EVALUATION OF VARIOUS TECHNIQUES TO MINIMIZES BLEEDING AND TO STUDY THEIR EFFECTS ON TISSUE IJ--L OXYGENATION AFTER OPEN HEART SURGERY.

Abstract

Cardiopulmonary bypass is a major activator of coagulation system. Contact of blood component with the cardiopulmonary bypass tubing system ad oxygenator causes platelet dysfunction, increases fibrinolytic activity and denaturates the coagulation factors. In addition haemodilution by the crystalloid priming fluid causes decreased level of platelets and clotting factors in the patients blood. All these factors-put patients undergoing cardiopulmonary bypass at

a great risk for postoperative bleeding and increases the requirement for blood transfusion that has a potential risk of transmission of diseases. A great effort was done, using pharmacological and non pharmacological methods, to decrease the coagulopathy produced by cardiopulmonary bypass. The present study evaluated the use of low dose Aprotinin,

Tranexamic acid, Epsilon aminocaproic acid and Acute normovloumic haemodilution with autologous fresh blood transfusion to decrease the post cardiopulmonary bypass bleeding and transfusion requirement with determination of changes in tissue oxygenations in the various groups. Fifty patients undergoing single valve surgery were classified into 5

groups. Group I received low dose aprotinin in the form of 500000 klu after induction of anaesthesia, 500000 klu on cardiopulmonary bypass machine and I 00000 klu per hour till termination of the cardiopulmonary bypass. Group II received transxamic acid in a dose of I0 mg/kg followed by I mg/kg!hour till 12 hours after the operation. Group illreceived Epsilon aminocaproic acid in a dose of I00 mg/kg after induction of anaesthesia followed by I 0 mg/kg!hour until twelve hours after the operation.