By Bradley J. Harlan M.D., Albert Starr M.D., Fredric M. Harwin B.F.A., M.S. (auth.)
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Additional resources for Manual of Cardiac Surgery: Volume 1
Warming is accomplished with bypass and with the blanket under the patient. The patient is warmed to about 34°C esophageal temperature and weaned from bypass. Warming to 34°C usually takes about 20 min. Warming is then completed by surface means. Complications Complications directly related to the technique of circulatory arrest are uncommon. Metabolic changes can occur in the postoperative period, including hypocalcemia and hyperkalemia, but these are usually easily managed. 18 Seizures may occur in the postoperative period but respond promptly to appropriate therapy.
Experiments have been conducted by surgeons interested in ischemia as it relates to the conduct and success of cardiac surgery, cardiologists studying acute myocardial infarction, and cellular pathologists seeking to define the subcellular pathophysiology of ischemia and the mechanisms of cell death. These experiments have increased our knowledge of the metabolic and structural changes occurring during ischemia and of the relation of such changes to the development of irreversibility or lethal cell injury.
4-2). Division of Sternum and Manubrium The midline of the manubrium and sternum is marked by coagulating the periosteum. The xiphoid process is cut in the midline, and the retrosternal space is bluntly dissected with the finger. A retractor is placed at the upper part of the incision, and the sternum is divided from xiphoid to manubrium with a saw (Fig. 4-3). Sternal periosteum is electrocoagulated and hemostasis of the marrow achieved with bone wax. Orthopedic stockinette wound towels are placed and the sternal retractor inserted and opened.
Manual of Cardiac Surgery: Volume 1 by Bradley J. Harlan M.D., Albert Starr M.D., Fredric M. Harwin B.F.A., M.S. (auth.)