Cardiothoracic and Vascular Surgery Department, All India Institute of Medical Sciences, New Delhi.
*Address for correspondence: Mrs. Punita Singh, C.T.V.S. Dept., A.I.I.M.S., New Delhi, E-mail: punitasingh33@gmail.com.
The neurological injury remains the most feared complication of cardiopulmonary bypass (CPB) and is very difficult to know which factor has the greatest impact on neurological outcome. One of the most common factor which influences the neurological outcome after CPB is blood gas management strategy during CPB. The optimal blood gas management strategy to be followed in pediatric patients undergoing corrective surgery with the use of hypothermia on CPB is controversial therefore requires a thorough study.
The aim of this study is to compare the neurological outcome in children with cyanotic congenital heart disease (Tetralogy of Fallot) undergoing total correction with the use of CPB and moderate hypothermia using either Alpha stat or pH stat at blood gas management.
30 children with congenital heart disease CHD (TOF) undergoing total correction on CPB with moderate hypothermia (28°C). The children under study were divided into two groups. In Group A (N=15) Alpha stat management was followed and in Group B (N=15) pH stat management was followed and in both groups same protocol was followed by surgeon, anesthetic and perfusionist. The same blood gas parameters and other parameter were noted for both the groups.
pH stat blood gas management is more beneficial in cyanotic pediatric patient undergoing cardiac surgery using hypothermia during CPB. Though it does not shows any significant change in neurological outcome, it shows better recovery post operatively by using less inotropic support and ventilatory support which leads to less ICU stay days.
For cerebral protection at moderate hypothermia (28°C) the pH stat strategy is better than alpha stat but with pH stat, cerebral blood flow varies in proportion to changes in cerebral perfusion pressure due to impaired cerebral auto regulation so pH stat blood gas management requires more expertise perfusion techniques.
Cerebral protection, Alpha stat, pH stat, Oxygen consumption, Blood flow
