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An innovative technique to improve safety of volatile anesthetics suction from the cardiopulmonary bypass circuit


1 Department of Anesthesia and Intensive Care, IRCCS San Raffaele Scientific Institute, Milan, Italy
2 Department of Biomedical Sciences, University of Cagliari, Cagliari, Italy
3 Dante Pazzanese Institute of Cardiology, São Paulo, Brazil
4 Department of Anesthesia and Intensive Care, IRCCS San Raffaele Scientific Institute; University Vita-Salute San Raffaele, Milan, Italy
5 Department of Anesthesia and Intensive Care, IRCCS San Raffaele Scientific Institute; Anesthesia and Intensive Care, Vita-Salute San Raffaele University, Milan, Italy

Correspondence Address:
Giovanni Landoni
Department of Anesthesia and Intensive Care, IRCCS San Raffaele Scientific Institute, University Vita-Salute San Raffaele, Milan
Italy
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Source of Support: None, Conflict of Interest: None


DOI: 10.4103/aca.ACA_50_17

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Year : 2017  |  Volume : 20  |  Issue : 4  |  Page : 399-402

 

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Context: Myocardial injury during cardiac surgery on cardiopulmonary bypass (CPB) is a major determinant of morbidity and mortality. Preclinical and clinical evidence of dose- and time-related cardioprotective effects of volatile anesthetic drugs exist and their use during the whole surgery duration could improve perioperative cardiac protection. Even if administering volatile agents during CPB are relatively easy, technical problems, such as waste gas scavenging, may prevent safe and manageable administration of halogenated vapors during CPB. Aims: The aim of this study is to improve the safe administration of volatile anesthesia during CPB. Settings and Design: Tertiary teaching hospital. Subjects and Methods: We describe an original device that collects and disposes of any volatile anesthetic vapors present in the exit stream of the oxygenator, hence preventing its dispersal into the operating theatre environment and adaptively regulates pressure of oxygenator chamber in the CPB circuit. Results: We have so far applied a prototype of this device in more than 1300 adult cardiac surgery patients who received volatile anesthetics during the CPB phase. Conclusions: Widespread implementation of scavenging system like the one we designed may facilitate the perfusionist and the anesthesiologist in delivering these cardioprotective drugs with beneficial impact on patients' outcome without compromising on safety.






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1 Department of Anesthesia and Intensive Care, IRCCS San Raffaele Scientific Institute, Milan, Italy
2 Department of Biomedical Sciences, University of Cagliari, Cagliari, Italy
3 Dante Pazzanese Institute of Cardiology, São Paulo, Brazil
4 Department of Anesthesia and Intensive Care, IRCCS San Raffaele Scientific Institute; University Vita-Salute San Raffaele, Milan, Italy
5 Department of Anesthesia and Intensive Care, IRCCS San Raffaele Scientific Institute; Anesthesia and Intensive Care, Vita-Salute San Raffaele University, Milan, Italy

Correspondence Address:
Giovanni Landoni
Department of Anesthesia and Intensive Care, IRCCS San Raffaele Scientific Institute, University Vita-Salute San Raffaele, Milan
Italy
Login to access the Email id

Source of Support: None, Conflict of Interest: None


DOI: 10.4103/aca.ACA_50_17

Rights and Permissions

Context: Myocardial injury during cardiac surgery on cardiopulmonary bypass (CPB) is a major determinant of morbidity and mortality. Preclinical and clinical evidence of dose- and time-related cardioprotective effects of volatile anesthetic drugs exist and their use during the whole surgery duration could improve perioperative cardiac protection. Even if administering volatile agents during CPB are relatively easy, technical problems, such as waste gas scavenging, may prevent safe and manageable administration of halogenated vapors during CPB. Aims: The aim of this study is to improve the safe administration of volatile anesthesia during CPB. Settings and Design: Tertiary teaching hospital. Subjects and Methods: We describe an original device that collects and disposes of any volatile anesthetic vapors present in the exit stream of the oxygenator, hence preventing its dispersal into the operating theatre environment and adaptively regulates pressure of oxygenator chamber in the CPB circuit. Results: We have so far applied a prototype of this device in more than 1300 adult cardiac surgery patients who received volatile anesthetics during the CPB phase. Conclusions: Widespread implementation of scavenging system like the one we designed may facilitate the perfusionist and the anesthesiologist in delivering these cardioprotective drugs with beneficial impact on patients' outcome without compromising on safety.






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