PH and Temp1

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erator Kingsoft Office}{\info {\title 9. pH AND TEMPERATURE }{\creatim \yr2016 \
mo10 \dy1 \hr14 \min18 }{\revtim \yr2411 \mo12 \dy30 \hr0 \min0 }{\version1 }}\p
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\hich \af0 \loch \af0 {\b1 \fs36 \kerning2 \dbch \af2 \hich \af0 \loch \f0 \cgri
d1 \langfe2052 \langfenp2052 \cf1 9. pH AND TEMPERATURE }{\fs21 \kerning2 \dbch
\af2 \hich \af0 \loch \f0 \cgrid1 \langfe2052 \langfenp2052 \par }\pard \plain \
qj \li0 \ri0 \widctlpar \aspalpha \faauto \adjustright \lin0 \rin0 \intbl1 \itap
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052 \langfenp2052 SHAPE \\* MERGEFORMAT }}{\*\fldrslt {\fs21 \kerning2 \dbch \a
f2 \hich \af0 \loch \af0 \cgrid1 \langfe2052 \langfenp2052 }{\fs21 \kerning2 \db
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\hich \af0 \loch \af0 \cgrid1 \langfe2052 \langfenp2052 }{\fs21 \kerning2 \dbch
\af2 \hich \af0 \loch \f0 \cgrid1 \langfe2052 \langfenp2052 \par }\pard \plain
\qj \li0 \ri0 \widctlpar \aspalpha \adjustright \lin0 \rin0 \intbl1 \itap1 \fs21
\kerning2 \dbch \af2 \hich \af0 \loch \af0 {\fs21 \kerning2 \dbch \af2 \hich \a
f0 \loch \f0 \cgrid1 \langfe2052 \langfenp2052 \cf1 If a patient's central tempe
rature is not near 37\uc1 \u65533 ?C and measurement of pH and PCO}{\fs15 \kerni
ng2 \dbch \af2 \hich \af0 \loch \f0 \cgrid1 \langfe2052 \langfenp2052 \cf1 2}{\f
s21 \kerning2 \dbch \af2 \hich \af0 \loch \f0 \cgrid1 \langfe2052 \langfenp2052
\cf1 are made on electrodes at 37\uc1 \u65533 ?C problems of interpretation of
the results exist. The readings of pH and PCO}{\fs15 \kerning2 \dbch \af2 \hich
\af0 \loch \f0 \cgrid1 \langfe2052 \langfenp2052 \cf1 2}{\fs21 \kerning2 \dbch \
af2 \hich \af0 \loch \f0 \cgrid1 \langfe2052 \langfenp2052 \cf1 differ from tho
se which would be obtained from electrodes held at the temperature of the patien
t.}{\fs21 \kerning2 \dbch \af2 \hich \af0 \loch \f0 \cgrid1 \langfe2052 \langfen
p2052 \par }\pard \plain \qj \li0 \ri0 \widctlpar \aspalpha \adjustright \lin0 \
rin0 \intbl1 \itap1 \fs21 \kerning2 \dbch \af2 \hich \af0 \loch \af0 {\fs21 \ker
ning2 \dbch \af2 \hich \af0 \loch \f0 \cgrid1 \langfe2052 \langfenp2052 \cf1 A s
econd set of problems are related to the physiological meaning of pH and PCO}{\f
\cf1 2}{\fs21 \kerning2 \dbch \af2 \hich \af0 \loch \f0 \cgrid1 \langfe2052 \lan
gfenp2052 \cf1 readings at patient temperatures other than 37\uc1 \u65533 ?C ev
en if the readings are made at or corrected for such a temperature.}{\fs21 \kern
ing2 \dbch \af2 \hich \af0 \loch \f0 \cgrid1 \langfe2052 \langfenp2052 \par }\pa
rd \plain \qj \li0 \ri0 \widctlpar \aspalpha \adjustright \lin0 \rin0 \intbl1 \i
tap1 \fs21 \kerning2 \dbch \af2 \hich \af0 \loch \af0 {\fs21 \kerning2 \dbch \af
2 \hich \af0 \loch \f0 \cgrid1 \langfe2052 \langfenp2052 \cf1 A third set of pro
blems are those related to gradients from one part of the body to another. If th
is is important, it will be most critical during extracorporeal cooling or warmi
ng if rapid changes in temperature are attempted, e.g. 1\uc1 \u65533 ?C/minute c
hange in oesophageal temperature.}{\fs21 \kerning2 \dbch \af2 \hich \af0 \loch \
f0 \cgrid1 \langfe2052 \langfenp2052 \par }\pard \plain \qj \li0 \ri0 \widctlpar
\aspalpha \adjustright \lin0 \rin0 \intbl1 \itap1 \fs21 \kerning2 \dbch \af2 \h
ich \af0 \loch \af0 {\fs21 \kerning2 \dbch \af2 \hich \af0 \loch \f0 \cgrid1 \la
ngfe2052 \langfenp2052 \cf1 I think that at all temperatures from which survival
can be reasonably expected (10 to 44\uc1 \u65533 ?C), optimal pH is near 7.4 an
d optimal PCO}{\fs15 \kerning2 \dbch \af2 \hich \af0 \loch \f0 \cgrid1 \langfe20
52 \langfenp2052 \cf1 2}{\fs21 \kerning2 \dbch \af2 \hich \af0 \loch \f0 \cgrid1
\langfe2052 \langfenp2052 \cf1 near 40mmHg at the temperature of the patient.}
{\fs21 \kerning2 \dbch \af2 \hich \af0 \loch \f0 \cgrid1 \langfe2052 \langfenp20
52 \par }\pard \plain \qj \li0 \ri0 \widctlpar \aspalpha \adjustright \lin0 \rin
0 \intbl1 \itap1 \fs21 \kerning2 \dbch \af2 \hich \af0 \loch \af0 {\fs21 \kernin
g2 \dbch \af2 \hich \af0 \loch \f0 \cgrid1 \langfe2052 \langfenp2052 \cf1 In }{\
field \fldedit {\*\fldinst {\fs21 \kerning2 \dbch \af2 \hich \af0 \loch \af0 \cg
rid1 \langfe2052 \langfenp2052 \cf13 \ul1 }{\fs21 \kerning2 \dbch \af2 \hich \af
0 \loch \f0 \cgrid1 \langfe2052 \langfenp2052 \cf13 \ul1 HYPERLINK "http://www.a
naesthesia.med.usyd.edu.au/resources/lectures/acidbase_mjb/phandtemp.html#tempph
a9"}}{\*\fldrslt {\fs21 \kerning2 \dbch \af2 \hich \af0 \loch \af0 \cgrid1 \lang
fe2052 \langfenp2052 \cf13 \ul1 }{\fs21 \kerning2 \dbch \af2 \hich \af0 \loch \f
0 \cgrid1 \langfe2052 \langfenp2052 \cf13 \ul1 Appendix 9}}}{\fs21 \kerning2 \db
ch \af2 \hich \af0 \loch \af0 \cgrid1 \langfe2052 \langfenp2052 \cf13 \ul1 }{\fs
21 \kerning2 \dbch \af2 \hich \af0 \loch \f0 \cgrid1 \langfe2052 \langfenp2052 \
cf1 , there is further discussion of various "optimal" desired pH and PCO}{\fs15
\kerning2 \dbch \af2 \hich \af0 \loch \f0 \cgrid1 \langfe2052 \langfenp2052 \cf
1 2}{\fs21 \kerning2 \dbch \af2 \hich \af0 \loch \f0 \cgrid1 \langfe2052 \langfe
np2052 \cf1 states advocated by different authorities. It is probably not possi
ble to resolve the differences because the criteria of "optimal" state are often
not comparable. For example, mortality of surgery, physiological manifestations
and biochemical phenomena have been used. The practical consequences to be disc
ussed are relevant whichever level of PCO2 or pH one decides to aim at:}{\fs21 \
kerning2 \dbch \af2 \hich \af0 \loch \f0 \cgrid1 \langfe2052 \langfenp2052 \par
}\pard \plain \qj \li0 \ri0 \widctlpar \aspalpha \adjustright \lin0 \rin0 \intbl
1 \itap1 \fs21 \kerning2 \dbch \af2 \hich \af0 \loch \af0 {\b1 \fs28 \kerning2 \
dbch \af2 \hich \af0 \loch \f0 \cgrid1 \langfe2052 \langfenp2052 \cf1 9.1. CO2 P
roduction when Body Temperature is low.}{\fs21 \kerning2 \dbch \af2 \hich \af0 \
loch \f0 \cgrid1 \langfe2052 \langfenp2052 \par }\pard \plain \qj \li0 \ri0 \wid
ctlpar \aspalpha \adjustright \lin0 \rin0 \intbl1 \itap1 \fs21 \kerning2 \dbch \
af2 \hich \af0 \loch \af0 {\fs21 \kerning2 \dbch \af2 \hich \af0 \loch \f0 \cgri
d1 \langfe2052 \langfenp2052 \cf1 In the steady state of low body temperature th
e metabolic rate is low and so CO}{\fs15 \kerning2 \dbch \af2 \hich \af0 \loch \
f0 \cgrid1 \langfe2052 \langfenp2052 \cf1 2}{\fs21 \kerning2 \dbch \af2 \hich \a
f0 \loch \f0 \cgrid1 \langfe2052 \langfenp2052 \cf1 production is low. The alve
olar ventilation will have to match this low production if the PaCO}{\fs15 \kern
ing2 \dbch \af2 \hich \af0 \loch \f0 \cgrid1 \langfe2052 \langfenp2052 \cf1 2}{\
fs21 \kerning2 \dbch \af2 \hich \af0 \loch \f0 \cgrid1 \langfe2052 \langfenp2052
\cf1 is to be kept near 40mmHg. This applies to both artificial and spontaneou
s respiration.}{\fs21 \kerning2 \dbch \af2 \hich \af0 \loch \f0 \cgrid1 \langfe2
052 \langfenp2052 \par }\pard \plain \qj \li0 \ri0 \widctlpar \aspalpha \adjustr
ight \lin0 \rin0 \intbl1 \itap1 \fs21 \kerning2 \dbch \af2 \hich \af0 \loch \af0
052 \cf1 In accidental hypothermia which occurs associated with exposure to cold
climatic conditions, often in patients who are already debilitated or intoxicat
ed, there may be little or no respiratory movement when first seen in the Emerge
ncy Department. It is tempting to institute intermittent positive pressure respi
ration in the presence of such a clinical picture. This may result in a very low
PaCO}{\fs15 \kerning2 \dbch \af2 \hich \af0 \loch \f0 \cgrid1 \langfe2052 \lang
fenp2052 \cf1 2}{\fs21 \kerning2 \dbch \af2 \hich \af0 \loch \f0 \cgrid1 \langfe
2052 \langfenp2052 \cf1 , e.g. less than 10mmHg.}{\fs21 \kerning2 \dbch \af2 \hi
ch \af0 \loch \f0 \cgrid1 \langfe2052 \langfenp2052 \par }\pard \plain \qj \li0
\ri0 \widctlpar \aspalpha \adjustright \lin0 \rin0 \intbl1 \itap1 \fs21 \kerning
2 \dbch \af2 \hich \af0 \loch \af0 {\fs21 \kerning2 \dbch \af2 \hich \af0 \loch
\f0 \cgrid1 \langfe2052 \langfenp2052 \cf1 In clinically induced hypothermia the
same problem can occur, if as is usual, artificial respiration is used for the
anaesthetic required to enable the body to be cooled. Ordinary respiratory rates
and tidal volumes will result in very low PaCO}{\fs15 \kerning2 \dbch \af2 \hic
h \af0 \loch \f0 \cgrid1 \langfe2052 \langfenp2052 \cf1 2}{\fs21 \kerning2 \dbch
\af2 \hich \af0 \loch \f0 \cgrid1 \langfe2052 \langfenp2052 \cf1 's.}{\fs21 \ke
rning2 \dbch \af2 \hich \af0 \loch \f0 \cgrid1 \langfe2052 \langfenp2052 \par }\
pard \plain \qj \li0 \ri0 \widctlpar \aspalpha \adjustright \lin0 \rin0 \intbl1
\itap1 \fs21 \kerning2 \dbch \af2 \hich \af0 \loch \af0 {\fs21 \kerning2 \dbch \
af2 \hich \af0 \loch \f0 \cgrid1 \langfe2052 \langfenp2052 \cf1 Although I know
of no studies specifically examining the effects of low PCO}{\fs15 \kerning2 \db
ch \af2 \hich \af0 \loch \f0 \cgrid1 \langfe2052 \langfenp2052 \cf1 2}{\fs21 \ke
rning2 \dbch \af2 \hich \af0 \loch \f0 \cgrid1 \langfe2052 \langfenp2052 \cf1 's
in hypothermia, when respiration is controlled, it is reasonable to assume very
low PCO}{\fs15 \kerning2 \dbch \af2 \hich \af0 \loch \f0 \cgrid1 \langfe2052 \l
angfenp2052 \cf1 2}{\fs21 \kerning2 \dbch \af2 \hich \af0 \loch \f0 \cgrid1 \lan
gfe2052 \langfenp2052 \cf1 's would not be beneficial. Cerebral vasoconstriction
and a shift of the oxygen dissociation curve are the main theoretical consequen
ces which would have to be sought in any such studies. The extreme shift in the
oxygen dissociation curve could lead to tissue hypoxia resulting in the release
of acidic products of metabolism and causing hypoxic tissue damage.}{\fs21 \kern
2 \hich \af0 \loch \f0 \cgrid1 \langfe2052 \langfenp2052 \cf1 To keep the PCO}{\
\cf1 2}{\fs21 \kerning2 \dbch \af2 \hich \af0 \loch \f0 \cgrid1 \langfe2052 \la
ngfenp2052 \cf1 from falling the following solutions can be applied together wi
th monitoring of end tidal CO}{\fs15 \kerning2 \dbch \af2 \hich \af0 \loch \f0 \
cgrid1 \langfe2052 \langfenp2052 \cf1 2}{\fs21 \kerning2 \dbch \af2 \hich \af0 \
loch \f0 \cgrid1 \langfe2052 \langfenp2052 \cf1 :}{\fs21 \kerning2 \dbch \af2 \h
ich \af0 \loch \f0 \cgrid1 \langfe2052 \langfenp2052 \par }\pard \plain \qj \fi0
\li360 \ri0 \widctlpar \aspalpha \adjustright \lin360 \rin0 \tql \tx720 \intbl1
\itap1 \ls1 \fs21 \kerning2 \dbch \af2 \hich \af0 \loch \af0 {\fs21 \kerning2 \
dbch \af2 \hich \af0 \loch \f0 \cgrid1 \langfe2052 \langfenp2052 Increasing the
inspired oxygen partial pressure but allowing the respiration to remain spontane
ous, e.g. endotracheal intubation and connecting the tube to some type of anaest
hetic circuit to which only oxygen is added.}{\fs21 \kerning2 \dbch \af2 \hich \
af0 \loch \f0 \cgrid1 \langfe2052 \langfenp2052 \par }\pard \plain \qj \fi0 \li3
60 \ri0 \widctlpar \aspalpha \adjustright \lin360 \rin0 \tql \tx720 \intbl1 \ita
p1 \ls1 \fs21 \kerning2 \dbch \af2 \hich \af0 \loch \af0 {\fs21 \kerning2 \dbch
\af2 \hich \af0 \loch \f0 \cgrid1 \langfe2052 \langfenp2052 Artificial ventilati
on with 5% CO2 in oxygen.}{\fs21 \kerning2 \dbch \af2 \hich \af0 \loch \f0 \cgri
d1 \langfe2052 \langfenp2052 \par }\pard \plain \qj \fi0 \li360 \ri0 \widctlpar
\aspalpha \adjustright \lin360 \rin0 \tql \tx720 \intbl1 \itap1 \ls1 \fs21 \kern
ing2 \dbch \af2 \hich \af0 \loch \af0 {\fs21 \kerning2 \dbch \af2 \hich \af0 \lo
ch \f0 \cgrid1 \langfe2052 \langfenp2052 Artificial ventilation with a closed an
aesthetic circuit without soda lime absorption and with a low fresh gas flow.}{\
\par }\pard \plain \qj \li0 \ri0 \widctlpar \aspalpha \adjustright \lin0 \rin0
\intbl1 \itap1 \fs21 \kerning2 \dbch \af2 \hich \af0 \loch \af0 {\fs21 \kerning2
\dbch \af2 \hich \af0 \loch \f0 \cgrid1 \langfe2052 \langfenp2052 \cf1 }{\fs21
\kerning2 \dbch \af2 \hich \af0 \loch \f0 \cgrid1 \langfe2052 \langfenp2052 \pa
r }\pard \plain \qj \li0 \ri0 \widctlpar \aspalpha \adjustright \lin0 \rin0 \int
bl1 \itap1 \fs21 \kerning2 \dbch \af2 \hich \af0 \loch \af0 {\b1 \fs28 \kerning2
\dbch \af2 \hich \af0 \loch \f0 \cgrid1 \langfe2052 \langfenp2052 \cf1 9.2 CO}{
\fs20 \kerning2 \dbch \af2 \hich \af0 \loch \f0 \cgrid1 \langfe2052 \langfenp205
2 \cf1 2}{\b1 \fs28 \kerning2 \dbch \af2 \hich \af0 \loch \f0 \cgrid1 \langfe205
2 \langfenp2052 \cf1 Balance during the Cooling Process.}{\fs21 \kerning2 \dbch
f0 \loch \f0 \cgrid1 \langfe2052 \langfenp2052 \cf1 During the cooling process t
he balance of CO}{\fs15 \kerning2 \dbch \af2 \hich \af0 \loch \f0 \cgrid1 \langf
e2052 \langfenp2052 \cf1 2}{\fs21 \kerning2 \dbch \af2 \hich \af0 \loch \f0 \cgr
id1 \langfe2052 \langfenp2052 \cf1 also has to be taken into account. If coolin
g is rapid (e.g. 1\uc1 \u65533 ?C every 3-5 minutes), the quantity of CO2 which
has to be dissolved in body tissues to prevent the PCO2 falling is great and eve
n if the lungs or the oxygenator are ventilated with a CO}{\fs15 \kerning2 \dbch
\af2 \hich \af0 \loch \f0 \cgrid1 \langfe2052 \langfenp2052 \cf1 2 }{\fs21 \ker
ning2 \dbch \af2 \hich \af0 \loch \f0 \cgrid1 \langfe2052 \langfenp2052 \cf1 con
taining mixture the PCO}{\fs15 \kerning2 \dbch \af2 \hich \af0 \loch \f0 \cgrid1
\langfe2052 \langfenp2052 \cf1 2}{\fs21 \kerning2 \dbch \af2 \hich \af0 \loch \
f0 \cgrid1 \langfe2052 \langfenp2052 \cf1 in arterial blood and/or mixed venous
blood may fall.}{\fs21 \kerning2 \dbch \af2 \hich \af0 \loch \f0 \cgrid1 \langf
e2052 \langfenp2052 \par }\pard \plain \qj \li0 \ri0 \widctlpar \aspalpha \adjus
tright \lin0 \rin0 \intbl1 \itap1 \fs21 \kerning2 \dbch \af2 \hich \af0 \loch \a
f0 {\fs21 \kerning2 \dbch \af2 \hich \af0 \loch \f0 \cgrid1 \langfe2052 \langfen
p2052 \cf1 To maintain the PCO}{\fs15 \kerning2 \dbch \af2 \hich \af0 \loch \f0
\cgrid1 \langfe2052 \langfenp2052 \cf1 2}{\fs21 \kerning2 \dbch \af2 \hich \af0
\loch \f0 \cgrid1 \langfe2052 \langfenp2052 \cf1 while the temperature is being
altered the following recommendations should be applied:}{\fs21 \kerning2 \dbch
f0 \loch \f0 \cgrid1 \langfe2052 \langfenp2052 \cf1 a) Surface Cooling: }{\fs21
\kerning2 \dbch \af2 \hich \af0 \loch \f0 \cgrid1 \langfe2052 \langfenp2052 \par
}\pard \plain \qj \li0 \ri0 \widctlpar \aspalpha \adjustright \lin0 \rin0 \intb
l1 \itap1 \fs21 \kerning2 \dbch \af2 \hich \af0 \loch \af0 {\fs21 \kerning2 \dbc
h \af2 \hich \af0 \loch \f0 \cgrid1 \langfe2052 \langfenp2052 \cf1 i) Administer
5% CO}{\fs15 \kerning2 \dbch \af2 \hich \af0 \loch \f0 \cgrid1 \langfe2052 \lan
gfenp2052 \cf1 2}{\fs21 \kerning2 \dbch \af2 \hich \af0 \loch \f0 \cgrid1 \langf
e2052 \langfenp2052 \cf1 with hyperventilation during cooling. Check the PaCO}{
2 \cf1 2}{\fs21 \kerning2 \dbch \af2 \hich \af0 \loch \f0 \cgrid1 \langfe2052 \l
angfenp2052 \cf1 during and after stability has been achieved. Correct PaCO}{\f
gfenp2052 \cf1 for temperature or set an electrode system at the lower temperat
ure. Adjust inspired CO}{\fs15 \kerning2 \dbch \af2 \hich \af0 \loch \f0 \cgrid1
f0 \cgrid1 \langfe2052 \langfenp2052 \cf1 to keep PaCO2 near 40mmHg at the temp
erature of the patient. (End tidal ie alveolar PCO}{\fs15 \kerning2 \dbch \af2 \
hich \af0 \loch \f0 \cgrid1 \langfe2052 \langfenp2052 \cf1 2}{\fs21 \kerning2 \d
bch \af2 \hich \af0 \loch \f0 \cgrid1 \langfe2052 \langfenp2052 \cf1 would be a
rapid guide in achieving the desired PCO}{\fs15 \kerning2 \dbch \af2 \hich \af0
\loch \f0 \cgrid1 \langfe2052 \langfenp2052 \cf1 2}{\fs21 \kerning2 \dbch \af2
\hich \af0 \loch \f0 \cgrid1 \langfe2052 \langfenp2052 \cf1 . If a Swan-Ganz cat
heter is in place the mixed venous PCO}{\fs15 \kerning2 \dbch \af2 \hich \af0 \l
och \f0 \cgrid1 \langfe2052 \langfenp2052 \cf1 2}{\fs21 \kerning2 \dbch \af2 \hi
ch \af0 \loch \f0 \cgrid1 \langfe2052 \langfenp2052 \cf1 may be more useful tha
n the arterial)}{\fs21 \kerning2 \dbch \af2 \hich \af0 \loch \f0 \cgrid1 \langfe
2052 \langfenp2052 \par }\pard \plain \qj \li0 \ri0 \widctlpar \aspalpha \adjust
right \lin0 \rin0 \intbl1 \itap1 \fs21 \kerning2 \dbch \af2 \hich \af0 \loch \af
0 {\fs21 \kerning2 \dbch \af2 \hich \af0 \loch \f0 \cgrid1 \langfe2052 \langfenp
2052 \cf1 ii) Use a low flow of gas into the anaesthetic circuit or allow sponta
neous respiration during the cooling process. Again it will be necessary to chec
k and adjust the PaCO}{\fs15 \kerning2 \dbch \af2 \hich \af0 \loch \f0 \cgrid1 \
langfe2052 \langfenp2052 \cf1 2}{\fs21 \kerning2 \dbch \af2 \hich \af0 \loch \f0
\cgrid1 \langfe2052 \langfenp2052 \cf1 .}{\fs21 \kerning2 \dbch \af2 \hich \af0
\loch \f0 \cgrid1 \langfe2052 \langfenp2052 \par }\pard \plain \qj \li0 \ri0 \w
idctlpar \aspalpha \adjustright \lin0 \rin0 \intbl1 \itap1 \fs21 \kerning2 \dbch
\af2 \hich \af0 \loch \af0 {\fs21 \kerning2 \dbch \af2 \hich \af0 \loch \f0 \cg
rid1 \langfe2052 \langfenp2052 \cf1 b) Extracorporeal Cooling: }{\fs21 \kerning2
\dbch \af2 \hich \af0 \loch \f0 \cgrid1 \langfe2052 \langfenp2052 \par }\pard \
plain \qj \li0 \ri0 \widctlpar \aspalpha \adjustright \lin0 \rin0 \intbl1 \itap1
\fs21 \kerning2 \dbch \af2 \hich \af0 \loch \af0 {\fs21 \kerning2 \dbch \af2 \h
ich \af0 \loch \f0 \cgrid1 \langfe2052 \langfenp2052 \cf1 Limit rate of cooling
to not greater than 1\uc1 \u65533 ?C/3 min. This is important to ensure eveness
of cooling as well as for maintenance of the desired pH and PCO}{\fs15 \kerning2
\dbch \af2 \hich \af0 \loch \f0 \cgrid1 \langfe2052 \langfenp2052 \cf1 2}{\fs21
1 state. Administer 20% CO}{\fs15 \kerning2 \dbch \af2 \hich \af0 \loch \f0 \cg
rid1 \langfe2052 \langfenp2052 \cf1 2}{\fs21 \kerning2 \dbch \af2 \hich \af0 \lo
ch \f0 \cgrid1 \langfe2052 \langfenp2052 \cf1 into the oxygenator during coolin
g. Check the PCO}{\fs15 \kerning2 \dbch \af2 \hich \af0 \loch \f0 \cgrid1 \langf
id1 \langfe2052 \langfenp2052 \cf1 of the mixed venous blood (i.e. from the ven
ous reservoir of the extracorporeal pump). Arterial blood would not be satisfact
ory as there is usually a very large gradient for CO}{\fs15 \kerning2 \dbch \af2
\hich \af0 \loch \f0 \cgrid1 \langfe2052 \langfenp2052 \cf1 2}{\fs21 \kerning2
\dbch \af2 \hich \af0 \loch \f0 \cgrid1 \langfe2052 \langfenp2052 \cf1 between
the arterial blood and the other tissues during cooling.}{\fs21 \kerning2 \dbch
\af2 \hich \af0 \loch \f0 \cgrid1 \langfe2052 \langfenp2052 \par }\pard \plain \
qj \li0 \ri0 \widctlpar \aspalpha \adjustright \lin0 \rin0 \intbl1 \itap1 \fs21
\kerning2 \dbch \af2 \hich \af0 \loch \af0 {\fs21 \kerning2 \dbch \af2 \hich \af
0 \loch \f0 \cgrid1 \langfe2052 \langfenp2052 \cf1 (Note: The arterial blood is
the same as the blood leaving the pump whereas the venous reservoir blood PCO}{\
ngfenp2052 \cf1 would be closer to that of the tissues during a period of rapid
uptake of CO}{\fs15 \kerning2 \dbch \af2 \hich \af0 \loch \f0 \cgrid1 \langfe20
\langfe2052 \langfenp2052 \cf1 ).}{\fs21 \kerning2 \dbch \af2 \hich \af0 \loch
\f0 \cgrid1 \langfe2052 \langfenp2052 \par }\pard \plain \qj \li0 \ri0 \widctlpa
r \aspalpha \adjustright \lin0 \rin0 \intbl1 \itap1 \fs21 \kerning2 \dbch \af2 \
hich \af0 \loch \af0 {\fs21 \kerning2 \dbch \af2 \hich \af0 \loch \f0 \cgrid1 \l
angfe2052 \langfenp2052 \cf1 During rewarming the liberation of CO}{\fs15 \kerni
\cf1 increases and will require adjustment of alveolar ventilation and/or stopp
ing of CO}{\fs15 \kerning2 \dbch \af2 \hich \af0 \loch \f0 \cgrid1 \langfe2052 \
langfenp2052 \cf1 2}{\fs21 \kerning2 \dbch \af2 \hich \af0 \loch \f0 \cgrid1 \la
ngfe2052 \langfenp2052 \cf1 administration to the extracorporeal circuit to kee
p the PCO}{\fs15 \kerning2 \dbch \af2 \hich \af0 \loch \f0 \cgrid1 \langfe2052 \
ngfe2052 \langfenp2052 \cf1 at the desired level. (}{\field \fldedit {\*\fldins
t {\fs21 \kerning2 \dbch \af2 \hich \af0 \loch \af0 \cgrid1 \langfe2052 \langfen
p2052 \cf13 \ul1 }{\fs21 \kerning2 \dbch \af2 \hich \af0 \loch \f0 \cgrid1 \lang
fe2052 \langfenp2052 \cf13 \ul1 HYPERLINK "http://www.anaesthesia.med.usyd.edu.a
u/resources/lectures/acidbase_mjb/phandtemp.html#temppha9"}}{\*\fldrslt {\fs21 \
kerning2 \dbch \af2 \hich \af0 \loch \af0 \cgrid1 \langfe2052 \langfenp2052 \cf1
3 \ul1 }{\fs21 \kerning2 \dbch \af2 \hich \af0 \loch \f0 \cgrid1 \langfe2052 \la
ngfenp2052 \cf13 \ul1 See Appendix A.9}}}{\fs21 \kerning2 \dbch \af2 \hich \af0
\loch \af0 \cgrid1 \langfe2052 \langfenp2052 \cf13 \ul1 }{\fs21 \kerning2 \dbch
\af2 \hich \af0 \loch \f0 \cgrid1 \langfe2052 \langfenp2052 \cf1 , below).}{\fs2
1 \kerning2 \dbch \af2 \hich \af0 \loch \f0 \cgrid1 \langfe2052 \langfenp2052 \p
ar }\pard \plain \qj \li0 \ri0 \widctlpar \aspalpha \faauto \adjustright \lin0 \
rin0 \intbl1 \itap1 \fs21 \kerning2 \dbch \af2 \hich \af0 \loch \af0 {\field \fl
dedit \flddirty {\*\fldinst {\fs21 \kerning2 \dbch \af2 \hich \af0 \loch \af0 \c
grid1 \langfe2052 \langfenp2052 }{\fs21 \kerning2 \dbch \af2 \hich \af0 \loch \f
0 \cgrid1 \langfe2052 \langfenp2052 SHAPE \\* MERGEFORMAT }}{\*\fldrslt {\fs21
\kerning2 \dbch \af2 \hich \af0 \loch \af0 \cgrid1 \langfe2052 \langfenp2052 }{\
fs21 \kerning2 \dbch \af2 \hich \af0 \loch \af0 \cgrid1 \langfe2052 \langfenp205
2 {\shp {\*\shpinst \shpleft0 \shptop0 \shpright8648 \shpbottom15 \shpfhdr0 \shp
bxcolumn \shpbxignore \shpbypara \shpbyignore \shpwr3 \shpwrk0 \shpfblwtxt1 \shp
z1 \shplid1027 {\sp {\sn shapeType}{\sv 20}}{\sp {\sn fFlipH}{\sv 0}}{\sp {\sn f
FlipV}{\sv 0}}{\sp {\sn fLockAgainstGrouping}{\sv 0}}{\sp {\sn fLockText}{\sv 0}
}{\sp {\sn fLockVerticies}{\sv 0}}{\sp {\sn fLockAspectRatio}{\sv 0}}{\sp {\sn f
LockRotation}{\sv 0}}{\sp {\sn WrapText}{\sv 0}}{\sp {\sn fFillOK}{\sv 0}}{\sp {
\sn fShadowOK}{\sv 1}}{\sp {\sn fFilled}{\sv 0}}{\sp {\sn lineWidth}{\sv 9842}}{
\sp {\sn lineStyle}{\sv 0}}{\sp {\sn fLine}{\sv 1}}{\sp {\sn fArrowheadsOK}{\sv
1}}{\sp {\sn fLayoutInCell}{\sv 1}}{\sp {\sn fPseudoInline}{\sv 1}}}}}{\fs21 \ke
rning2 \dbch \af2 \hich \af0 \loch \af0 \cgrid1 \langfe2052 \langfenp2052 {\*\sh
ppict {\pict {\*\picprop \shplid0 {\sp {\sn shapeType}{\sv 75}}{\sp {\sn fFlipH}
{\sv 0}}{\sp {\sn fFlipV}{\sv 0}}{\sp {\sn fPseudoInline}{\sv 1}}}}}}}}{\fs21 \k
erning2 \dbch \af2 \hich \af0 \loch \af0 \cgrid1 \langfe2052 \langfenp2052 }{\fs
par }\pard \plain \qj \li0 \ri0 \widctlpar \aspalpha \adjustright \lin0 \rin0 \i
ntbl1 \itap1 \fs21 \kerning2 \dbch \af2 \hich \af0 \loch \af0 {\fs21 \kerning2 \
dbch \af2 \hich \af0 \loch \f0 \cgrid1 \langfe2052 \langfenp2052 \cf1 }{\fs21 \
}\pard \plain \qc \li0 \ri0 \widctlpar \aspalpha \adjustright \lin0 \rin0 \intbl
1 \itap1 \fs21 \kerning2 \dbch \af2 \hich \af0 \loch \af0 {\b1 \fs36 \kerning2 \
dbch \af2 \hich \af0 \loch \f0 \cgrid1 \langfe2052 \langfenp2052 \cf1 A.9. Tempe
rature and pH}{\fs21 \kerning2 \dbch \af2 \hich \af0 \loch \f0 \cgrid1 \langfe20
52 \langfenp2052 \par }\pard \plain \qj \li0 \ri0 \widctlpar \aspalpha \faauto \
adjustright \lin0 \rin0 \intbl1 \itap1 \fs21 \kerning2 \dbch \af2 \hich \af0 \lo
ch \af0 {\field \fldedit \flddirty {\*\fldinst {\fs21 \kerning2 \dbch \af2 \hich
\af0 \loch \af0 \cgrid1 \langfe2052 \langfenp2052 }{\fs21 \kerning2 \dbch \af2
\hich \af0 \loch \f0 \cgrid1 \langfe2052 \langfenp2052 SHAPE \\* MERGEFORMAT }}
{\*\fldrslt {\fs21 \kerning2 \dbch \af2 \hich \af0 \loch \af0 \cgrid1 \langfe205
2 \langfenp2052 }{\fs21 \kerning2 \dbch \af2 \hich \af0 \loch \af0 \cgrid1 \lang
fe2052 \langfenp2052 {\shp {\*\shpinst \shpleft0 \shptop0 \shpright8648 \shpbott
om15 \shpfhdr0 \shpbxcolumn \shpbxignore \shpbypara \shpbyignore \shpwr3 \shpwrk
0 \shpfblwtxt1 \shpz2 \shplid1028 {\sp {\sn shapeType}{\sv 20}}{\sp {\sn fFlipH}
{\sv 0}}{\sp {\sn fFlipV}{\sv 0}}{\sp {\sn fLockAgainstGrouping}{\sv 0}}{\sp {\s
n fLockText}{\sv 0}}{\sp {\sn fLockVerticies}{\sv 0}}{\sp {\sn fLockAspectRatio}
{\sv 0}}{\sp {\sn fLockRotation}{\sv 0}}{\sp {\sn WrapText}{\sv 0}}{\sp {\sn fFi
llOK}{\sv 0}}{\sp {\sn fShadowOK}{\sv 1}}{\sp {\sn fFilled}{\sv 0}}{\sp {\sn lin
eWidth}{\sv 9842}}{\sp {\sn lineStyle}{\sv 0}}{\sp {\sn fLine}{\sv 1}}{\sp {\sn
fArrowheadsOK}{\sv 1}}{\sp {\sn fLayoutInCell}{\sv 1}}{\sp {\sn fPseudoInline}{\
sv 1}}}}}{\fs21 \kerning2 \dbch \af2 \hich \af0 \loch \af0 \cgrid1 \langfe2052 \
langfenp2052 {\*\shppict {\pict {\*\picprop \shplid0 {\sp {\sn shapeType}{\sv 75
}}{\sp {\sn fFlipH}{\sv 0}}{\sp {\sn fFlipV}{\sv 0}}{\sp {\sn fPseudoInline}{\sv
1}}}}}}}}{\fs21 \kerning2 \dbch \af2 \hich \af0 \loch \af0 \cgrid1 \langfe2052
\langfenp2052 }{\fs21 \kerning2 \dbch \af2 \hich \af0 \loch \f0 \cgrid1 \langfe2
052 \langfenp2052 \par }\pard \plain \qj \li0 \ri0 \widctlpar \aspalpha \adjustr
ight \lin0 \rin0 \intbl1 \itap1 \fs21 \kerning2 \dbch \af2 \hich \af0 \loch \af0
052 \cf1 Partial pressure of a gas is that pressure which would be present if th
e particular gas alone occupied the space containing the gas mixture. The total
pressure of a gas mixture is equal to the sum of the separate partial pressure o
f each component of the mixture. The partial pressure of a gas in a liquid is de
fined as the partial pressure of that gas which would be present in a gas mixtur
e in equilibrium with the liquid.}{\fs21 \kerning2 \dbch \af2 \hich \af0 \loch \
f0 \cgrid1 \langfe2052 \langfenp2052 \par }\pard \plain \qj \li0 \ri0 \widctlpar
ngfe2052 \langfenp2052 \cf1 Solubility of a gas in liquids increases as the temp
erature decreases, i.e. a larger quantity of gas will dissolve at any particular
partial pressure if the temperature falls or when there is no gaseous phase in
contact with the liquid, the partial pressure falls when the temperature falls.}
g2 \dbch \af2 \hich \af0 \loch \f0 \cgrid1 \langfe2052 \langfenp2052 \cf1 When a
patient's central temperature deviates much from 37\uc1 \u65533 ?C interpretati
on in the literature of pH and PCO}{\fs15 \kerning2 \dbch \af2 \hich \af0 \loch
\f0 \cgrid1 \langfe2052 \langfenp2052 \cf1 2}{\fs21 \kerning2 \dbch \af2 \hich \
af0 \loch \f0 \cgrid1 \langfe2052 \langfenp2052 \cf1 data is very confused. Rea
sons for confusion:}{\fs21 \kerning2 \dbch \af2 \hich \af0 \loch \f0 \cgrid1 \la
ngfe2052 \langfenp2052 \par }\pard \plain \qj \li0 \ri0 \widctlpar \aspalpha \ad
justright \lin0 \rin0 \intbl1 \itap1 \fs21 \kerning2 \dbch \af2 \hich \af0 \loch
\af0 {\fs21 \kerning2 \dbch \af2 \hich \af0 \loch \f0 \cgrid1 \langfe2052 \lang
fenp2052 \cf1 1) Electrode systems of measuring physiological pH and PCO}{\fs15
\kerning2 \dbch \af2 \hich \af0 \loch \f0 \cgrid1 \langfe2052 \langfenp2052 \cf1
2}{\fs21 \kerning2 \dbch \af2 \hich \af0 \loch \f0 \cgrid1 \langfe2052 \langfen
p2052 \cf1 are usually held at 37\uc1 \u65533 ?C. }{\fs21 \kerning2 \dbch \af2
\hich \af0 \loch \f0 \cgrid1 \langfe2052 \langfenp2052 \par }\pard \plain \qj \l
i0 \ri0 \widctlpar \aspalpha \adjustright \lin0 \rin0 \intbl1 \itap1 \fs21 \kern
ch \f0 \cgrid1 \langfe2052 \langfenp2052 \cf1 2) Solubility of CO}{\fs15 \kernin
g2 \dbch \af2 \hich \af0 \loch \f0 \cgrid1 \langfe2052 \langfenp2052 \cf1 2}{\fs
cf1 varies with temperature. Changes in temperature when blood is placed in an
electrode will alter the PaCO}{\fs15 \kerning2 \dbch \af2 \hich \af0 \loch \f0 \
cgrid1 \langfe2052 \langfenp2052 \cf1 2}{\fs21 \kerning2 \dbch \af2 \hich \af0 \
loch \f0 \cgrid1 \langfe2052 \langfenp2052 \cf1 and, therefore, the pH independ
ently of any change in pH which would occur in a buffer solution which did not c
ontain CO}{\fs15 \kerning2 \dbch \af2 \hich \af0 \loch \f0 \cgrid1 \langfe2052 \
ngfe2052 \langfenp2052 \cf1 .}{\fs21 \kerning2 \dbch \af2 \hich \af0 \loch \f0 \
cgrid1 \langfe2052 \langfenp2052 \par }\pard \plain \qj \li0 \ri0 \widctlpar \as
palpha \adjustright \lin0 \rin0 \intbl1 \itap1 \fs21 \kerning2 \dbch \af2 \hich
\af0 \loch \af0 {\fs21 \kerning2 \dbch \af2 \hich \af0 \loch \f0 \cgrid1 \langfe
2052 \langfenp2052 \cf1 3) pH of the standard buffers vary with temperature. If
the temperature of electrodes are held near to the patient's central temperature
a correction factor has to be applied to the standard. Such correction factors
for the standards can be justifiable on theoretical grounds and the conventions
of standard buffer solutions (Vogel, 1961).}{\fs21 \kerning2 \dbch \af2 \hich \a
f0 \loch \f0 \cgrid1 \langfe2052 \langfenp2052 \par }\pard \plain \qj \li0 \ri0
\widctlpar \aspalpha \adjustright \lin0 \rin0 \intbl1 \itap1 \fs21 \kerning2 \db
ch \af2 \hich \af0 \loch \af0 {\fs21 \kerning2 \dbch \af2 \hich \af0 \loch \f0 \
cgrid1 \langfe2052 \langfenp2052 \cf1 PCO}{\fs15 \kerning2 \dbch \af2 \hich \af0
\hich \af0 \loch \f0 \cgrid1 \langfe2052 \langfenp2052 \cf1 electrodes are cali
brated against gas mixtures; the partial pressure of CO}{\fs15 \kerning2 \dbch \
af2 \hich \af0 \loch \f0 \cgrid1 \langfe2052 \langfenp2052 \cf1 2}{\fs21 \kernin
g2 \dbch \af2 \hich \af0 \loch \f0 \cgrid1 \langfe2052 \langfenp2052 \cf1 in th
e gas mixture is independent of temperature.}{\fs21 \kerning2 \dbch \af2 \hich \
af0 \loch \f0 \cgrid1 \langfe2052 \langfenp2052 \par }\pard \plain \qj \li0 \ri0
\widctlpar \aspalpha \adjustright \lin0 \rin0 \intbl1 \itap1 \fs21 \kerning2 \d
bch \af2 \hich \af0 \loch \af0 {\fs21 \kerning2 \dbch \af2 \hich \af0 \loch \f0
\cgrid1 \langfe2052 \langfenp2052 \cf1 4) There is no concensus of the "normal"
or optimal arterial or mixed venous pH or PCO}{\fs15 \kerning2 \dbch \af2 \hich
af2 \hich \af0 \loch \f0 \cgrid1 \langfe2052 \langfenp2052 \cf1 in humans at te
mperatures other than 37\uc1 \u65533 ?C. (}{\field \fldedit {\*\fldinst {\fs21 \
ngfenp2052 \cf13 \ul1 HYPERLINK "http://www.anaesthesia.med.usyd.edu.au/resource
s/lectures/acidbase_mjb/references.html#williams82"}}{\*\fldrslt {\fs21 \kerning
2 \dbch \af2 \hich \af0 \loch \af0 \cgrid1 \langfe2052 \langfenp2052 \cf13 \ul1
}{\fs21 \kerning2 \dbch \af2 \hich \af0 \loch \f0 \cgrid1 \langfe2052 \langfenp2
052 \cf13 \ul1 Williams & Marshall, 1982}}}{\fs21 \kerning2 \dbch \af2 \hich \af
0 \loch \af0 \cgrid1 \langfe2052 \langfenp2052 \cf13 \ul1 }{\fs21 \kerning2 \dbc
h \af2 \hich \af0 \loch \f0 \cgrid1 \langfe2052 \langfenp2052 \cf1 ).}{\fs21 \ke
rning2 \dbch \af2 \hich \af0 \loch \f0 \cgrid1 \langfe2052 \langfenp2052 \par }\
pard \plain \qj \li0 \ri0 \widctlpar \aspalpha \adjustright \lin0 \rin0 \intbl1
af2 \hich \af0 \loch \f0 \cgrid1 \langfe2052 \langfenp2052 \cf1 5) There is unce
rtainty in the questions:}{\fs21 \kerning2 \dbch \af2 \hich \af0 \loch \f0 \cgri
d1 \langfe2052 \langfenp2052 \par }\pard \plain \qj \li0 \ri0 \widctlpar \aspalp
ha \adjustright \lin0 \rin0 \intbl1 \itap1 \fs21 \kerning2 \dbch \af2 \hich \af0
\loch \af0 {\fs21 \kerning2 \dbch \af2 \hich \af0 \loch \f0 \cgrid1 \langfe2052
\langfenp2052 \cf1 a) Whether changes in temperature per se produce changes in
pH by, for example, increased lactic acid production. }{\fs21 \kerning2 \dbch \a
f2 \hich \af0 \loch \f0 \cgrid1 \langfe2052 \langfenp2052 \par }\pard \plain \qj
\li0 \ri0 \widctlpar \aspalpha \adjustright \lin0 \rin0 \intbl1 \itap1 \fs21 \k
erning2 \dbch \af2 \hich \af0 \loch \af0 {\fs21 \kerning2 \dbch \af2 \hich \af0
\loch \f0 \cgrid1 \langfe2052 \langfenp2052 \cf1 b) Whether incidental changes,
e.g. in PCO2 may produce circulatory states which result in tissue hypoxia and t
herefore, increased metabolic acid production.}{\fs21 \kerning2 \dbch \af2 \hich
\af0 \loch \f0 \cgrid1 \langfe2052 \langfenp2052 \par }\pard \plain \qj \li0 \r
i0 \widctlpar \aspalpha \adjustright \lin0 \rin0 \intbl1 \itap1 \fs21 \kerning2
\dbch \af2 \hich \af0 \loch \af0 {\fs21 \kerning2 \dbch \af2 \hich \af0 \loch \f
0 \cgrid1 \langfe2052 \langfenp2052 \cf1 c) Whether any such process can be modi
fied by manipulation of pH by adding inorganic acid (HCl) or CO}{\fs15 \kerning2
1 .}{\fs21 \kerning2 \dbch \af2 \hich \af0 \loch \f0 \cgrid1 \langfe2052 \langfe
np2052 \par }\pard \plain \qj \li0 \ri0 \widctlpar \aspalpha \adjustright \lin0
\rin0 \intbl1 \itap1 \fs21 \kerning2 \dbch \af2 \hich \af0 \loch \af0 {\fs21 \ke
rning2 \dbch \af2 \hich \af0 \loch \f0 \cgrid1 \langfe2052 \langfenp2052 \cf1 In
the literature it is often impossible to decide how the measurements were made.
Controls are rare when various clinical regimens have been reported. In vitro m
easurements are often not accompanied by a clear indication of the details of th
e patient and the electrode temperatures.}{\fs21 \kerning2 \dbch \af2 \hich \af0
rid1 \langfe2052 \langfenp2052 \cf1 The }{\field \fldedit {\*\fldinst {\fs21 \ke
rning2 \dbch \af2 \hich \af0 \loch \af0 \cgrid1 \langfe2052 \langfenp2052 \cf13
\ul1 }{\fs21 \kerning2 \dbch \af2 \hich \af0 \loch \f0 \cgrid1 \langfe2052 \lang
fenp2052 \cf13 \ul1 HYPERLINK "http://www.anaesthesia.med.usyd.edu.au/resources/
lectures/acidbase_mjb/references.html#rosenthal48"}}{\*\fldrslt {\fs21 \kerning2
\dbch \af2 \hich \af0 \loch \af0 \cgrid1 \langfe2052 \langfenp2052 \cf13 \ul1 }
52 \cf13 \ul1 Rosenthal factor (1948)}}}{\fs21 \kerning2 \dbch \af2 \hich \af0 \
loch \af0 \cgrid1 \langfe2052 \langfenp2052 \cf13 \ul1 }{\fs21 \kerning2 \dbch \
af2 \hich \af0 \loch \f0 \cgrid1 \langfe2052 \langfenp2052 \cf1 corrects blood
pH for the difference between the temperature of the patient and that of the mea
suring electrode. It is applied to in vitro measurements where no gas can escape
from the sample before or during the measurement.}{\fs21 \kerning2 \dbch \af2 \
hich \af0 \loch \f0 \cgrid1 \langfe2052 \langfenp2052 \par }\pard \plain \qj \li
0 \ri0 \widctlpar \aspalpha \adjustright \lin0 \rin0 \intbl1 \itap1 \fs21 \kerni
ng2 \dbch \af2 \hich \af0 \loch \af0 {\fs21 \kerning2 \dbch \af2 \hich \af0 \loc
h \f0 \cgrid1 \langfe2052 \langfenp2052 \cf1 The factor is 0.0147 per C\uc1 \u65
533 ?. The formula for its use is :}{\fs21 \kerning2 \dbch \af2 \hich \af0 \loch
\f0 \cgrid1 \langfe2052 \langfenp2052 \par }\pard \plain \qj \li0 \ri0 \widctlp
ar \aspalpha \adjustright \lin0 \rin0 \intbl1 \itap1 \fs21 \kerning2 \dbch \af2
\hich \af0 \loch \af0 {\fs21 \kerning2 \dbch \af2 \hich \af0 \loch \f0 \cgrid1 \
langfe2052 \langfenp2052 \cf1 Blood pHt1 = Blood pHt}{\fs15 \kerning2 \dbch \af2
\dbch \af2 \hich \af0 \loch \f0 \cgrid1 \langfe2052 \langfenp2052 \cf1 - 0.0147
(t}{\fs15 \kerning2 \dbch \af2 \hich \af0 \loch \f0 \cgrid1 \langfe2052 \langfen
p2052 \cf1 1}{\fs21 \kerning2 \dbch \af2 \hich \af0 \loch \f0 \cgrid1 \langfe205
2 \langfenp2052 \cf1 -t}{\fs15 \kerning2 \dbch \af2 \hich \af0 \loch \f0 \cgrid1
f0 \cgrid1 \langfe2052 \langfenp2052 \cf1 ) where t}{\fs15 \kerning2 \dbch \af2
\hich \af0 \loch \f0 \cgrid1 \langfe2052 \langfenp2052 \cf1 1}{\fs21 \kerning2 \
dbch \af2 \hich \af0 \loch \f0 \cgrid1 \langfe2052 \langfenp2052 \cf1 and t}{\f
gfenp2052 \cf1 are temperature readings.}{\fs21 \kerning2 \dbch \af2 \hich \af0
rid1 \langfe2052 \langfenp2052 \cf1 Example: Blood is taken from a patient with
a central temperature of 30\uc1 \u65533 ?C. The pH is measured in an electrode s
et at 37\uc1 \u65533 ?C. To ascertain what the pH is at 30\uc1 \u65533 ?C apply
the formular pH at 30\uc1 \u65533 ?C = pH reading at 37\uc1 \u65533 ?C - 0.0147
(30-37).}{\fs21 \kerning2 \dbch \af2 \hich \af0 \loch \f0 \cgrid1 \langfe2052 \l
angfenp2052 \par }\pard \plain \qj \li0 \ri0 \widctlpar \aspalpha \adjustright \
lin0 \rin0 \intbl1 \itap1 \fs21 \kerning2 \dbch \af2 \hich \af0 \loch \af0 {\fie
ld \fldedit {\*\fldinst {\fs21 \kerning2 \dbch \af2 \hich \af0 \loch \af0 \cgrid
1 \langfe2052 \langfenp2052 \cf13 \ul1 }{\fs21 \kerning2 \dbch \af2 \hich \af0 \
loch \f0 \cgrid1 \langfe2052 \langfenp2052 \cf13 \ul1 HYPERLINK "http://www.anae
sthesia.med.usyd.edu.au/resources/lectures/acidbase_mjb/references.html#edmark59
"}}{\*\fldrslt {\fs21 \kerning2 \dbch \af2 \hich \af0 \loch \af0 \cgrid1 \langfe
2052 \langfenp2052 \cf13 \ul1 }{\fs21 \kerning2 \dbch \af2 \hich \af0 \loch \f0
\cgrid1 \langfe2052 \langfenp2052 \cf13 \ul1 Edmark (1959)}}}{\fs21 \kerning2 \d
bch \af2 \hich \af0 \loch \af0 \cgrid1 \langfe2052 \langfenp2052 \cf13 \ul1 }{\f
\cf1 and }{\field \fldedit {\*\fldinst {\fs21 \kerning2 \dbch \af2 \hich \af0 \
loch \af0 \cgrid1 \langfe2052 \langfenp2052 \cf13 \ul1 }{\fs21 \kerning2 \dbch \
af2 \hich \af0 \loch \f0 \cgrid1 \langfe2052 \langfenp2052 \cf13 \ul1 HYPERLINK
"http://www.anaesthesia.med.usyd.edu.au/resources/lectures/acidbase_mjb/referenc
es.html#brooks64"}}{\*\fldrslt {\fs21 \kerning2 \dbch \af2 \hich \af0 \loch \af0
\cgrid1 \langfe2052 \langfenp2052 \cf13 \ul1 }{\fs21 \kerning2 \dbch \af2 \hich
\af0 \loch \f0 \cgrid1 \langfe2052 \langfenp2052 \cf13 \ul1 Brooks (1964)}}}{\f
s21 \kerning2 \dbch \af2 \hich \af0 \loch \af0 \cgrid1 \langfe2052 \langfenp2052
\cf13 \ul1 }{\fs21 \kerning2 \dbch \af2 \hich \af0 \loch \f0 \cgrid1 \langfe205
2 \langfenp2052 \cf1 point out that, if the blood is tonometered with gas at PC
O}{\fs15 \kerning2 \dbch \af2 \hich \af0 \loch \f0 \cgrid1 \langfe2052 \langfenp
2052 \cf1 2}{\fs21 \kerning2 \dbch \af2 \hich \af0 \loch \f0 \cgrid1 \langfe2052
\langfenp2052 \cf1 40mmHg and the pH measured at the same temperature as the t
onometer, the pH does not alter with the temperature. In other words if the PCO}
52 \cf1 2}{\fs21 \kerning2 \dbch \af2 \hich \af0 \loch \f0 \cgrid1 \langfe2052 \
langfenp2052 \cf1 is kept at 40mmHg, pH of blood which was 7.4 at 37\uc1 \u6553
3 ?C, will be 7.4 at other temperatures or that the alteration of pH of blood wi
th temperature is mainly, if not only, due to changes in PCO}{\fs15 \kerning2 \d
bch \af2 \hich \af0 \loch \f0 \cgrid1 \langfe2052 \langfenp2052 \cf1 2}{\fs21 \k
erning2 \dbch \af2 \hich \af0 \loch \f0 \cgrid1 \langfe2052 \langfenp2052 \cf1 .
052 \par }\pard \plain \qj \li0 \ri0 \widctlpar \aspalpha \adjustright \lin0 \ri
n0 \intbl1 \itap1 \fs21 \kerning2 \dbch \af2 \hich \af0 \loch \af0 {\fs21 \kerni
ng2 \dbch \af2 \hich \af0 \loch \f0 \cgrid1 \langfe2052 \langfenp2052 \cf1 I am
surprisied that the pH does not alter with temperature when it is the partial pr
essure of carbon dioxide which is kept constant at 40mmHg. As the solubility of
CO}{\fs15 \kerning2 \dbch \af2 \hich \af0 \loch \f0 \cgrid1 \langfe2052 \langfen
p2052 \cf1 2}{\fs21 \kerning2 \dbch \af2 \hich \af0 \loch \f0 \cgrid1 \langfe205
2 \langfenp2052 \cf1 (and all gases) increases as the temperature falls the qua
ntity of CO}{\fs15 \kerning2 \dbch \af2 \hich \af0 \loch \f0 \cgrid1 \langfe2052
\langfenp2052 \cf1 2}{\fs21 \kerning2 \dbch \af2 \hich \af0 \loch \f0 \cgrid1 \
langfe2052 \langfenp2052 \cf1 dissolved will be greater at lower temperatures.
For the ratios between dissolved CO}{\fs15 \kerning2 \dbch \af2 \hich \af0 \loch
\f0 \cgrid1 \langfe2052 \langfenp2052 \cf1 2}{\fs21 \kerning2 \dbch \af2 \hich
\af0 \loch \f0 \cgrid1 \langfe2052 \langfenp2052 \cf1 , carbonic acid and the pr
oducts of ionisation H}{\fs15 \kerning2 \dbch \af2 \hich \af0 \loch \f0 \cgrid1
\langfe2052 \langfenp2052 \cf1 \super1 +}{\fs21 \kerning2 \dbch \af2 \hich \af0
\loch \f0 \cgrid1 \langfe2052 \langfenp2052 \cf1 and HCO}{\fs15 \kerning2 \dbch
\af2 \hich \af0 \loch \f0 \cgrid1 \langfe2052 \langfenp2052 \cf1 3}{\fs21 \kern
ing2 \dbch \af2 \hich \af0 \loch \f0 \cgrid1 \langfe2052 \langfenp2052 \cf1 \sup
er1 -}{\fs21 \kerning2 \dbch \af2 \hich \af0 \loch \f0 \cgrid1 \langfe2052 \lang
fenp2052 \cf1 to be such that the pH happens to end up at 7.4 if the PCO}{\fs15
1 2}{\fs21 \kerning2 \dbch \af2 \hich \af0 \loch \f0 \cgrid1 \langfe2052 \langfe
np2052 \cf1 is 40mmHg seems too neat to be fortuitous.}{\fs21 \kerning2 \dbch \
af2 \hich \af0 \loch \f0 \cgrid1 \langfe2052 \langfenp2052 \par }\pard \plain \q
j \li0 \ri0 \widctlpar \aspalpha \adjustright \lin0 \rin0 \intbl1 \itap1 \fs21 \
kerning2 \dbch \af2 \hich \af0 \loch \af0 {\fs21 \kerning2 \dbch \af2 \hich \af0
\loch \f0 \cgrid1 \langfe2052 \langfenp2052 \cf1 It seems to me that:}{\fs21 \k
erning2 \dbch \af2 \hich \af0 \loch \f0 \cgrid1 \langfe2052 \langfenp2052 \par }
\pard \plain \qj \li0 \ri0 \widctlpar \aspalpha \adjustright \lin0 \rin0 \intbl1
\itap1 \fs21 \kerning2 \dbch \af2 \hich \af0 \loch \af0 {\fs21 \kerning2 \dbch
\af2 \hich \af0 \loch \f0 \cgrid1 \langfe2052 \langfenp2052 \cf1 a) There must b
e some important physico-chemical reason for this, or, }{\fs21 \kerning2 \dbch \
\loch \f0 \cgrid1 \langfe2052 \langfenp2052 \cf1 b) there are special propertie
s of protein buffering mechanism to account for it, or,}{\fs21 \kerning2 \dbch \
\loch \f0 \cgrid1 \langfe2052 \langfenp2052 \cf1 c) that all authors have overl
ooked some important factors.}{\fs21 \kerning2 \dbch \af2 \hich \af0 \loch \f0 \
2052 \langfenp2052 \cf1 In the practical and clinical application of pH and PCO}
langfenp2052 \cf1 manipulation in hypothermia, the papers of }{\field \fldedit
{\*\fldinst {\fs21 \kerning2 \dbch \af2 \hich \af0 \loch \af0 \cgrid1 \langfe205
2 \langfenp2052 \cf13 \ul1 }{\fs21 \kerning2 \dbch \af2 \hich \af0 \loch \f0 \cg
rid1 \langfe2052 \langfenp2052 \cf13 \ul1 HYPERLINK "http://www.anaesthesia.med.
usyd.edu.au/resources/lectures/acidbase_mjb/references.html#edmark59"}}{\*\fldrs
lt {\fs21 \kerning2 \dbch \af2 \hich \af0 \loch \af0 \cgrid1 \langfe2052 \langfe
np2052 \cf13 \ul1 }{\fs21 \kerning2 \dbch \af2 \hich \af0 \loch \f0 \cgrid1 \lan
gfe2052 \langfenp2052 \cf13 \ul1 Edmark (1959)}}}{\fs21 \kerning2 \dbch \af2 \hi
ch \af0 \loch \af0 \cgrid1 \langfe2052 \langfenp2052 \cf13 \ul1 }{\fs21 \kerning
2 \dbch \af2 \hich \af0 \loch \f0 \cgrid1 \langfe2052 \langfenp2052 \cf1 , }{\fi
eld \fldedit {\*\fldinst {\fs21 \kerning2 \dbch \af2 \hich \af0 \loch \af0 \cgri
d1 \langfe2052 \langfenp2052 \cf13 \ul1 }{\fs21 \kerning2 \dbch \af2 \hich \af0
\loch \f0 \cgrid1 \langfe2052 \langfenp2052 \cf13 \ul1 HYPERLINK "http://www.ana
esthesia.med.usyd.edu.au/resources/lectures/acidbase_mjb/references.html#carson6
2"}}{\*\fldrslt {\fs21 \kerning2 \dbch \af2 \hich \af0 \loch \af0 \cgrid1 \langf
e2052 \langfenp2052 \cf13 \ul1 }{\fs21 \kerning2 \dbch \af2 \hich \af0 \loch \f0
\cgrid1 \langfe2052 \langfenp2052 \cf13 \ul1 Carson et al (1962)}}}{\fs21 \kern
ing2 \dbch \af2 \hich \af0 \loch \af0 \cgrid1 \langfe2052 \langfenp2052 \cf13 \u
l1 }{\fs21 \kerning2 \dbch \af2 \hich \af0 \loch \f0 \cgrid1 \langfe2052 \langfe
np2052 \cf1 , }{\field \fldedit {\*\fldinst {\fs21 \kerning2 \dbch \af2 \hich \a
f0 \loch \af0 \cgrid1 \langfe2052 \langfenp2052 \cf13 \ul1 }{\fs21 \kerning2 \db
ch \af2 \hich \af0 \loch \f0 \cgrid1 \langfe2052 \langfenp2052 \cf13 \ul1 HYPERL
INK "http://www.anaesthesia.med.usyd.edu.au/resources/lectures/acidbase_mjb/refe
rences.html#brooks64"}}{\*\fldrslt {\fs21 \kerning2 \dbch \af2 \hich \af0 \loch
\af0 \cgrid1 \langfe2052 \langfenp2052 \cf13 \ul1 }{\fs21 \kerning2 \dbch \af2 \
hich \af0 \loch \f0 \cgrid1 \langfe2052 \langfenp2052 \cf13 \ul1 Brooks (1964)}}
}{\fs21 \kerning2 \dbch \af2 \hich \af0 \loch \af0 \cgrid1 \langfe2052 \langfenp
2052 \cf13 \ul1 }{\fs21 \kerning2 \dbch \af2 \hich \af0 \loch \f0 \cgrid1 \langf
e2052 \langfenp2052 \cf1 , }{\field \fldedit {\*\fldinst {\fs21 \kerning2 \dbch
\af2 \hich \af0 \loch \af0 \cgrid1 \langfe2052 \langfenp2052 \cf13 \ul1 }{\fs21
3 \ul1 HYPERLINK "http://www.anaesthesia.med.usyd.edu.au/resources/lectures/acid
base_mjb/references.html#burton64"}}{\*\fldrslt {\fs21 \kerning2 \dbch \af2 \hic
h \af0 \loch \af0 \cgrid1 \langfe2052 \langfenp2052 \cf13 \ul1 }{\fs21 \kerning2
\dbch \af2 \hich \af0 \loch \f0 \cgrid1 \langfe2052 \langfenp2052 \cf13 \ul1 Bu
rton (1964)}}}{\fs21 \kerning2 \dbch \af2 \hich \af0 \loch \af0 \cgrid1 \langfe2
052 \langfenp2052 \cf13 \ul1 }{\fs21 \kerning2 \dbch \af2 \hich \af0 \loch \f0 \
cgrid1 \langfe2052 \langfenp2052 \cf1 , }{\field \fldedit {\*\fldinst {\fs21 \ke
lectures/acidbase_mjb/references.html#mcconnell75"}}{\*\fldrslt {\fs21 \kerning2
52 \cf13 \ul1 McConnell et al (1975)}}}{\fs21 \kerning2 \dbch \af2 \hich \af0 \l
och \af0 \cgrid1 \langfe2052 \langfenp2052 \cf13 \ul1 }{\fs21 \kerning2 \dbch \a
f2 \hich \af0 \loch \f0 \cgrid1 \langfe2052 \langfenp2052 \cf1 , }{\field \flded
it {\*\fldinst {\fs21 \kerning2 \dbch \af2 \hich \af0 \loch \af0 \cgrid1 \langfe
\cgrid1 \langfe2052 \langfenp2052 \cf13 \ul1 HYPERLINK "http://www.anaesthesia.m
ed.usyd.edu.au/resources/lectures/acidbase_mjb/references.html#rahn75"}}{\*\fldr
slt {\fs21 \kerning2 \dbch \af2 \hich \af0 \loch \af0 \cgrid1 \langfe2052 \langf
enp2052 \cf13 \ul1 }{\fs21 \kerning2 \dbch \af2 \hich \af0 \loch \f0 \cgrid1 \la
ngfe2052 \langfenp2052 \cf13 \ul1 Rahn et al (1975)}}}{\fs21 \kerning2 \dbch \af
2 \hich \af0 \loch \af0 \cgrid1 \langfe2052 \langfenp2052 \cf13 \ul1 }{\fs21 \ke
rning2 \dbch \af2 \hich \af0 \loch \f0 \cgrid1 \langfe2052 \langfenp2052 \cf1 ,
}{\field \fldedit {\*\fldinst {\fs21 \kerning2 \dbch \af2 \hich \af0 \loch \af0
\af0 \loch \f0 \cgrid1 \langfe2052 \langfenp2052 \cf13 \ul1 HYPERLINK "http://ww
w.anaesthesia.med.usyd.edu.au/resources/lectures/acidbase_mjb/references.html#no
rwood79"}}{\*\fldrslt {\fs21 \kerning2 \dbch \af2 \hich \af0 \loch \af0 \cgrid1
\langfe2052 \langfenp2052 \cf13 \ul1 }{\fs21 \kerning2 \dbch \af2 \hich \af0 \lo
ch \f0 \cgrid1 \langfe2052 \langfenp2052 \cf13 \ul1 Norwood et al (1974)}}}{\fs2
1 \kerning2 \dbch \af2 \hich \af0 \loch \af0 \cgrid1 \langfe2052 \langfenp2052 \
cf13 \ul1 }{\fs21 \kerning2 \dbch \af2 \hich \af0 \loch \f0 \cgrid1 \langfe2052
\langfenp2052 \cf1 , }{\field \fldedit {\*\fldinst {\fs21 \kerning2 \dbch \af2 \
hich \af0 \loch \af0 \cgrid1 \langfe2052 \langfenp2052 \cf13 \ul1 }{\fs21 \kerni
ng2 \dbch \af2 \hich \af0 \loch \f0 \cgrid1 \langfe2052 \langfenp2052 \cf13 \ul1
HYPERLINK "http://www.anaesthesia.med.usyd.edu.au/resources/lectures/acidbase_m
jb/references.html#becker81"}}{\*\fldrslt {\fs21 \kerning2 \dbch \af2 \hich \af0
\loch \af0 \cgrid1 \langfe2052 \langfenp2052 \cf13 \ul1 }{\fs21 \kerning2 \dbch
\af2 \hich \af0 \loch \f0 \cgrid1 \langfe2052 \langfenp2052 \cf13 \ul1 Becker e
t al (1981)}}}{\fs21 \kerning2 \dbch \af2 \hich \af0 \loch \af0 \cgrid1 \langfe2
052 \langfenp2052 \cf13 \ul1 }{\fs21 \kerning2 \dbch \af2 \hich \af0 \loch \f0 \
cgrid1 \langfe2052 \langfenp2052 \cf1 , }{\field \fldedit {\*\fldinst {\fs21 \ke
lectures/acidbase_mjb/references.html#white81"}}{\*\fldrslt {\fs21 \kerning2 \db
cf13 \ul1 White (1981)}}}{\fs21 \kerning2 \dbch \af2 \hich \af0 \loch \af0 \cgri
\loch \f0 \cgrid1 \langfe2052 \langfenp2052 \cf1 and }{\field \fldedit {\*\fldi
nst {\fs21 \kerning2 \dbch \af2 \hich \af0 \loch \af0 \cgrid1 \langfe2052 \langf
enp2052 \cf13 \ul1 }{\fs21 \kerning2 \dbch \af2 \hich \af0 \loch \f0 \cgrid1 \la
ngfe2052 \langfenp2052 \cf13 \ul1 HYPERLINK "http://www.anaesthesia.med.usyd.edu
.au/resources/lectures/acidbase_mjb/references.html#williams82"}}{\*\fldrslt {\f
s21 \kerning2 \dbch \af2 \hich \af0 \loch \af0 \cgrid1 \langfe2052 \langfenp2052
\cf13 \ul1 }{\fs21 \kerning2 \dbch \af2 \hich \af0 \loch \f0 \cgrid1 \langfe205
2 \langfenp2052 \cf13 \ul1 Williams et al (1982)}}}{\fs21 \kerning2 \dbch \af2 \
hich \af0 \loch \af0 \cgrid1 \langfe2052 \langfenp2052 \cf13 \ul1 }{\fs21 \kerni
ng2 \dbch \af2 \hich \af0 \loch \f0 \cgrid1 \langfe2052 \langfenp2052 \cf1 are
relevant.}{\fs21 \kerning2 \dbch \af2 \hich \af0 \loch \f0 \cgrid1 \langfe2052 \
langfenp2052 \par }\pard \plain \qj \li0 \ri0 \widctlpar \aspalpha \adjustright
\lin0 \rin0 \intbl1 \itap1 \fs21 \kerning2 \dbch \af2 \hich \af0 \loch \af0 {\fi
eld \fldedit {\*\fldinst {\fs21 \kerning2 \dbch \af2 \hich \af0 \loch \af0 \cgri
\loch \f0 \cgrid1 \langfe2052 \langfenp2052 \cf13 \ul1 HYPERLINK "http://www.ana
esthesia.med.usyd.edu.au/resources/lectures/acidbase_mjb/references.html#edmark5
9"}}{\*\fldrslt {\fs21 \kerning2 \dbch \af2 \hich \af0 \loch \af0 \cgrid1 \langf
e2052 \langfenp2052 \cf13 \ul1 }{\fs21 \kerning2 \dbch \af2 \hich \af0 \loch \f0
\cgrid1 \langfe2052 \langfenp2052 \cf13 \ul1 Edmark}}}{\fs21 \kerning2 \dbch \a
f2 \hich \af0 \loch \af0 \cgrid1 \langfe2052 \langfenp2052 \cf13 \ul1 }{\fs21 \k
erning2 \dbch \af2 \hich \af0 \loch \f0 \cgrid1 \langfe2052 \langfenp2052 \cf1
formed the impression that at low temperatures the optimal pH should be lower th
an 7.4 measured at the temperature of the patient. This he achieved by adding HC
l during extracorporeal cooling. In his subjectgs it appears that artificial res
piration was continued. It is not stated if CO}{\fs15 \kerning2 \dbch \af2 \hich
\af0 \loch \f0 \cgrid1 \langfe2052 \langfenp2052 \cf1 2}{\fs21 \kerning2 \dbch
\af2 \hich \af0 \loch \f0 \cgrid1 \langfe2052 \langfenp2052 \cf1 was added to t
he pump but he says that pH would have risen to 7.53 if HCl was not added. The r
ate of cooling was 12\uc1 \u65533 ?C in 20 minutes. He seems to have compared ca
rdiac rhythm and ease of defibrillation at 25\uc1 \u65533 ?C when the pH was 7.5
3 with no CO}{\fs15 \kerning2 \dbch \af2 \hich \af0 \loch \f0 \cgrid1 \langfe205
\langfe2052 \langfenp2052 \cf1 or HCl added and at 25\uc1 \u65533 ?C when HCl w
as added to produce a pH of 7.15 without adding CO}{\fs15 \kerning2 \dbch \af2 \
hich \af0 \loch \f0 \cgrid1 \langfe2052 \langfenp2052 \cf1 2}{\fs21 \kerning2 \d
bch \af2 \hich \af0 \loch \f0 \cgrid1 \langfe2052 \langfenp2052 \cf1 . The compa
rison was clinical and without any statistics. He did not examine 25\uc1 \u65533
?C with pH 7.1 by adding more CO}{\fs15 \kerning2 \dbch \af2 \hich \af0 \loch \
f0 \cgrid1 \langfe2052 \langfenp2052 \cf1 2}{\fs21 \kerning2 \dbch \af2 \hich \a
f0 \loch \f0 \cgrid1 \langfe2052 \langfenp2052 \cf1 .}{\fs21 \kerning2 \dbch \af
2 \hich \af0 \loch \f0 \cgrid1 \langfe2052 \langfenp2052 \par }\pard \plain \qj
\li0 \ri0 \widctlpar \aspalpha \adjustright \lin0 \rin0 \intbl1 \itap1 \fs21 \ke
rning2 \dbch \af2 \hich \af0 \loch \af0 {\field \fldedit {\*\fldinst {\fs21 \ker
ning2 \dbch \af2 \hich \af0 \loch \af0 \cgrid1 \langfe2052 \langfenp2052 \cf13 \
ul1 }{\fs21 \kerning2 \dbch \af2 \hich \af0 \loch \f0 \cgrid1 \langfe2052 \langf
enp2052 \cf13 \ul1 HYPERLINK "http://www.anaesthesia.med.usyd.edu.au/resources/l
ectures/acidbase_mjb/references.html#brooks64"}}{\*\fldrslt {\fs21 \kerning2 \db
cf13 \ul1 Brooks}}}{\fs21 \kerning2 \dbch \af2 \hich \af0 \loch \af0 \cgrid1 \la
ngfe2052 \langfenp2052 \cf13 \ul1 }{\fs21 \kerning2 \dbch \af2 \hich \af0 \loch
\f0 \cgrid1 \langfe2052 \langfenp2052 \cf1 although obviously aware of Edmark's
work and giving a full discussion of in vitro changes in pH and PCO2 with tempe
rature elected in some (he does not state the proportion) patients to ventilate
the lungs normally (i.e. minute volumes suitable for normal metabolism at 37\uc1
\u65533 ?C) while using Drew's technique for extra-corporeal cooling. The Drew
technique uses the patient's lungs but replaces the right and left ventricles wi
th separate roller pumps. He added NaHCO}{\fs15 \kerning2 \dbch \af2 \hich \af0
\loch \f0 \cgrid1 \langfe2052 \langfenp2052 \cf1 2}{\fs21 \kerning2 \dbch \af2 \
hich \af0 \loch \f0 \cgrid1 \langfe2052 \langfenp2052 \cf1 in amounts required
to keep the pH from falling during the period of hypothermia. In some cases he a
dded CO}{\fs15 \kerning2 \dbch \af2 \hich \af0 \loch \f0 \cgrid1 \langfe2052 \la
ngfenp2052 \cf1 2}{\fs21 \kerning2 \dbch \af2 \hich \af0 \loch \f0 \cgrid1 \lang
fe2052 \langfenp2052 \cf1 to the respiratory circuit to keep the end tidal PCO}
langfenp2052 \cf1 at 40mmHg. It is not possible to deduce from this paper what,
if any, differences there were in the end result with different methods of mani
pulation of the pH and PCO}{\fs15 \kerning2 \dbch \af2 \hich \af0 \loch \f0 \cgr
id1 \langfe2052 \langfenp2052 \cf1 2}{\fs21 \kerning2 \dbch \af2 \hich \af0 \loc
h \f0 \cgrid1 \langfe2052 \langfenp2052 \cf1 . It appears that at least when CO}
langfenp2052 \cf1 was not added a metabolic acidosis occurred.}{\fs21 \kerning2
\dbch \af2 \hich \af0 \loch \f0 \cgrid1 \langfe2052 \langfenp2052 \par }\pard \
plain \qj \li0 \ri0 \widctlpar \aspalpha \adjustright \lin0 \rin0 \intbl1 \itap1
\fs21 \kerning2 \dbch \af2 \hich \af0 \loch \af0 {\field \fldedit {\*\fldinst {
\fs21 \kerning2 \dbch \af2 \hich \af0 \loch \af0 \cgrid1 \langfe2052 \langfenp20
52 \cf13 \ul1 }{\fs21 \kerning2 \dbch \af2 \hich \af0 \loch \f0 \cgrid1 \langfe2
052 \langfenp2052 \cf13 \ul1 HYPERLINK "http://www.anaesthesia.med.usyd.edu.au/r
esources/lectures/acidbase_mjb/references.html#burton64"}}{\*\fldrslt {\fs21 \ke
fenp2052 \cf13 \ul1 Burton (1964)}}}{\fs21 \kerning2 \dbch \af2 \hich \af0 \loch
\af0 \cgrid1 \langfe2052 \langfenp2052 \cf13 \ul1 }{\fs21 \kerning2 \dbch \af2
\hich \af0 \loch \f0 \cgrid1 \langfe2052 \langfenp2052 \cf1 reported on satisfa
ctory clinical results on 69 cases of induced hypothermia to around 15\uc1 \u655
33 ?C when the PCO}{\fs15 \kerning2 \dbch \af2 \hich \af0 \loch \f0 \cgrid1 \lan
gfe2052 \langfenp2052 \cf1 2}{\fs21 \kerning2 \dbch \af2 \hich \af0 \loch \f0 \c
grid1 \langfe2052 \langfenp2052 \cf1 (end tidal and arterial) were kept near 40
mmHg. This was not a controlled study but before attempting to keep the PCO}{\fs
cf1 2}{\fs21 \kerning2 \dbch \af2 \hich \af0 \loch \f0 \cgrid1 \langfe2052 \lang
fenp2052 \cf1 near 40mmHg the end tidal CO}{\fs15 \kerning2 \dbch \af2 \hich \a
f0 \loch \f0 \cgrid1 \langfe2052 \langfenp2052 \cf1 2}{\fs21 \kerning2 \dbch \af
2 \hich \af0 \loch \f0 \cgrid1 \langfe2052 \langfenp2052 \cf1 had been noticed
in other subjects to be unmeasurably low and may have contributed to a state of
metabolic acidosis which presented post-operatively.}{\fs21 \kerning2 \dbch \af2
\hich \af0 \loch \f0 \cgrid1 \langfe2052 \langfenp2052 \par }\pard \plain \qj \
li0 \ri0 \widctlpar \aspalpha \adjustright \lin0 \rin0 \intbl1 \itap1 \fs21 \ker
ning2 \dbch \af2 \hich \af0 \loch \af0 {\field \fldedit {\*\fldinst {\fs21 \kern
np2052 \cf13 \ul1 HYPERLINK "http://www.anaesthesia.med.usyd.edu.au/resources/le
ctures/acidbase_mjb/references.html#carson62"}}{\*\fldrslt {\fs21 \kerning2 \dbc
h \af2 \hich \af0 \loch \af0 \cgrid1 \langfe2052 \langfenp2052 \cf13 \ul1 }{\fs2
1 \kerning2 \dbch \af2 \hich \af0 \loch \f0 \cgrid1 \langfe2052 \langfenp2052 \c
f13 \ul1 Carson and Morris}}}{\fs21 \kerning2 \dbch \af2 \hich \af0 \loch \af0 \
cgrid1 \langfe2052 \langfenp2052 \cf13 \ul1 }{\fs21 \kerning2 \dbch \af2 \hich \
af0 \loch \f0 \cgrid1 \langfe2052 \langfenp2052 \cf1 added CO}{\fs15 \kerning2
to the extracorporeal circuit to produce a pH of the level recommended by Edma
rk. They claim that this method prevented the occurrence of metabolic acidosis.
After cessation of cardiopulmonary bypass non-respiratory acidosis did occur in
cases which were "unsuccessful", presumably due to low cardiac output. It is, of
course, possible that the metabolic disturbance might have caused or aggravated
the low cardiac output. These authors noted that at low temperatures when CO}{\
ngfenp2052 \cf1 was administered, respiration continued and general anaesthesia
had to be administered as the patients appeared to be awakening. In this paper
the low temperatures reported are those of the pumpoxygenator during the period
of cardiopulmonary bypass and oesophageal during the rest of the operation. 25\u
c1 \u65533 ?C was the lowest temperature mentioned in the context of clinical hy
pothermia but as the records show these to be pump temperatures one must presume
that the oesophageal and naso-pharyngeal temperatures were higher.}{\fs21 \kern
2 \hich \af0 \loch \f0 \cgrid1 \langfe2052 \langfenp2052 \cf1 Our experience has
been in cardiac surgery using deep (20\uc1 \u65533 ?C) and mild (30\uc1 \u65533
?C) hypothermia using extracorporeal circulation. As well as this we operated o
n some twenty patients with cerebral aneurysms who were cooled to 15\uc1 \u65533
?C for operation.}{\fs21 \kerning2 \dbch \af2 \hich \af0 \loch \f0 \cgrid1 \lan
gfe2052 \langfenp2052 \par }\pard \plain \qj \li0 \ri0 \widctlpar \aspalpha \adj
ustright \lin0 \rin0 \intbl1 \itap1 \fs21 \kerning2 \dbch \af2 \hich \af0 \loch
\af0 {\fs21 \kerning2 \dbch \af2 \hich \af0 \loch \f0 \cgrid1 \langfe2052 \langf
enp2052 \cf1 The circumstances of the neurosurgical procedures enabled us to mak
e some observations. We used extra-thoracic cooling by way of the femoral artery
and both femoral veins and partial bypass until or if ventricular fibrillation
occurred. As the chest was not open it was feasible to use spontaneous respirati
on with halothane anaesthesia. The oxygenator was ventilated with oxygen to whic
h was added halothane and up to 20% CO}{\fs15 \kerning2 \dbch \af2 \hich \af0 \l
ch \af0 \loch \f0 \cgrid1 \langfe2052 \langfenp2052 \cf1 . After some trials and
errors we limited the rate of cooling of the nasopharynx to 1\uc1 \u65533 ?C/3
minutes. If cooling was faster, PCO2 in the mixed venous blood often fell below
40mmHg at the nasopharyngeal temperature of the patient and respiration ceased.
If cooling was stopped but perfusion continued respiration would recommence afte
r some minutes. Blood taken from the venous reservoir when respiration recommenc
ed was invariably near 40mmHg at the nasopharyngeal temperature of the patient.}
g2 \dbch \af2 \hich \af0 \loch \f0 \cgrid1 \langfe2052 \langfenp2052 \cf1 The ex
planation of this is that the temperature fell and the solubility of CO}{\fs15 \
kerning2 \dbch \af2 \hich \af0 \loch \f0 \cgrid1 \langfe2052 \langfenp2052 \cf1
2}{\fs21 \kerning2 \dbch \af2 \hich \af0 \loch \f0 \cgrid1 \langfe2052 \langfenp
2052 \cf1 increased so that it was difficult to supply the quantity of CO}{\fs1
5 \kerning2 \dbch \af2 \hich \af0 \loch \f0 \cgrid1 \langfe2052 \langfenp2052 \c
f1 2}{\fs21 \kerning2 \dbch \af2 \hich \af0 \loch \f0 \cgrid1 \langfe2052 \langf
enp2052 \cf1 required to keep the tissue PCO}{\fs15 \kerning2 \dbch \af2 \hich
af2 \hich \af0 \loch \f0 \cgrid1 \langfe2052 \langfenp2052 \cf1 near 40mmHg eve
n if the arterial blood had a high PCO}{\fs15 \kerning2 \dbch \af2 \hich \af0 \l
ch \af0 \loch \f0 \cgrid1 \langfe2052 \langfenp2052 \cf1 . At a constant low tem
perature equilibrium could occur so that adding 5% CO}{\fs15 \kerning2 \dbch \af
2 \hich \af0 \loch \f0 \cgrid1 \langfe2052 \langfenp2052 \cf1 2}{\fs21 \kerning2
\dbch \af2 \hich \af0 \loch \f0 \cgrid1 \langfe2052 \langfenp2052 \cf1 into th
e pump oxygenator was sufficient but during the cooling phase the PCO}{\fs15 \ke
rning2 \dbch \af2 \hich \af0 \loch \f0 \cgrid1 \langfe2052 \langfenp2052 \cf1 2}
52 \cf1 of the tissues fell if the rate of cooling was too fast and/or insuffic
ient CO}{\fs15 \kerning2 \dbch \af2 \hich \af0 \loch \f0 \cgrid1 \langfe2052 \la
ngfenp2052 \cf1 2}{\fs21 \kerning2 \dbch \af2 \hich \af0 \loch \f0 \cgrid1 \lang
fe2052 \langfenp2052 \cf1 was added to the pump. It is possible that other work
ers cooled patients too quickly and/or that CO}{\fs15 \kerning2 \dbch \af2 \hich
\af0 \loch \f0 \cgrid1 \langfe2052 \langfenp2052 \cf1 2}{\fs21 \kerning2 \dbch
\af2 \hich \af0 \loch \f0 \cgrid1 \langfe2052 \langfenp2052 \cf1 administered t
o the oxygenator was insufficient for the PCO}{\fs15 \kerning2 \dbch \af2 \hich
af2 \hich \af0 \loch \f0 \cgrid1 \langfe2052 \langfenp2052 \cf1 of the tissues
to be near 40mmHg during parts of the periods of hypothermia.}{\fs21 \kerning2 \
dbch \af2 \hich \af0 \loch \f0 \cgrid1 \langfe2052 \langfenp2052 \par }\pard \pl
ain \qj \li0 \ri0 \widctlpar \aspalpha \adjustright \lin0 \rin0 \intbl1 \itap1 \
fs21 \kerning2 \dbch \af2 \hich \af0 \loch \af0 {\fs21 \kerning2 \dbch \af2 \hic
h \af0 \loch \f0 \cgrid1 \langfe2052 \langfenp2052 \cf1 We also found, as did }{
\field \fldedit {\*\fldinst {\fs21 \kerning2 \dbch \af2 \hich \af0 \loch \af0 \c
grid1 \langfe2052 \langfenp2052 \cf13 \ul1 }{\fs21 \kerning2 \dbch \af2 \hich \a
f0 \loch \f0 \cgrid1 \langfe2052 \langfenp2052 \cf13 \ul1 HYPERLINK "http://www.
anaesthesia.med.usyd.edu.au/resources/lectures/acidbase_mjb/references.html#cars
on62"}}{\*\fldrslt {\fs21 \kerning2 \dbch \af2 \hich \af0 \loch \af0 \cgrid1 \la
ngfe2052 \langfenp2052 \cf13 \ul1 }{\fs21 \kerning2 \dbch \af2 \hich \af0 \loch
\f0 \cgrid1 \langfe2052 \langfenp2052 \cf13 \ul1 Carson}}}{\fs21 \kerning2 \dbch
\af2 \hich \af0 \loch \af0 \cgrid1 \langfe2052 \langfenp2052 \cf13 \ul1 }{\fs21
1 et al, that anaesthesia was necessary at low temperatures. In our initial cas
es we turned off the halothane to the oxygenators when the temperature fell belo
w 30\uc1 \u65533 ?C, but we soon found that it was necessary to continue to admi
nister halothane. One patient appeared to be arousing 15\uc1 \u65533 ?C. Halotha
ne administration rendered the patient "quiet". Spontaneous respiration continue
d at 15\uc1 \u65533 ?C at a rate of about 4/minute but with quite large tidal vo
lumes provided again the PCO}{\fs15 \kerning2 \dbch \af2 \hich \af0 \loch \f0 \c
grid1 \langfe2052 \langfenp2052 \cf1 2}{\fs21 \kerning2 \dbch \af2 \hich \af0 \l
och \f0 \cgrid1 \langfe2052 \langfenp2052 \cf1 was at or above 40mmHg. Metaboli
c acidosis was not a feature of these cases. Base excess measurements were made
at 37\uc1 \u65533 ?C. If we added NaHCO}{\fs15 \kerning2 \dbch \af2 \hich \af0 \
loch \f0 \cgrid1 \langfe2052 \langfenp2052 \cf1 2}{\fs21 \kerning2 \dbch \af2 \h
ich \af0 \loch \f0 \cgrid1 \langfe2052 \langfenp2052 \cf1 to the priming soluti
on of the pump so that the base excess of the prime was zero, no alteration of b
ase excess occurred in the patient during or after cooling. If we did not "zero"
the base excess in the pump, then the base excess dropped suddenly when bypass
started. It remained unchanged while the temperature was low and then corrected
slowly during and after rewarming.}{\fs21 \kerning2 \dbch \af2 \hich \af0 \loch
\f0 \cgrid1 \langfe2052 \langfenp2052 \par }\pard \plain \qj \li0 \ri0 \widctlpa
r \aspalpha \adjustright \lin0 \rin0 \intbl1 \itap1 \fs21 \kerning2 \dbch \af2 \
hich \af0 \loch \af0 {\fs21 \kerning2 \dbch \af2 \hich \af0 \loch \f0 \cgrid1 \l
angfe2052 \langfenp2052 \cf1 Our conclusion was that if tissue PCO}{\fs15 \kerni
\cf1 is kept near 40mmHg at all temperatures, metabolic acidosis does not occur
, and that some complex CNS functions continue as at normal temperature. So that
we think that the optimal pH is 7.4 and PCO2 40mmHg at all temperatures.}{\fs21
\kerning2 \dbch \af2 \hich \af0 \loch \f0 \cgrid1 \langfe2052 \langfenp2052 \pa
r }\pard \plain \qj \li0 \ri0 \widctlpar \aspalpha \adjustright \lin0 \rin0 \int
bl1 \itap1 \fs21 \kerning2 \dbch \af2 \hich \af0 \loch \af0 {\fs21 \kerning2 \db
ch \af2 \hich \af0 \loch \f0 \cgrid1 \langfe2052 \langfenp2052 \cf1 In contrast,
}{\field \fldedit {\*\fldinst {\fs21 \kerning2 \dbch \af2 \hich \af0 \loch \af0
\af0 \loch \f0 \cgrid1 \langfe2052 \langfenp2052 \cf13 \ul1 HYPERLINK "http://w
ww.anaesthesia.med.usyd.edu.au/resources/lectures/acidbase_mjb/references.html#r
ahn75"}}{\*\fldrslt {\fs21 \kerning2 \dbch \af2 \hich \af0 \loch \af0 \cgrid1 \l
angfe2052 \langfenp2052 \cf13 \ul1 }{\fs21 \kerning2 \dbch \af2 \hich \af0 \loch
\f0 \cgrid1 \langfe2052 \langfenp2052 \cf13 \ul1 Rhan et al, (1975)}}}{\fs21 \k
erning2 \dbch \af2 \hich \af0 \loch \af0 \cgrid1 \langfe2052 \langfenp2052 \cf13
\ul1 }{\fs21 \kerning2 \dbch \af2 \hich \af0 \loch \f0 \cgrid1 \langfe2052 \lan
gfenp2052 \cf1 propose that at all temperatures the CO}{\fs15 \kerning2 \dbch \
af2 \hich \af0 \loch \f0 \cgrid1 \langfe2052 \langfenp2052 \cf1 2}{\fs21 \kernin
g2 \dbch \af2 \hich \af0 \loch \f0 \cgrid1 \langfe2052 \langfenp2052 \cf1 conte
nt of the blood should be the same, i.e. the optimal pH and PCO}{\fs15 \kerning2
1 would be the same as those which occur if blood is warmed or cooled in a clos
ed system and the pH and PCO}{\fs15 \kerning2 \dbch \af2 \hich \af0 \loch \f0 \c
grid1 \langfe2052 \langfenp2052 \cf1 2}{\fs21 \kerning2 \dbch \af2 \hich \af0 \l
och \f0 \cgrid1 \langfe2052 \langfenp2052 \cf1 measured at the altered temperat
ure. If the pH and PCO}{\fs15 \kerning2 \dbch \af2 \hich \af0 \loch \f0 \cgrid1
\langfe2052 \langfenp2052 \cf1 2}{\fs21 \kerning2 \dbch \af2 \hich \af0 \loch \f
0 \cgrid1 \langfe2052 \langfenp2052 \cf1 measuring system is maintained at 37\u
c1 \u65533 ?C then the desired pH would be 7.4 and desired PCO}{\fs15 \kerning2
40mmHg.}{\fs21 \kerning2 \dbch \af2 \hich \af0 \loch \f0 \cgrid1 \langfe2052 \
\lin0 \rin0 \intbl1 \itap1 \fs21 \kerning2 \dbch \af2 \hich \af0 \loch \af0 {\fs
cf1 In the clinical situation of induced hypothermia, pulmonary ventilation woul
d be similar to that imposed at normal temperature as the increased solubility a
nd decreased production would at least partially compensate for each other. Moni
toring would be done on arterial blood if extracorporeal circulation is not bein
g used or the mixed venous blood from the venous reservoir if the circulation is
extracorporeal.}{\fs21 \kerning2 \dbch \af2 \hich \af0 \loch \f0 \cgrid1 \langf
e2052 \langfenp2052 \par }\pard \plain \qj \li0 \ri0 \widctlpar \aspalpha \adjus
p2052 \cf1 The justification for these recommendations are:}{\fs21 \kerning2 \db
ch \af2 \hich \af0 \loch \f0 \cgrid1 \langfe2052 \langfenp2052 \par }\pard \plai
n \qj \li0 \ri0 \widctlpar \aspalpha \adjustright \lin0 \rin0 \intbl1 \itap1 \fs
21 \kerning2 \dbch \af2 \hich \af0 \loch \af0 {\fs21 \kerning2 \dbch \af2 \hich
\af0 \loch \f0 \cgrid1 \langfe2052 \langfenp2052 \cf1 a) The neutral point of wa
ter changes with temperature, i.e. pH 6.8 at 37\uc1 \u65533 ?C (which correspond
s to normal intracellular pH) or pH 7.5 at 0\uc1 \u65533 ?C. }{\fs21 \kerning2 \
h \af0 \loch \f0 \cgrid1 \langfe2052 \langfenp2052 \cf1 b) In cold blooded anima
ls pH and PCO}{\fs15 \kerning2 \dbch \af2 \hich \af0 \loch \f0 \cgrid1 \langfe20
\langfe2052 \langfenp2052 \cf1 alter with temperature in a similar way. This i
s therefore suggested as being optimal for human hypothermia.}{\fs21 \kerning2 \
h \af0 \loch \f0 \cgrid1 \langfe2052 \langfenp2052 \cf1 In contrast, hibernating
animals which presumably are evolutionarily closer to humans than poikilothermi
c animals, respond differently to low temperatures. Hibernating animals keep the
PCO}{\fs15 \kerning2 \dbch \af2 \hich \af0 \loch \f0 \cgrid1 \langfe2052 \langf
enp2052 \cf1 2}{\fs21 \kerning2 \dbch \af2 \hich \af0 \loch \f0 \cgrid1 \langfe2
052 \langfenp2052 \cf1 near 40 torr or higher, while the temperature is low. A
summary of the published findings for the hibernating animals is given by }{\fie
ld \fldedit {\*\fldinst {\fs21 \kerning2 \dbch \af2 \hich \af0 \loch \af0 \cgrid
1 \langfe2052 \langfenp2052 \cf13 \ul1 }{\fs21 \kerning2 \dbch \af2 \hich \af0 \
loch \f0 \cgrid1 \langfe2052 \langfenp2052 \cf13 \ul1 HYPERLINK "http://www.anae
sthesia.med.usyd.edu.au/resources/lectures/acidbase_mjb/references.html#goodrich
73"}}{\*\fldrslt {\fs21 \kerning2 \dbch \af2 \hich \af0 \loch \af0 \cgrid1 \lang
fe2052 \langfenp2052 \cf13 \ul1 }{\fs21 \kerning2 \dbch \af2 \hich \af0 \loch \f
0 \cgrid1 \langfe2052 \langfenp2052 \cf13 \ul1 Goodrich (1973)}}}{\fs21 \kerning
2 \dbch \af2 \hich \af0 \loch \af0 \cgrid1 \langfe2052 \langfenp2052 \cf13 \ul1
052 \cf1 .}{\fs21 \kerning2 \dbch \af2 \hich \af0 \loch \f0 \cgrid1 \langfe2052
\langfenp2052 \par }\pard \plain \qj \li0 \ri0 \widctlpar \aspalpha \adjustright
\lin0 \rin0 \intbl1 \itap1 \fs21 \kerning2 \dbch \af2 \hich \af0 \loch \af0 {\f
\cf1 The argument for optimal pH management at low temperatures by analogy with
poikilothermic animals is not conclusive. One could just as well argue that pH o
ptimisation should follow the hibernating animals or some other set of condition
s.}{\fs21 \kerning2 \dbch \af2 \hich \af0 \loch \f0 \cgrid1 \langfe2052 \langfen
p2052 \par }\pard \plain \qj \li0 \ri0 \widctlpar \aspalpha \adjustright \lin0 \
rin0 \intbl1 \itap1 \fs21 \kerning2 \dbch \af2 \hich \af0 \loch \af0 {\field \fl
dedit {\*\fldinst {\fs21 \kerning2 \dbch \af2 \hich \af0 \loch \af0 \cgrid1 \lan
gfe2052 \langfenp2052 \cf13 \ul1 }{\fs21 \kerning2 \dbch \af2 \hich \af0 \loch \
f0 \cgrid1 \langfe2052 \langfenp2052 \cf13 \ul1 HYPERLINK "http://www.anaesthesi
a.med.usyd.edu.au/resources/lectures/acidbase_mjb/references.html#becker81"}}{\*
\fldrslt {\fs21 \kerning2 \dbch \af2 \hich \af0 \loch \af0 \cgrid1 \langfe2052 \
langfenp2052 \cf13 \ul1 }{\fs21 \kerning2 \dbch \af2 \hich \af0 \loch \f0 \cgrid
1 \langfe2052 \langfenp2052 \cf13 \ul1 Becker et al, (1981)}}}{\fs21 \kerning2 \
dbch \af2 \hich \af0 \loch \af0 \cgrid1 \langfe2052 \langfenp2052 \cf13 \ul1 }{\
\cf1 have advocated blood pH higher than 7.4 at low temperature. This is achie
ved by lowering PCO}{\fs15 \kerning2 \dbch \af2 \hich \af0 \loch \f0 \cgrid1 \la
ngfe2052 \langfenp2052 \cf1 2}{\fs21 \kerning2 \dbch \af2 \hich \af0 \loch \f0 \
cgrid1 \langfe2052 \langfenp2052 \cf1 by ventilation of the lungs or extracorpo
real oxygenator. They use small groups of animals and show quite large differenc
es in circulatory dynamics and ease of resuscitation. The comparison is between
animals in which the pH is kept at 7.4 and others where the pH is above 7.4 (bot
h measured at 37\uc1 \u65533 ?C). The claim is higher cardiac output and easier
cardiac rhythm managements when pH is greater than 7.4. Similar claims were made
by }{\field \fldedit {\*\fldinst {\fs21 \kerning2 \dbch \af2 \hich \af0 \loch \
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NK "http://www.anaesthesia.med.usyd.edu.au/resources/lectures/acidbase_mjb/refer
ences.html#carson62"}}{\*\fldrslt {\fs21 \kerning2 \dbch \af2 \hich \af0 \loch \
af0 \cgrid1 \langfe2052 \langfenp2052 \cf13 \ul1 }{\fs21 \kerning2 \dbch \af2 \h
ich \af0 \loch \f0 \cgrid1 \langfe2052 \langfenp2052 \cf13 \ul1 Carson}}}{\fs21
\kerning2 \dbch \af2 \hich \af0 \loch \af0 \cgrid1 \langfe2052 \langfenp2052 \cf
13 \ul1 }{\fs21 \kerning2 \dbch \af2 \hich \af0 \loch \f0 \cgrid1 \langfe2052 \l
angfenp2052 \cf1 and Morris when the pH was deliberately lowered below 7.4 on c
ooling. }{\field \fldedit {\*\fldinst {\fs21 \kerning2 \dbch \af2 \hich \af0 \lo
ch \af0 \cgrid1 \langfe2052 \langfenp2052 \cf13 \ul1 }{\fs21 \kerning2 \dbch \af
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ttp://www.anaesthesia.med.usyd.edu.au/resources/lectures/acidbase_mjb/references
.html#carson62"}}{\*\fldrslt {\fs21 \kerning2 \dbch \af2 \hich \af0 \loch \af0 \
cgrid1 \langfe2052 \langfenp2052 \cf13 \ul1 }{\fs21 \kerning2 \dbch \af2 \hich \
af0 \loch \f0 \cgrid1 \langfe2052 \langfenp2052 \cf13 \ul1 Carson}}}{\fs21 \kern
np2052 \cf1 and Morris also claimed that the low pH due to CO}{\fs15 \kerning2
administration was associated with low production of non-respiratory acids; th
e same is claimed by Becker et al for the technique of using a high pH.}{\fs21 \
1 \itap1 \fs21 \kerning2 \dbch \af2 \hich \af0 \loch \af0 {\fs21 \kerning2 \dbch
\af2 \hich \af0 \loch \f0 \cgrid1 \langfe2052 \langfenp2052 \cf1 It is apparent
that there is great confusion in the literature which cannot be resolved by the
methods being used at present (i.e. using small groups of animals and extrapola
ting results to human experiences where much larger groups are used and results
between different groups using different pH management are not obvious). There a
re several types of arguments being used. I will try to classify these:}{\fs21 \
\af2 \hich \af0 \loch \f0 \cgrid1 \langfe2052 \langfenp2052 \cf1 a) Evolutionar
y or comparative considerations. These compare what cold blooded or hibernating
animals do biochemically when the temperatures are below 37\uc1 \u65533 ?C. Any
conclusions from these must be applied to large numbers of humans and produce a
very obvious difference before acceptance. }{\fs21 \kerning2 \dbch \af2 \hich \a
cgrid1 \langfe2052 \langfenp2052 \cf1 Animal experiments are done on a small (e.
g. six or twelve) numbers of animals (}{\field \fldedit {\*\fldinst {\fs21 \kern
np2052 \cf13 \ul1 HYPERLINK "http://www.anaesthesia.med.usyd.edu.au/resources/le
ctures/acidbase_mjb/references.html#mcconnell75"}}{\*\fldrslt {\fs21 \kerning2 \
dbch \af2 \hich \af0 \loch \af0 \cgrid1 \langfe2052 \langfenp2052 \cf13 \ul1 }{\
\cf13 \ul1 McConnell (1979)}}}{\fs21 \kerning2 \dbch \af2 \hich \af0 \loch \af0
\af0 \loch \f0 \cgrid1 \langfe2052 \langfenp2052 \cf1 , }{\field \fldedit {\*\f
ldinst {\fs21 \kerning2 \dbch \af2 \hich \af0 \loch \af0 \cgrid1 \langfe2052 \la
ngfenp2052 \cf13 \ul1 }{\fs21 \kerning2 \dbch \af2 \hich \af0 \loch \f0 \cgrid1
\langfe2052 \langfenp2052 \cf13 \ul1 HYPERLINK "http://www.anaesthesia.med.usyd.
edu.au/resources/lectures/acidbase_mjb/references.html#becker81"}}{\*\fldrslt {\
52 \langfenp2052 \cf13 \ul1 Becker (1975)}}}{\fs21 \kerning2 \dbch \af2 \hich \a
f0 \loch \af0 \cgrid1 \langfe2052 \langfenp2052 \cf13 \ul1 }{\fs21 \kerning2 \db
ch \af2 \hich \af0 \loch \f0 \cgrid1 \langfe2052 \langfenp2052 \cf1 and }{\fiel
d \fldedit {\*\fldinst {\fs21 \kerning2 \dbch \af2 \hich \af0 \loch \af0 \cgrid1
\langfe2052 \langfenp2052 \cf13 \ul1 }{\fs21 \kerning2 \dbch \af2 \hich \af0 \l
och \f0 \cgrid1 \langfe2052 \langfenp2052 \cf13 \ul1 HYPERLINK "http://www.anaes
thesia.med.usyd.edu.au/resources/lectures/acidbase_mjb/references.html#norwood79
"}}{\*\fldrslt {\fs21 \kerning2 \dbch \af2 \hich \af0 \loch \af0 \cgrid1 \langfe
\cgrid1 \langfe2052 \langfenp2052 \cf13 \ul1 Norwood et al (1979)}}}{\fs21 \kern
np2052 \cf1 ). The results show marked superiority of one technique. If such res
ults were transferable to clinical practice, very obvious differences in clinica
l outcome would be apparent. Clinical outcome for coronary artery grafting and c
ongenital heart repairs do not appear to be much influenced by such details of p
erfusion technique as the pH and PCO}{\fs15 \kerning2 \dbch \af2 \hich \af0 \loc
h \f0 \cgrid1 \langfe2052 \langfenp2052 \cf1 2}{\fs21 \kerning2 \dbch \af2 \hich
\af0 \loch \f0 \cgrid1 \langfe2052 \langfenp2052 \cf1 of the patient.}{\fs21 \
\af2 \hich \af0 \loch \f0 \cgrid1 \langfe2052 \langfenp2052 \cf1 b) Arguments b
ased on the clinical outcome when various pH and PCO}{\fs15 \kerning2 \dbch \af2
\dbch \af2 \hich \af0 \loch \f0 \cgrid1 \langfe2052 \langfenp2052 \cf1 manoeuvr
es are used at low temperatures. Criteria are such things as rhythm changes and
stability, ease of discontinuation of extracorporeal circulation and alterations
in contractile activity of the myocardium.}{\fs21 \kerning2 \dbch \af2 \hich \a
cgrid1 \langfe2052 \langfenp2052 \cf1 c) Arguments of physiological response dur
ing periods of low temperature.}{\fs21 \kerning2 \dbch \af2 \hich \af0 \loch \f0
\cgrid1 \langfe2052 \langfenp2052 \par }\pard \plain \qj \li0 \ri0 \widctlpar \
aspalpha \adjustright \lin0 \rin0 \intbl1 \itap1 \fs21 \kerning2 \dbch \af2 \hic
h \af0 \loch \af0 {\fs21 \kerning2 \dbch \af2 \hich \af0 \loch \f0 \cgrid1 \lang
fe2052 \langfenp2052 \cf1 i) Peripheral circulation (presence or absence of vaso
constriction or dilatation). }{\fs21 \kerning2 \dbch \af2 \hich \af0 \loch \f0 \
2052 \langfenp2052 \cf1 ii) Rates and eveness of cooling.}{\fs21 \kerning2 \dbch
f0 \loch \f0 \cgrid1 \langfe2052 \langfenp2052 \cf1 iii) Occurrence of ventricul
ar or arterial arrythmias or fibrillation and ease of management of these.}{\fs2
1 \kerning2 \dbch \af2 \hich \af0 \loch \f0 \cgrid1 \langfe2052 \langfenp2052 \p
ar }\pard \plain \qj \li0 \ri0 \widctlpar \aspalpha \adjustright \lin0 \rin0 \in
tbl1 \itap1 \fs21 \kerning2 \dbch \af2 \hich \af0 \loch \af0 {\fs21 \kerning2 \d
bch \af2 \hich \af0 \loch \f0 \cgrid1 \langfe2052 \langfenp2052 \cf1 iv) Central
nervous system activity as shown by respiratory muscle contraction or states of
arousal.}{\fs21 \kerning2 \dbch \af2 \hich \af0 \loch \f0 \cgrid1 \langfe2052 \
\lin0 \rin0 \intbl1 \itap1 \fs21 \kerning2 \dbch \af2 \hich \af0 \loch \af0 {\fs
cf1 The following is a recapitulation of the main regimens recommended for pH co
ntrol when body temperature is less than 37\uc1 \u65533 ?C:}{\fs21 \kerning2 \db
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red disease is less than 3% (2.7% of 15,399 cases. }{\field \fldedit {\*\fldinst
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\hich \af0 \loch \f0 \cgrid1 \langfe2052 \langfenp2052 \cf1 ). Studies show larg
e differences in small groups of animals subject to alterations in pH management
during hypothermia. Such differences in pH management have been applied in the
clinical situation by different groups. The clinical outcome of such application
s has not been shown to be very different. It is hard to imagine a major clinica
l cardiovascular or cerebral alteration which is obvious in 6 animals not being
apparent in the massive clinical use during coronary artery grafting. One can on
ly conclude that the animals results are not applicable to the clinical situatio
n. The reasons for not being able to apply them may range from species differenc
e to poor design or execution of the studies.}{\fs21 \kerning2 \dbch \af2 \hich
\af0 \loch \f0 \cgrid1 \langfe2052 \langfenp2052 \par }\pard \plain \qj \li0 \ri
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dbch \af2 \hich \af0 \loch \af0 {\fs21 \kerning2 \dbch \af2 \hich \af0 \loch \f0
\cgrid1 \langfe2052 \langfenp2052 \cf1 At present, I think that it is not possi
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being superior to any other. I think that it is unlikely that it will be shown t
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