Caetano Nigro Neto1, Francesco De Simone2, Luigi Cassara2, Carlos Gustavo Dos Santos Silva1, Thiago Augusto Almeida Maranhão Cardoso1, Francesco Carco2, Alberto Zangrillo3, Giovanni Landoni3
1 Department of Surgery and Anesthesia, Dante Pazzanese Institute of Cardiology, São Paulo, Italy
2 Department of Anesthesia and Intensive Care, IRCCS San Raffaele Scientific Institute, Milan, Italy
3 Department of Anesthesia and Intensive Care, IRCCS San Raffaele Scientific Institute; Department of Anesthesia and Intensive Care, Vita-Salute San Raffaele University, Milan, Italy
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.
Department of Anesthesia and Intensive Care, IRCCS San Raffaele Scientific Institute, Via Olgettina 60, 20132 Milan
Source of Support: None, Conflict of Interest: None
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