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Ann Thorac Surg 1995;60:1202
© 1995 The Society of Thoracic Surgeons

Invited Commentary

Invited Commentary

Michael Scallan, FRCA, Christopher Lincoln, FRCS

Department of Cardiac Surgery, Royal Brompton National Heart and Lung Hospital, Sydney St, London SW3 6NP, England

See also page 1198.

In the past, it was believed that the management of cardiopulmonary bypass in infants and small children should be based on the preferences (prejudices?) and practice of the institution. The feeling was that the ``package'' that worked well in the institution's practice should not be changed. This view should now be challenged. With the improving survival after heart operations in infants, the need to look at quality of life and in particular neurologic quality has become increasingly important. Several centers are now studying this, and slowly a picture is emerging of what is ``best practice.'' This study is a valuable contribution to this end.

In this study, pH management during cooling followed alpha stat principles. Recent evidence suggests that pH stat management is superior, perhaps through enhanced brain cooling. A repeat of this study using pH stat acid-base management may define ``best practice'' more clearly.


Related Article

Comparing Two Strategies of Cardiopulmonary Bypass Cooling on Jugular Venous Oxygen Saturation in Neonates and Infants
Frank H. Kern, Ross M. Ungerleider, Scott R. Schulman, Jon N. Meliones, Randall M. Schell, Beatrice Baldwin, Paul R. Hickey, Mark F. Newman, Richard A. Jonas, and William J. Greeley
Ann. Thorac. Surg. 1995 60: 1198-1202. [Abstract] [Full Text]




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