TY - JOUR
T1 - Tricks, tips, and literature review on the adapted vaporize system to deliver volatile agents during cardiopulmonary bypass
AU - Neto, Caetano
AU - Simone, Francesco
AU - Cassara, Luigi
AU - Silva, Carlos Gustavo
AU - Cardoso, Thiago Augusto
AU - Carco, Francesco
AU - Zangrillo, Alberto
AU - Landoni, Giovanni
PY - 2016/4/1
Y1 - 2016/4/1
N2 - Background: Recently, evidence of cardio-protection and reduction in mortality due to the use of volatile agents during cardiac surgery led to an increase in their use during cardiopulmonary bypass (CPB). These findings seem to be enhanced when the volatile agents are used during all the surgical procedure, including the CPB period. Aims: Since the administration of volatile agents through CPB can be beneficial to the patients, we decided to review the use of volatile agents vaporized in the CPB circuit and to summarize some tricks and tips of this technique using our 10-year experience of Brazilian and Italian centers with a large volume of cardiac surgeries. Study Setting: Hospital. Methods: A literature review. Results: During the use of the volatile agents in CPB, it is very important to analyze all gases that come in and go out of the membrane oxygenators. The proper monitoring of inhaled and exhaled fraction of the gas allows not only monitoring of anesthesia level, but also the detection of possible leakage in the circuit. Any volatile agent in the membrane oxygenator is supposed to pollute the operating theater. This is the major reason why proper scavenging systems are always necessary when this technique is used. Conclusion: While waiting for industry upgrades, we recommend that volatile agents should be used during CPB only by skilled perfusionists and physicians with the aim to reduce postoperative morbidity and mortality.
AB - Background: Recently, evidence of cardio-protection and reduction in mortality due to the use of volatile agents during cardiac surgery led to an increase in their use during cardiopulmonary bypass (CPB). These findings seem to be enhanced when the volatile agents are used during all the surgical procedure, including the CPB period. Aims: Since the administration of volatile agents through CPB can be beneficial to the patients, we decided to review the use of volatile agents vaporized in the CPB circuit and to summarize some tricks and tips of this technique using our 10-year experience of Brazilian and Italian centers with a large volume of cardiac surgeries. Study Setting: Hospital. Methods: A literature review. Results: During the use of the volatile agents in CPB, it is very important to analyze all gases that come in and go out of the membrane oxygenators. The proper monitoring of inhaled and exhaled fraction of the gas allows not only monitoring of anesthesia level, but also the detection of possible leakage in the circuit. Any volatile agent in the membrane oxygenator is supposed to pollute the operating theater. This is the major reason why proper scavenging systems are always necessary when this technique is used. Conclusion: While waiting for industry upgrades, we recommend that volatile agents should be used during CPB only by skilled perfusionists and physicians with the aim to reduce postoperative morbidity and mortality.
KW - Anesthesia
KW - Cardiac surgery
KW - Cardiopulmonary bypass
KW - Sevoflurane
KW - Volatile anesthetic
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U2 - 10.4103/0971-9784.179592
DO - 10.4103/0971-9784.179592
M3 - Article
AN - SCOPUS:84964889999
VL - 19
SP - 240
EP - 244
JO - Annals of Cardiac Anaesthesia
JF - Annals of Cardiac Anaesthesia
SN - 0971-9784
IS - 2
ER -