Circ Arrest

[Monty Python]

Recently we had a case posted for Bentall repair with CABG, and we were discussing current methods of circ arrest management. The different approaches included +/- propofol, +/- midaz, +/- steroids. All approaches mentioned packing the head in ice.

I was wondering what others were doing these days given the apparent non-availability of pentothal.

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[T-burglar]

Make sure the nasal temp is 18, not just the venous temp.

You can silence the EEG with drugs if you want but a sufficiently chilled brain will be electrically silent without any drug help

Turn off all warm drug and fluid infusions during the DHCA period

Anything else is probably voodoo.

If I was having arch surgery I would want SACP personally. Take your time and do a good job with minimal risk of brain injury

 

[IceMD]

If the surgeons truly want to arrest before the EEG becomes isoelectric, I'll usually bolus some propofol right before. I doubt it does anything other than makes me feel better though. At my institution, the general trend is just cooling and ice on the head to prevent ambient rewarming. PTEs get a whole slew of voodoo pharmacology due to surgeon preference.

 

[RK.md]

Propofol and adequate cerebral cooling (18-22 degrees C). ACP is also great!
Some of our surgeons like steroids.

 

[vector2]

Surgeons here request methylpred, pentobarbital, head packing.

 

[Robotic Wis-Hipple]

RCP, no steroids, no propofol bolus, no head packing where I’m at.

 

[McPoyle]

Temperature, time, and ACP I think are all that’s beneficial. With that said some of the voodoo we do are:
-head packing
-prop to at least burst suppress
-lido and Mg

I feel like none of it is beneficial but importantly likely doesn’t hurt either. Thank god the surgeons don’t ask for steroids...


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[deleted162650]

-prop to at least burst suppress

If you're not iso-electric from the hypothermia you're not cold enough.

 

[McPoyle]

If you're not iso-electric from the hypothermia you're not cold enough.

I agree, like I said, it’s voodoo.


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