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September 17, 1982

Pathophysiology and Techniques of Cardiopulmonary Bypass

JAMA. 1982;248(11):1396. doi:10.1001/jama.1982.03330110080043

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After four prospective randomized studies have finally proved that coronary bypass surgery prolongs life in many subsets of patients, an illusion has arisen that cardiac surgery is routine and unproblematic. A book revealing the vacuities and turgidities in knowledge about pump pathophysiology is thus a welcome corrective.

Many chapters enhance one's sense of the complexities, eg, how bypass alters platelet function or when a high Hill coefficient becomes disadvantageous for oxygen delivery. While no essay neglects the space between the conventional and the experimental, those about synthetic bloods and how other species handle acid-base problems during hypothermia remain as calls for further investigation rather than practical treatises.

Pragmatists will learn why hyperkalemia rather than the usual hypokalemia may become an intraoperative problem if propranolol hydrochloride administration is continued until the last preoperative minute. Besides potassium kinetics, the chapter on how bypass alters pharmacologic interventions is particularly helpful. Plasma concentrations of