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M Kurusz

Publications and source records attributed to M Kurusz.

13 recordsLinked to original sources
PubMed1992

Pediatric myocardial protection in the United States: a survey of current clinical practice.

A nationwide survey of institutions in the United States that perform congenital heart disease surgery was conducted to obtain an overview of the current use of myocardial protection in pediatric patients (aged 0-16 years). One hundred and one (55%) of 183 institutions responded, completing a 4-page questionnaire about pediatric cases in 1989. A total of 12,072 cases were represented. Caseloads ranged from 7 to 498 at these institutions (mean 124, median 30). Cardioplegia was used by 100 institutions (44 blood, 45 crystalloid, 11 both). Administration was guided by formulas alone in 69 and by clinical criteria alone in 32. A wide variety of compositions of cardioplegic solutions was found with no preference for any particular type. No correlation between caseloads and cardioplegic solutions was found. Hypothermia was used by all institutions, with a mean of 25.8 +/- 3.5 degrees C for a simple ventricular septal defect closure. Deep hypothermia and circulatory arrest were used in 3048 cases (25.2%). A clear trend indicated that circulatory arrest was used more frequently in larger institutions (p less than 0.0001). Fibrillation as a strategy was used in 45 institutions. Twenty-five institutions changed cardioplegia technique during 1989. The findings suggest that, even though no consensus exists about its ideal composition, cardioplegia in conjunction with hypothermia is currently the strategy most often used for pediatric myocardial protection.

Adolescent↗
PubMed1990

Oxygenator failure.

Explore the source record for details and available documents.

Cardiopulmonary Bypass↗
PubMed1990

Risk containment during cardiopulmonary bypass.

It is evident that positive attitudes towards patient care are the cornerstone of risk containment during CPB. Positive attitudes are shaped by education and training, including continuing education. Mutual respect among team members can foster positive attitudes that are manifested in an orderly, quiet operating room, with those present always mindful of the patient's welfare. Vigilance is the key in preventing complacency during CPB procedures that have now become routine. Collins writes that the best airplane pilots develop a curious and suspicious attitude in the cockpit and, again, the applicability of the aviation and perfusion analogy is apparent. Monitors, standards, protocols, and safety devices can never fully replace vigilance in overcoming human frailty or error. Vigilance has been defined as "a state of clinical awareness whereby dangerous conditions are anticipated or recognized and promptly treated." Stoelting further writes that levels of vigilance may be reduced by extraneous distractions, fatigue, and stress. Gaba et al have studied anesthetic mishaps in the context of accident investigations in unrelated fields and have suggested two responsibilities in breaking the chain of accident evolution. The first is to scrutinize our own abilities and limitations ... and implement the procedures and training that can be shown to optimize patient safety, and second ... to reexamine the entire structure of our industry, attempting to steer the interacting sources of incentive and constraint towards a system that promotes patient safety. Guides to acceptability of risk include the twin tenets of reasonableness and custom of usage, prevailing professional practice, the best available practice, and the degree of necessity or benefit.(ABSTRACT TRUNCATED AT 250 WORDS)

Cardiopulmonary Bypass↗
PubMed1988

Effect of the Trendelenburg position on the distribution of arterial air emboli in dogs.

We examined the effects of buoyancy on the distribution of arterial gas bubbles using in vitro and in vivo techniques in dogs. A simulated carotid artery preparation was used to determine the effects of bubble size and vessel angle on the velocity and direction of bubble movement in flowing blood. Because buoyancy tends to float bubbles away from dependent areas, bubble velocity would be expected to decrease as the vessel angle increased. We found that larger bubbles increased in velocity in the same direction as the blood flow at 0-, 10-, and 30-degree vessel angles and decreased when the vessel was positioned at 90 degrees. Smaller bubbles did not change velocity from 0 to 30 degrees and increased in velocity in the same direction as blood flow at 90 degrees. In 10 anesthetized dogs, we studied the effects of 0-, 10-, 15-, and 30-degree Trendelenburg's position on carotid artery distribution of gas bubbles injected into the left ventricle or ascending aorta. Regardless of the degree of the Trendelenburg position, the bubbles passed into the carotid artery simultaneously with passage into the abdominal aorta. We conclude that the forces of buoyancy do not overcome the force of arterial blood flow and that the Trendelenburg position does not prevent arterial bubbles from reaching the brain.

Animals↗
PubMed1983

A technique for cardioplegic infusion and left heart venting during coronary artery bypass grafting.

A method for administering cardioplegia and venting the left heart that utilizes a single cannula in the aortic root and minimizes the risk of air entering the left heart is presented. This technique permits precise control of flow and pressure of the cardioplegic solution. Left heart decompression is accomplished by siphon drainage with controlled negative pressure. This method effectively vents the left heart while preventing aspiration of air around the cannula insertion site or retrograde through an opened coronary artery with a nonocclusive proximal lesion during the construction of the distal anastomoses.

Aorta↗
PubMed1981

Use of cold cardioplegic solution for vein graft distention and preservation: a light and scanning electron microscopic study.

To evaluate the effect of a cardioplegic solution on the endothelium of the saphenous vein, portions of this vein were harvested from each of 5 patients undergoing coronary artery bypass operation. Each sample was divided into five segments. One segment was distended with heparinized saline solution, one with heparinized blood, and one with heparinized cardioplegic solution (25 mEq of potassium per liter). All of the distending solutions were kept at 10 degrees C, and pressure was carefully limited to 200 mm Hg. The fourth segment of vein was distended with heparinized saline solution but no effort was made to limit distending pressure, and the fifth segment was not distended. All samples were then examined with light and scanning electron microscopy. There were no great morphological differences in the endothelium of veins distended to 200 mm Hg with saline solution, blood, or cardioplegic solution. The morphology of these samples compared favorably with the control vein endothelium although scattered areas of endothelial disruption were present in every sample. Veins distended without pressure control showed massive endothelial disruption. The particular solution used to distend the sephenous veins is not as important as limiting the distending pressure.

Blood↗
PubMed1979

Runaway pump head: new cause of gas embolism during cardiopulmonary bypass.

Massive gas embolism was narrowly avoided during a recent case of cardiopulmonary bypass for aortic valve replacement. Cause of the mishap was an arterial pump head that had rapidly accelerated spontaneously, emptying the oxygenator of blood within seconds. No gas entered the patient's vascular system, but a period of circulatory arrest was required in order to purge the extracorporeal circuit of gas and to re-establish blood flow. Only an instantaneous response by the perfusionist prevented massive gas embolism.

Cardiopulmonary Bypass↗
PubMed1978

Similarity of clinical and laboratory results obtained with microporous teflon membrane oxygenator and bubble-film hybrid oxygenator.

For 80 elective clinical cardiopulmonary bypasses we alternately used either a commercial microporous Teflon membrane oxygenator or a commercial hybrid bubble-film oxygenator. Setup time was a little longer with the membrane unit (20 minutes), but priming volume (2,250 ml) was the same. No problems were encountered with the hybrid oxygenator. However, despite our monitoring of additional variables, including shim and inlet pressure and recirculation flow, gas exchange abnormalities were encountered in 5 patients on whom the membrane oxygenator was used; in 4 of these cases the abnormalities were encountered prior to our recognition of the potential for occasional internal shunting with this device. There were no hospital deaths. When the two groups, matched except for oxygenator selection, were compared, there were no significant differences clinically or hematologically. For cardiopulmonary bypass of 2 hours or less, both oxygenators studied are definite improvements over previous silicone membrane and high-gas-flow bubble oxygenators. However, lower cost and reduced complexity favor the hybrid oxygenator.

Blood Glucose↗
PubMedDate not supplied

Gaseous microemboli: sources, causes, and clinical considerations.

Patients undergoing open-heart surgery are exposed to gaseous microemboli (GME) from several sources, including bubble oxygenators, which are used in a majority of cases for cardiopulmonary bypass. If present in large quantities, GME can reduce blood flow and delivery of oxygen to tissues and may be responsible, in part, for some of the complications that commonly follow cardiopulmonary bypass. Gaseous microemboli are defined, and the causes of this phenomenon are examined. The literature from the last 30 years on this topic is also reviewed, and measures for reducing GME during cardiopulmonary bypass are recommended. Current considerations for users of cardiopulmonary bypass systems are discussed, and five unanswered questions are raised in the conclusion.

Cardiopulmonary Bypass↗