The metabolic management of patients on cardiopulmonary bypass (CPB) is a complex process, involving several key biochemical and physiological parameters essential to maintaining homeostasis and reducing morbidity and mortality associated with CPB and cardiac surgery.There is movement toward goal directed perfusion (GDP), using indexed parameters such as carbon dioxide production, oxygen delivery and oxygen consumption to individualize perfusion strategies. This chapter provides an overview of the fundamental principles surrounding the metabolic management of the patient on CPB.

Avoiding unnecessary myocardial damage has been at the forefront of cardiac surgery since its early days. The ability to arrest and immobilize the heart and revive it again without loss of function has facilitated more and more complex surgeries. Effective myocardial protection, particularly for the duration of aortic cross clamping, involves multimodal strategies consisting of temperature management, cardioplegic solutions delivered by various routes as well as non-cardioplegic techniques like ischemic preconditioning through intermittent cross-clamping or pharmacological protection.

Neurological complications after a cardiac surgery are common and have a large impact on patient outcomes. They are the result of a combination of numerous factors, many of them associated with cardiopulmonary bypass (CPB). Blood pressure control is essential to reduce the incidence of cerebral hypoperfusion and ischemic stroke during and after cardiac surgery. Cerebral oxygen saturation can be tracked using near infrared spectroscopy to assess cerebral perfusion and oxygenation. Careful temperature management plays a key role in preventing cerebral morbidity. Despite multiple attempts to find pharmacologic strategies to prevent neurologic injury, no such solution has been found to reduce the burden of neurologic complications associated with cardiac surgery.

This chapter explores temperature regulation and how it can be managed perioperatively. First, it addresses the components and mechanisms that control and regulate temperature in humans. Second, it explores the abnormalities that may occur due to pathologies, surgery, and anaesthesia. Lastly, it addresses how perioperative practitioners can regulate temperature effectively using a range of methods.