I got a message quite awhile ago regarding del Nido cardioplegia. I posted it a year or so ago- but saw a great post regarding this on Perflist, and contacted Jorge Molina, CCP for his opinion…
“I wanted to post a question on your site asking if anyone has experience, protocols or literature supporting the use of Del Nido cardioplegia in adults. Love the site.“
From Jorge Molina, CCP
Plasmalyte-A based cardioplegias made possible by Toronto Sick Children’s cardioplegia master, Dr. Ivan Rebeyka which was put into the formulary there in March of 1993.
It was originally a 2:1 ratio by Dr. Rebeyka and still in use there. Dr. Rebeyka, now in Edmonton utilizes a 1:4 ratio. There have been various Lidocaine formulas with different dosages as well as different potassium dosages in the clinical arena and well established.
The most popular is the Boston/del Nido formula which utilizes higher lidocaine/KCL for longer cross-clamps. It has been discussed that the current Rebeyka formula may be the best choice for short cross-clamps under 60 minutes.
- Rebeyka uses 20 mEq of KCL and 100 mg Lidocaine.
- The Morell uses 75 mgs Lidocaine and about 26 mEq of KCL.
My choice for shorter cross-clamps is the Rebeyka 20 & 100 doses. Otherwise some colleagues say that the heart is sluggish for a while before it wakes up.
The other thought by Boston is to simply give half the dose. Because myocardial preservation requires hypothermia as a principle goal in addition to drugs, it is the opinion of this perfusionist to simply give the full dose of 20ml/kg but with the other two established formulas for projected short cross-clamps times.
Food for thought from this hombre.
From Bijender pal singh Bali,
Chief Pediatric Perfusionist, Fortis Escorts Heart Hospital, New Delhi, India
An extremely well written and organized power point presentation.
Click on image to view online