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A 7-month old, 7 kg, male is undergoing definitive repair of tetralogy of Fallot.<br />
He has had previous palliative surgery to place a modified Blalock-Taussig shunt<br />
(MBTS). CPB has been initiated uneventfully, and the surgeon is preparing to<br />
isolate and clamp the BT shunt. You note that the cerebral NIRS value has<br />
drifted down, and also note that the MAP is 30. The following will improve these<br />
changes EXCEPT:<br />
<br />
a) Increasing CPB flow rates<br />
<br />
b) Transfusing packed red blood cells<br />
<br />
c) Clamping the BT shunt<br />
<br />
d) Giving a bolus of phentolamine into the CPB reservoir<br />
<br />
e) Decreasing volatile agent on the CPB circuit<br />
<div class="mw-customtoggle-TYK_Answer" style="text-align: right; color:#0000ff">Click for Answer</div><br />
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==Answer==<br />
Answer d. Hypotension on CPB may be due to low flow rates, hemodilution, or<br />
collateral shunts. High concentrations of volatile agent administered into the<br />
CPB circuit may also contribute to the fall in MAP. A small incremental dose of<br />
vasoconstrictor, such as phenylephrine, can be given if improvement is not seen.<br />
A vasodilator such as phentolamine would be expected to decrease blood<br />
pressure for this patient.<br />
==Notes==<br />
<references /><br />
:This question originally printed in the [http://www.amazon.com/Justin-L.-Lockman/e/B00FLG5AEE/ref=ntt_dp_epwbk_0 Pediatric Anesthesiology Review Topics] kindle book series, and appears courtesy of Naerthwyn Press, LLC.<br />
==Keywords==<br />
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