DeBakey for blood transfusions while he was a medical student in 1932 and later used by him for cardiopulmonary bypass systems. A specialized nonocclusive roller pump (US Patent 5222880) using soft flat tubing was developed in 1992 for cardiopulmonary bypass systems. Peristaltic pumps are typically used to pump clean/sterile or aggressive fluids without exposing those fluids to contamination

neg: Transplant surgeon especially recently, with better technology and better knowledge and protocols, be made, per the discretion of the organ network, the institutions, and the patient's doctor and surgical team. Because these patients are often somewhat unstable, on some form of life support and/or life-sustaining technologies (cardiopulmonary bypass, respirator/ventilator or breathing tube, implantable cardioverter/defibrillator, some form of dialysis or other renal replacement therapy, artificial liver, parenteral nutrition, etc.), these procedures- especially if they involve the vital organs (heart, lung, liver, pancreas; kidney transplantation could be included here but is more common)- usually only take place in Level I trauma centers that usually

neg: Cardiothoracic surgery and Lillehei as noted above. The development of cardiac surgery and cardiopulmonary bypass techniques has reduced the mortality rates of these surgeries to relatively low ranks. For instance, repairs of congenital heart defects are currently estimated to have 4–6% mortality rates. A major concern with cardiac surgery is the incidence of neurological damage. Stroke occurs in 5% of all people undergoing cardiac surgery, and is higher in patients at risk for stroke. A more subtle constellation of neurocognitive deficits attributed to cardiopulmonary bypass is known as postperfusion syndrome, sometimes called "pumphead". The symptoms of postperfusion syndrome were initially felt to

neg: Cardiothoracic anesthesiology research project. The arenas of research can be as diverse as neuroprotection, myocardial protection, blood conservation strategies, and port access surgery. Fellows are trained to provide perioperative anesthetic management for patients with severe cardiopulmonary pathology. Some of the cardiac surgeries they train for include the following: coronary artery bypass surgery (CABG) both on cardiopulmonary bypass as well as on a beating heart, heart valve surgery, aortic reconstruction requiring deep hypothermic arrest, mechanical ventricular assist device (VAD) placement, thoracic aortic aneurysm repair, aortic dissection repair, heart transplants, lung transplants, heart/lung transplants, and adult congenital heart surgery. Adequate exposure and experience provided

neg: Coronary artery bypass surgery two alternative techniques are also available, allowing CABG to be performed on a beating heart either without using the cardiopulmonary bypass, a procedure referred to as "off-pump" surgery, or performing beating surgery using partial assistance of the cardiopulmonary bypass, a procedure referred to as "on-pump beating" surgery. The latter procedure offers the advantages of the on-pump stopped and off-pump while minimizing their respective side-effects. CABG is often indicated when coronary arteries have a 50 to 99 percent obstruction. The obstruction being bypassed is typically due to arteriosclerosis, atherosclerosis, or both. Arteriosclerosis is characterized by thickening, loss of elasticity, and calcification

neg: Deep hypothermic circulatory arrest by external cooling was difficult and hazardous. At temperatures below 24 °C, the human heart is prone to fibrillation and stopping. This can begin circulatory arrest before the brain has reached a safe temperature. Cardiopulmonary bypass machines allow blood circulation and cooling to continue below the temperature at which the heart stops working. By cooling blood directly, cardiopulmonary bypass also cools people faster than surface cooling, even if the heart is not functioning. In 1959, using cardiopulmonary bypass (CPB), Barnes Woodhall and colleagues at Duke Medical Center performed the first brain surgery using DHCA, a tumor resection, at a brain

neg: Bariatric surgery is the Roux-en-Y gastric bypass, designed to reduce the amount of food a person is able to eat by cutting away a part of the stomach. Gastric bypass is a permanent procedure that helps patients by changing how the stomach and small intestine handle the food that is eaten to achieve and maintain weight loss goals. After the surgery, the stomach will be smaller. A patient will feel full with less food. The gastric bypass had been the most commonly performed operation for weight loss in the United States, and approximately 140,000 gastric bypass procedures were performed in 2005. Its

neg: Off-pump coronary artery bypass technically challenging. The technique has a steep learning curve, but with adequate training and experience, the quality of the anastomoses has been shown to be similar to on-pump results in surgeons with comparable experience On February 18, 2012 Amano Atsushi performed a successful off-pump coronary artery bypass operation on Emperor Akihito. Off-pump coronary artery bypass Off-pump coronary artery bypass or "beating heart" surgery is a form of coronary artery bypass graft (CABG) surgery performed without cardiopulmonary bypass (heart-lung machine) as a treatment for coronary heart disease. It was primarily developed in the early 1990s by Dr. Amano Atsushi. During most

neg: Impella and Impella LD heart pumps received FDA 510(k) clearance for circulatory support for periods of up to 6 hours during cardiac procedures not requiring cardiopulmonary bypass. In July 2010, the Automated Impella Controller received FDA 510(k) clearance for intended use by trained healthcare professionals in healthcare facilities and medical transport (ie, ambulance, helicopter, or fixed-wing aircraft) environments. In January 2015, the Impella RP was granted a humanitarian device exemption (HDE) to provide circulatory assistance for people who develop right heart failure. Impella Impella is a family of medical devices used for temporary ventricular support device in people with depressed heart

neg: Off-pump coronary artery bypass a blockage. Off-pump coronary artery bypass was developed partly to avoid the complications of cardiopulmonary bypass during cardiac surgery. The medical community believes cardiopulmonary bypass causes a post-operative cognitive decline known as postperfusion syndrome (informally called "pumphead"), but research has shown no long-term difference between on and off pump coronary artery bypass in patients of lower risk. This is probably because the pump is not the main cause of brain damage at all, rather it is the embolic process described below. Sometimes the fatty type materials that collects to form a blockage or lining on the walls of the artery

neg: Upendra Kaul Upendra Kaul Upendra Kaul is an Indian cardiologist and one of the pioneers of interventional cardiology in India. He is the Chairman and Dean Academics and Research at the Batra Hospital and Medical Research Center.. He is known for his expertise in procedures such as Percutaneous Cardiopulmonary bypass, Rotational and Directional Atherectomy, Coronary stenting and Percutaneous Laser Myocardial Revascularization. He graduated in medicine (MBBS) from the Maulana Azad Medical College and continued his studies at the same institution to secure MD in 1975 and, DM in cardiology in 1978. Later, he obtained advanced training in interventional cardiology from Australia during

neg: Mitral valve replacement to treat heart valve disease without surgery are divided into three categories: Clinical Practice treatment (this is used in every day clinical practice), Investigational treatment (current clinical studies that are underway), Early Development treatment (early stages of investigation). People having mitral valve surgery receive general anesthesia. Incision can be made somewhat horizontally under the left breast, or vertically through the sternum. After the heart is exposed, canulae are placed to reroute blood to a heart-lung machine for cardiopulmonary bypass. An incision is made in the left atrium to expose the mitral valve. The valve is then replaced with either a

neg: Extracorporeal cardiopulmonary resuscitation cava. The positions of the respective guidewires is confirmed with a chest x-ray. Once successful cannulation is confirmed, 5000 units of intravenous Heparin is administered. The patients cannula are attached to an ECMO circuit with blood flow targets of 3Lmin and oxygen blood flow of 3L min commenced. An arterial blood gas is used to assess for successful oxygenation and metabolic improvement following the commencement of ECMO. In the CHEER trial, mean arterial perfusion pressures of 70mmHg were targeted. Once the patient is stabilised on the ECMO circuit, they are transferred for further management of causal pathology, for example to

neg: Cardiothoracic surgery successful, but Rogers, a cancer sufferer, died from an infection 54 days after surgery. Since the 1990s, surgeons have begun to perform "off-pump bypass surgery" – coronary artery bypass surgery without the aforementioned cardiopulmonary bypass. In these operations, the heart is beating during surgery, but is stabilized to provide an almost still work area in which to connect the conduit vessel that bypasses the blockage; in the U.S., most conduit vessels are harvested endoscopically, using a technique known as endoscopic vessel harvesting (EVH). Some researchers believe that the off-pump approach results in fewer post-operative complications, such as postperfusion syndrome, and

neg: Deep hypothermic circulatory arrest Soviet heart surgeon, Eugene Meshalkin, in Novosibirsk during the 1960s. In these procedures, cooling was accomplished externally by applying cold water or melting ice to the surface of the body. The advent of cardiopulmonary bypass in the United States during the 1950s allowed the heart to be stopped for surgery without having to stop circulation to the rest of the body. Cooling more than a few degrees was no longer needed for heart surgery. Thereafter, the only surgeries that required stopping blood circulation to the whole body ("total circulatory arrest") were surgeries involving blood supply to the brain. The only

neg: Cannula transfer should be quickly flushed out with an appropriate solvent to prevent undetectable corrosion damage to the stainless steel. Since they are usually used for air-sensitive work, they are commonly kept in a hot oven, to reduce the adsorption of water molecules. Before use, they are usually subjected to three vacuum-refill cycles to remove any traces of air. The two ends of the cannula are inserted through the septa covering donating and receiving flasks. The cannula extends below the surface of the fluid to be transferred. A vacuum is applied to the receiving flask, and the low pressure relative to the

neg: Deep hypothermic circulatory arrest system. People who are to undergo DHCA surgery are placed on cardiopulmonary bypass (CPB), a procedure that uses an external heart-lung machine that can artificially replace the function of the heart and lungs. A portion of the circulating blood supply is removed and stored for later replacement, with the remaining blood diluted by added fluids with the objective of reducing viscosity and clotting tendencies at cold temperature. The remaining diluted blood is cooled by the heart-lung machine until hypothermia causes the heart to stop beating normally, after which the blood pump of the heart-lung machine continues blood circulation through the

neg: Cardiopulmonary bypass 1960s focused on overcoming the gas exchange handicap of the membrane barrier, leading to the development of high-performance microporous hollow-fibre oxygenators that eventually replaced direct-contact oxygenators in cardiac theatres. Cardiopulmonary bypass consists of two main functional units, the pump and the oxygenator which removes relatively oxygen-depleted blood from a patient's body and replaces it with oxygen-rich blood through a series of tubes (hoses). The components of the CPB circuit are interconnected by a series of tubes made of silicone rubber or PVC. The pump console usually comprises several rotating motor-driven pumps that peristaltically "massage" tubing. This action gently propels the

neg: Minimized extracorporeal circulation same time (1999). The increasing application in clinical practice explains this machine's success. The benefits of this type of extracorporeal circulation are that a lower consumption of blood and blood products is observed in the peri-operative and post-operative phase and that a lower inflammatory response is being measured in peri-operative blood samples in comparison to conventional cardiopulmonary bypass. Minimized extracorporeal circulation Minimized extracorporeal circulation (MECC) is a kind of cardiopulmonary bypass (heart-lung machine), a part of heart surgery. The introduction of extracorporeal circulation has facilitated open heart surgery. The development of modern techniques in extracorporeal circulation is the result of

neg: Mitral insufficiency the patient is placed on a heart-lung machine (cardiopulmonary bypass). This allows the complex surgery to proceed in a still environment. Due to the physiological stress associated with open-heart surgery, elderly and very sick patients may be subject to increased risk, and may not be candidates for this type of surgery. As a consequence, there are attempts to identify means of correcting MR on a beating heart. The Alfieri technique for instance, has been replicated using a percutaneous catheter technique, which installs a "MitraClip" device to hold the middle of the mitral valve closed. Indications for surgery for chronic MR

neg: Extracorporeal membrane oxygenation body. In VA ECMO, this blood is returned to the arterial system and in VV ECMO the blood is returned to the venous system. In VV ECMO, no cardiac support is provided. In veno-arterial (VA) ECMO, a venous cannula is usually placed in the right or left common femoral vein for extraction, and an arterial cannula is usually placed into the right or left femoral artery for infusion. The tip of the femoral venous cannula should be maintained near the junction of the inferior vena cava and right atrium, while the tip of the femoral arterial cannula is maintained in

neg: Minimaze procedure the posterior mitral annulus. Therefore, the mini-maze procedure cannot be performed epicardially by means of any presently available energy source.” Although Dr. Cox's 2004 definition specifically excludes an epicardial approach to eliminate AF, he and others pursued this important goal, and the meaning of the term changed as successful epicardial procedures were developed. In 2002 Saltman performed a completely endoscopic surgical ablation of AF and subsequently published their results in 14 patients. These were performed epicardially, on the beating heart, "without cardiopulmonary bypass or median sternotomy". Their method came to be known as the minimaze or microwave minimaze procedure, because

neg: Postperfusion syndrome bypass, but may also occur in patients with very similar risk factors for cardiovascular and cerebrovascular disease. Physicians have theorized that the syndrome is caused by tiny debris and air bubbles (microemboli) that enter the brain via cardiopulmonary bypass. Surgeons attempt to minimize time spent on bypass to decrease postoperative deficits; studies have shown increased bypass time is associated with increased incidence and severity of postperfusion syndrome and mortality. It is unclear how increases in bypass time would result in such increases if pre-existing cardiovascular and cerebrovascular conditions are the principal causative mechanisms of postperfusion syndrome. Postperfusion syndrome Postperfusion syndrome,

neg: Gastric bypass surgery procedure. A mini gastric bypass creates a long narrow tube of the stomach along its right border (the lesser curvature). A loop of the small gut is brought up and hooked to this tube at about 180 cm from the start of the intestine Numerous studies show that the loop reconstruction (Billroth II gastrojejunostomy) works more safely when placed low on the stomach, but can be a disaster when placed adjacent to the esophagus. Today thousands of "loops" are used for surgical procedures to treat gastric problems such as ulcers, stomach cancer, and injury to the stomach. The mini gastric

neg: Deep hypothermic circulatory arrest Since heart-lung machines, also known as cardiopulmonary bypass (CPB), hadn't been invented yet, stopping the heart meant stopping blood circulation to the whole body, including the brain. The first heart surgery using hypothermia to provide a longer time that blood circulation through the whole body could be safely stopped was performed by F. John Lewis and Mansur Taufic at the University of Minnesota in 1952. In this procedure, the first successful open heart surgery, Lewis repaired an atrial septal defect in a 5-year-old girl during 5 minutes of total circulatory arrest at 28 °C. Many similar procedures were performed by

neg: Nasal cannula Nasal cannula The nasal cannula (NC) is a device used to deliver supplemental oxygen or increased airflow to a patient or person in need of respiratory help. This device consists of a lightweight tube which on one end splits into two prongs which are placed in the nostrils and from which a mixture of air and oxygen flows. The other end of the tube is connected to an oxygen supply such as a portable oxygen generator, or a wall connection in a hospital via a flowmeter. The cannula is generally attached to the patient by way of the tube hooking

neg: Nasal cannula mixture delivered via a nasal cannula at flows that exceed the patient’s inspiratory flow demands with gas that has been optimally conditioned by warming and humidifying the gas to close to 100% relative humidity at body temperature. Nasal cannula The nasal cannula (NC) is a device used to deliver supplemental oxygen or increased airflow to a patient or person in need of respiratory help. This device consists of a lightweight tube which on one end splits into two prongs which are placed in the nostrils and from which a mixture of air and oxygen flows. The other end of the

neg: Gerald Buckberg techniques in surgical treatment of patients in shock following an acute heart attack, lowered mortality to below 10%, from the over 50% death rate previously associated with conventional methods. These new techniques continue to be tested internationally to verify their improved outcomes in heart attack patients who might otherwise sustain irreversible loss of heart muscle. Buckberg introduced the concept of "unintended reoxygenation injury" when blue babies (cyanotic) are placed on cardiopulmonary bypass (heart-lung machine) to correct the congenital defect causing cyanosis. This study called attention to the role of active interventions, including antioxidants, to limit this injury, and provided the

neg: Shape-memory polymer SMPs are now being used in various ophthalmic devices including punctal plugs, glaucoma shunts and introacular lenses. SMPs are smart materials with potential applications as, e.g., intravenous cannula, self-adjusting orthodontic wires and selectively pliable tools for small scale surgical procedures where currently metal-based shape-memory alloys such as Nitinol are widely used. Another application of SMP in the medical field could be its use in implants: for example minimally invasive, through small incisions or natural orifices, implantation of a device in its small temporary shape. Shape-memory technologies have shown great promise for cardiovascular stents, since they allow a small stent to

neg: Perfusionist perfusion, intraperitoneal hyperthermic chemoperfusion and tracheal resection/repair. Perfusionist A perfusionist, also known as a Clinical Perfusionist, Cardiovascular Perfusionist, Clinical Perfusion Scientist, or Medical Perfusionist, is a healthcare professional who uses the cardiopulmonary bypass machine (heart–lung machine) during cardiac surgery and other surgeries that require cardiopulmonary bypass to manage the patient's physiological status. Perfusionists form part of the wider cardiothoracic surgical team which includes cardiac surgeons, anesthesiologists and physician assistants. The perfusionist shares responsibility with the cardiac surgeon and anesthesiologist for the management of the physiological and metabolic needs of the cardiac surgical patient, so that the surgeon may operate on

neg: Cannula transfer of exposing the needle tip to the air, it is withdrawn into the inerted tube. Where desired, it may be inserted into a flask via two septa (one on the tube, one on the flask). Used this way, needle tip fires are eliminated, reducing the obvious hazards. Also, there is a reduced tendency for the needle tip to clog due to the reaction of traces of the reagent with air to give salts. Filtration is most easily accomplished using a syringe filter. PTFE filters tend to be most chemically resistant; nylon filters are less so. Using a cannula, a filter

neg: Nasal cannula do not need oxygen to the degree of wearing a non-rebreather mask. It is especially useful in those patients where vasoconstriction could negatively impact their condition, such as those suffering from strokes. A nasal cannula may also be used by pilots and passengers in small, unpressurized aircraft that do not exceed certain altitudes. The cannula provides extra oxygen to compensate for the lower oxygen content available for breathing at the low ambient air pressures of high altitude, preventing hypoxia. Special aviation cannula systems are manufactured for this purpose. Since the early 2000s, with the introduction of nasal cannula which uses

neg: Congenital diaphragmatic hernia baby will usually be immediately placed on a ventilator. Extracorporeal membrane oxygenation (ECMO) has been used as part of the treatment strategy at some hospitals. ECMO acts as a baby heart-lung bypass (though it can be used for older children as well). A venous cannula is inserted into the jugular vein or the common femoral vein(ECMO is divided into two types; (arteriovenous AV and venovenous VV), allowing the blood to exit the body and begin its trek through the ECMO circuit, it is then scrubbed, oxygenated, and passes through a filter before being returned to the body via a second

neg: Menstrual extraction some countries where abortion is illegal, such as Bangladesh, a similar technique called “menstrual regulation” or “menstrual extraction” are used as euphemisms for early pregnancy terminations. In 1971, members of a feminist reproductive health self-help group, Lorraine Rothman and Carol Downer modified equipment found in an underground abortion clinic that was developed for a new non-traumatic, manually-operated-suction abortion technique. They took the thin, flexible plastic Karman cannula (about the size of a soda straw), and the syringe (50 or 60ml), and added a one-way bypass valve, to fix two main problems. The contraption could prevent air from being pumped into

neg: Mannitol shown to reduce graft rejection. Mannitol acts as an osmotic laxative in oral doses larger than 20 g, and is sometimes sold as a laxative for children.. The use of mannitol, when inhaled, as a bronchial irritant as an alternative method of diagnosis of exercise-induced asthma has been proposed. A 2013 systematic review concluded evidence to support its use for this purpose at this time is insufficient. Mannitol is commonly used in the circuit prime of a heart lung machine during cardiopulmonary bypass. The presence of mannitol preserves renal function during the times of low blood flow and pressure, while

neg: Cardiopulmonary bypass a number of associated problems: As a consequence, CPB is only used during the several hours a cardiac surgery may take. Most oxygenators come with a manufacturer's recommendation that they are only used for a maximum of 6 hours, although they are sometimes used for up to 10 hours, with care being taken to ensure they do not clot off and stop working. For longer periods than this, an ECMO (extracorporeal membrane oxygenation) is used, which can be in operation for up to 31 days – such as in this Taiwanese case, for 16 days, after which the patient received

neg: Infusion set quick-release that leaves the cannula and adhesive pad in place. This is convenient when swimming or showering (since most pumps are not fully waterproof), or when engaging in any activity when it is not desirable to be attached to the pump. There are several types, styles, and sizes of infusion sets available to allow an insulin pump user a choice to customize what works best for them. These vary in cannula length, cannula entry angle and in the length of tube connecting the cannula to the pump. For instance, an individual with little body fat may choose to use a

neg: Trocar Trocar A trocar (or trochar) is a medical or veterinary device that is made up of an obturator (which may be a metal or plastic sharpened or non-bladed tip), a cannula (basically a hollow tube), and a seal. Trocars are placed through the abdomen during laparoscopic surgery. The trocar functions as a portal for the subsequent placement of other instruments, such as graspers, scissors, staplers, etc. Trocars also allow the escape of gas or fluid from organs within the body. The word "trocar", less commonly "trochar", comes from French "trocart", "trois-quarts", from "trois" 'three' and "carre" 'side, face of an

neg: Cardiopulmonary bypass blood through the tubing. This is commonly referred to as a roller pump, or peristaltic pump. Many CPB circuits now employ a centrifugal pump for the maintenance and control of blood flow during CPB. By altering the speed of revolution (RPM) of the pump head, blood flow is produced by centrifugal force. This type of pumping action is considered to be superior to the action of the roller pump by many because it is thought to produce less blood damage (hemolysis, etc.), but mostly due to the centrifugal pump being pressure limited, therefore less likely to rupture the system if

neg: Nasal cannula around the patient's ears or by elastic head band. The earliest, and most widely used form of adult nasal cannula carries 1–5 litres of oxygen per minute. Cannulae with smaller prongs intended for infant or neonatal use can carry less than one litre per minute. Flow rates of up to 60 litres of air/oxygen per minute can be delivered through wider bore humidified nasal cannula. The nasal cannula was invented by Wilfred Jones and patented in 1949 by his employer, BOC. A nasal cannula is generally used wherever small amounts of supplemental oxygen are required, without rigid control of respiration,

neg: Cannulated cow Cannulated cow A cannulated cow or "fistulated cow" refers to a cow that has been surgically fitted with a cannula. A cannula acts as a porthole-like device that allows access to the rumen of a cow, to perform research and analysis of the digestive system. The practice can be traced back to as early as the 1920s. A forage analysis can take place due to the access of the rumen through a cannula. Once the cannula is surgically placed in the cow, a cow is then allowed to graze for a certain period of time. Once the allotted time is

neg: Intravenous therapy used although arm and hand veins are used most commonly, with leg and foot veins used to a much lesser extent. In infants, the scalp veins are sometimes used. The caliber of needles and catheters can be given in Birmingham gauge or French gauge. A Birmingham gauge of 14 is a very large cannula (used in resuscitation settings) and 24-26 is the smallest. The most common sizes are 16-gauge (midsize line used for blood donation and transfusion), 18- and 20-gauge (all-purpose line for infusions and blood draws), and 22-gauge (all-purpose pediatric line). 12- and 14-gauge peripheral lines are capable of

neg: Double aortic arch procedure is performed in general anesthesia. It is useful to place pulse oximeter probes on "both hands" and "one foot" so that test occlusion of one arch or its branches will allow confirmation of the anatomy. In addition blood pressure cuffs should also be placed on one leg and both arms to confirm the absence of a pressure gradient when the intended point of division of the lesser arch is temporarily occluded with forceps. Isolated double aortic arch without associated intracardiac defects is a vascular anomaly that can be corrected without the support of cardiopulmonary bypass. For surgical division of

neg: Cardiothoracic anesthesiology CPB. After completion of the "on bypass" surgical correction, preparations are made to separate the patient from CPB. In other words, the heart and lung are prepared to receive, oxygenate, and pump the blood which had immediately previous been done by the CPB machine. Separation can be complicated by the CPB machine, the patient's inherent pathology/physiology, surgical correction, and the dynamic interaction of all three. Cardiopulmonary bypass has effects on the patient's hematology, physiology, and immunology, which must be acutely managed by the cardiothoracic anesthesiologist in order to ensure effective separation from CPB. Patients with cardiothoracic pathology who present for

neg: Minimally invasive direct coronary artery bypass surgery Minimally invasive direct coronary artery bypass surgery Minimally Invasive Direct Coronary Artery Bypass (MIDCAB) is a surgical treatment for coronary heart disease that is a less invasive method of coronary artery bypass surgery (CABG). MIDCAB gains surgical access to the heart with a smaller incision than other types of CABG. MIDCAB is sometimes referred to as "keyhole" heart surgery because the operation is analogous to operating through a keyhole. MIDCAB is a form of off-pump coronary artery bypass surgery (OPCAB), performed "off-pump" - without the use of cardiopulmonary bypass (the heart-lung machine). MIDCAB differs from OPCAB in the type of

neg: Minimally invasive direct coronary artery bypass surgery and coronary stenting. Minimally invasive direct coronary artery bypass surgery Minimally Invasive Direct Coronary Artery Bypass (MIDCAB) is a surgical treatment for coronary heart disease that is a less invasive method of coronary artery bypass surgery (CABG). MIDCAB gains surgical access to the heart with a smaller incision than other types of CABG. MIDCAB is sometimes referred to as "keyhole" heart surgery because the operation is analogous to operating through a keyhole. MIDCAB is a form of off-pump coronary artery bypass surgery (OPCAB), performed "off-pump" - without the use of cardiopulmonary bypass (the heart-lung machine). MIDCAB differs from OPCAB in

neg: Cannula of intravenous fluids, for obtaining blood samples and for administering medicines. An arterial cannula is inserted into an artery, commonly the radial artery, and is used during major operations and in critical care areas to measure beat-to-beat blood pressure and to draw repeated blood samples. Insertion of the venous cannula is a painful procedure that can lead to anxiety and stress. Use of a vapocoolant (cold spray) immediately before cannulation reduces pain during the procedure, without increasing the difficulty of cannulation. Complications may arise in the vein as a result of the cannulation procedure, the four main groups of complication

neg: Cold-weather warfare on the temperature and range from shivering and mental confusion to increased risk of the heart stopping. The treatment of mild hypothermia involves warm drinks, warm clothing and physical activity. In those with moderate hypothermia heating blankets and warmed intravenous fluids are recommended. People with moderate or severe hypothermia should be moved gently. In severe hypothermia extracorporeal membrane oxygenation (ECMO) or cardiopulmonary bypass may be useful. In those without a pulse cardiopulmonary resuscitation (CPR) is indicated along with the above measures. Rewarming is typically continued until a person's temperature is greater than . Adequate insulation from clothing is the best

neg: Cardiothoracic surgery performed without any complications, was by Ludwig Rehn of Frankfurt, Germany, who repaired a stab wound to the right ventricle on September 7, 1896. Surgery in great vessels (aortic coarctation repair, Blalock-Taussig shunt creation, closure of patent ductus arteriosus) became common after the turn of the century and falls in the domain of cardiac surgery, but technically cannot be considered heart surgery. One of the more commonly known cardiac surgery procedures is the coronary artery bypass graft (CABG), also known as "bypass surgery." In this procedure, vessels from elsewhere in the patient's body are harvested, and grafted to the coronary

neg: Bland embolization hours. Liver abscess is a rare complication of hepatic embolization, so the typical post-embolzation appearance of a low density lesson with scattered gas bubbles should not be confused with liver abscess. It is seen most commonly in patient who have undergone bilioenteric bypass or who for any reason do not have an intact sphincter of Oddi. In a review of almost 1000 patients undergoing over 2000 embolization procedures, the risk of liver abscess in patients with a contaminated biliary tree was found to be 300 times higher than the baseline risk. Non-target embolization is one of the most dreaded complications

neg: Coronary artery bypass surgery statins, antihypertensives, smoking cessation, and /or tight blood sugar control in diabetics - do not satisfactorily relieve ischemic symptoms. Alternate methods of minimally invasive coronary artery bypass surgery have been developed. Off-pump coronary artery bypass (OPCAB) is a technique of performing bypass surgery without the use of cardiopulmonary bypass (the heart-lung machine). Avoidance of aortic manipulation may be achieved through the "anaortic" or no-touch OPCAB technique, which has been shown to reduce stroke and mortality compared to on-pump CABG. Further refinements to OPCAB have resulted in minimally invasive direct coronary artery bypass surgery (MIDCAB), a technique of performing bypass surgery

neg: Hip arthroscopy passed into the joint, and the needle is removed over it, leaving the guide wire in situ. A small cut in the skin is made around the wire, to allow for larger cannulae to be placed over the wire through the portal. The wire therefore guides the larger cannulae into the joint. The most common external diameters of cannulae used are between 4.5 and 5.5 mm. Once the surgeon is satisfied that the cannula is in the correct position, by a combination of feel and x-ray guidance, the guide wire can be withdrawn. Once the first portal is correctly placed,

neg: Perfusionist 150 clinical procedures, they must undertake a practical exam. For this exam, the candidate is observed by two external examiners whilst building and priming a cardiopulmonary circuit, then using it during a surgical operation. After the practical exam, trainees must complete a 40-minute "viva voce" exam, which tests their academic knowledge. After this is successfully completed, they are awarded a postgraduate diploma and the status of qualified clinical perfusion scientist. They must maintain this by performing a minimum of 40 clinical procedures per year. In Australia, there are both Clinical and medical perfusionists.There are significantly more Clinical Perfusionists in Australia,

neg: Bubble sensor pump that is supplying the blood to the heart. Depending on the size of the bubble detected the pump will respond in different ways. The sensors allow the operator to set a size threshold for the size of the bubbles to detect. If the bubbles are below the threshold it is displayed to the user as microbubble activity. When a bubble equal to or greater than the threshold is detected an audio and visual alarm is generated and the arterial pump is stopped, this effectively terminates the cardiopulmonary bypass. The operator must identify and remove the bubble before bypass can

neg: Dextro-Transposition of the great arteries the Rastelli procedure. The pulmonal artery is shifted with help of conduit to the right ventricle. It has been used since 1960s. It has a disadvantage that the conduit does not grow, so re-operation is necessary. The Jatene procedure surgery is the preferred, and most frequently used, method of correcting d-TGA; ideally, it is performed on an infant between 8–14 days old. The heart and vessels are accessed via median sternotomy, and a cardiopulmonary bypass machine is used; as this machine needs its "circulation" to be filled with blood, a child will require a blood transfusion for this surgery. The

neg: Management of obesity prevention. When the two main techniques are compared, gastric bypass procedures are found to lead to 30% more weight loss than banding procedures one year after surgery. Ileojejunal bypass, in which the digestive tract is rerouted to bypass the small intestine, was an experimental surgery designed as a remedy for morbid obesity. The effects of liposuction on obesity are less well determined. Some small studies show benefits while others show none. A treatment involving the placement of an intragastric balloon via gastroscopy has shown promise. One type of balloon led to a weight loss of 5.7 BMI units over 6

neg: Tracheal intubation claims, whereas late sequelae occurred in 65%. Although it offers the greatest degree of protection against regurgitation and pulmonary aspiration, tracheal intubation is not the only means to maintain a patent airway. Alternative techniques for airway management and delivery of oxygen, volatile anesthetics or other breathing gases include the laryngeal mask airway, i-gel, cuffed oropharyngeal airway, continuous positive airway pressure (CPAP mask), nasal BiPAP mask, simple face mask, and nasal cannula. General anesthesia is often administered without tracheal intubation in selected cases where the procedure is brief in duration, or procedures where the depth of anesthesia is not sufficient to

neg: Safe-cracking Safe-cracking Safe-cracking is the process of opening a safe without either the combination or the key. Different procedures may be used to crack a safe, depending on its construction. Different procedures are required to open different safes so safe-crackers need to be aware of the differences. Lock manipulation is the stereotypical safe cracking technique commonly portrayed in movies. It's a damage free combination recovery method, and a well known surreptitious bypass technique. Manipulation only requires fingers, eyes, and proper technique but it's a skill that takes years to develop and decades to master. Manipulation is a Group 2 mechanical lock

neg: Alcor Life Extension Foundation simultaneously pumping an organ preservation solution through the veins. Patients are transported as quickly as possible to Alcor headquarters in Scottsdale, where they undergo final preparations in Alcor's cardiopulmonary bypass lab. In the Patient Care Bay they are monitored by computer sensors while kept in liquid nitrogen in dewars. Liquid nitrogen is refilled on a weekly basis. Riverside County, California deputy coroner Dan Cupido said that Alcor had better equipment than some medical facilities. Membership dues cover one-third of Alcor's yearly budget, with donations and case income from cryopreservations covering the rest. Alcor receives $50,000 each year from television royalties

neg: Renal angina and prognosis of AKI. The most frequently studied new biomarkers include Cystatin C (CysC), neutrophil gelatinase associated lipocalin (NGAL), interleukin-18, liver-fatty acid binding protein (l-FABP), and kidney injury molecule-1 (KIM-1). Children following cardiopulmonary bypass are often used to derive biomarker performance and validate optimal cut-off values given a known timing and duration of insult, relative homogeneity, and freedom from co-morbidities. Unfortunately, when these and other biomarkers are applied to a more heterogeneous patient population (the general intensive care unit, non-critically ill patients, patients in the emergency department), they demonstrate less robust predictive performance. The inability to detect AKI in the