IABP

There’s always a good reason to review the physiology and reasons for placement of an Intra Aortic Balloon Pump (IABP).  We come across these a couple of times a month in our cardiac patients.  They’re a great temporary measure to stabilizing and treating the patient.

Contemporary Clinical Niche for Intra-Aortic Balloon Counterpulsation in Perioperative Cardiovascular Practice: An Evidence-Based Review for the Cardiovascular Anesthesiologist. JCVA, February 2017. Volume 31, Issue 1, Pages 309–320.

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From JCVA, Feb 2017.

One of the best explanations that I have ever seen for the IABP is from Dr. Rishi Kumar.  He’s a board certified anesthesiologist and is ICU fellowship trained and is pursuing a cardiac anesthesia fellowship as well.  This lovely human is no joke.  I’ve read his blog and his instagram posts, and he’s a wonderful teacher and mentor to those he reaches.  Please click his link for an entry regarding IABPs on his blog.

RKMD.com: Intra-Aortic Balloon Pump, Arterial Line, and EKG Waveforms. April 2018.

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TEE for placement of IABP

Anesthesia & Analgesia, July 2011. Vol 113, No. 1.

  • Want the tip 1-2 cm from left subclavian artery (LSCA)
  • X-plane aortic arch down to descending aorta to see the left subclavian artery
  • Visible during systole when the IABP balloon is deflated

Good visualization of the LSCA

A Novel Technique for Intra-aortic Balloon Positioning in the Intensive Care Unit.  J Extra Corpor Technol. 2012 Sep; 44(3): 160–162.

 

CABG and Ketamine #cardiac #pain

Back in residency, I had learned about the wonderful uses of ketamine for pain control…especially in patients with morbid obesity coming in for gastric bypass procedures.  Ketamine worked wonderfully in these patients to decrease the amount of narcotic that could have bad side effects such as respiratory depression.

Then, I got to thinking about CABGs and ketamine for decreasing heavy dose narcotics and aiding “fast-tracking” these cardiac patients.  Lo and behold, I came across these articles that provided me with some information:

So, instead of inducing with ketamine and midazolam, I think I’ll continue my same induction… however, work in ketamine during rewarming from CPB and provide no further narcotic.  I’m wondering if ketamine’s cardiac depressant effects will hurt me during this time.  After that thought, maybe it’s better that I consider ketamine for induction.

Any thoughts?