Weaning from cardiopulmonary bypass: problems and remedies.

W a patient from cardiopulmonary bypass (CPB) is an important step of surgical procedures. It requires the anaesthesiologist to apply the basic principles of cardiovascular physiology and pharmacology. The goal is a smooth transition from the mechanical pump back to the heart as the source of blood flow. Weaning off CPB should always be conducted in a coordinated fashion. The surgeon directs the weaning process with input from anaesthesiologist and perfusionist. A skillful anaesthesiologist usually shares the control of weaning with the surgeon. Weaning from pump involves optimising cardiovascular variables. The time for optimisation is compressed to minutes or seconds, and decision must be made quickly to avoid myocardial injury or damage to the other major organ systems. The subject will be dealt under following headings.