Volatile anesthetics in oxygenators during cardiopulmonary bypass
Abstract
Introduction: Continuous monitoring of exhaled concentrations and CO2 levels is often lacking during the administration of inhaled anesthetics in cardiopulmonary bypass (CPB), these levels often being adjusted intermittently based on blood gas values. This approach disregards variations in fresh gas and circulatory flows between blood samples.
Objective: To assess gas behavior during bypass circulation, evaluate data reliability, and analyze gradients through the membrane oxygenator.
Methods: Real-time monitoring of inhaled and exhaled volatile anesthetics, CO2, and oxygen was conducted at the oxygenator inlet and outlet ports during CPB. Seventy adult patients undergoing cardiac surgery on CPB were included in order to analyze the impact of circulatory flow across different oxygenators.
Results: A strong correlation was found between end-tidal CO2 and arterial blood gas CO2 (Spearman’s Rho = 0.74, p = 0.00). Isoflurane gradients differed significantly among the Affinity, Fusion, and Terumo oxygenators (p = 0.015). Equilibrium for Isoflurane was reached in 493.9 ± 164.98 seconds (95% CI: 454–532 seconds). When circulatory flow was reduced to 0.5 L/min, exhaled concentrations increased significantly (Fisher’s T, p = 0.07). Sevoflurane washout varied significantly across oxygenators at CPB initiation (mean: 117.5 s).
Conclusion: Continuous monitoring of inhaled and exhaled gases during CPB should be mandatory to optimize anesthetic delivery and achieve targeted plasma concentrations.
References
1. Philipp A, Wiesenack C, Behr R, Schmid FX, Birnbaum DE. High risk of intraoperative awareness during cardiopulmonary bypass with isoflurane administration via diffusion membrane oxygenators. Perfusion. 2002;17(3):175-8. https://doi.org/10.1191/0267659102pf566oa
2. Nigro Neto C, Tardelli MA, Paulista PH. Use of Volatile Anesthetics in Extracorporeal Circulation. Rev Bras Anestesiol. 2012;62(3):346-55. https://doi.org/10.1016/S0034-7094(12)70135-6
3. Warltier DC, Laffey JG, Boylan JF, Cheng DCH. The systemic inflammatory response to cardiac surgery. Anesthesiology. 2002;97(1):215-52. https://doi.org/10.1097/00000542-200207000-00030
4. Barry AE, Chaney MA, London MJ. Anesthetic management during cardiopulmonary bypass: A systematic review. Anesth Analg. 2015;120(4):749-69. https://doi.org/10.1213/ANE.0000000000000612
5. Wiesenack C, Wiesner G, Keyl C, et al. In vivo uptake and elimination of isoflurane by different membrane oxygenators during cardiopulmonary bypass. Anesthesiology. 2002;97(1):133-8. https://doi.org/10.1097/00000542-200207000-00019
6. Henderson JM, Nathan HJ, Lalande M, Winkler MH, Dub LM. Washin and washout of isoflurane during cardiopulmonary bypass. Can J Anaesth. 1988;35(6):587-90. https://doi.org/10.1007/BF03020345
7. Doi M, Gajraj RJ, Mantzaridis H, Kenny GN. Effects of cardiopulmonary bypass and hypothermia on electroencephalographic variables. Anesthesia. 1997;52(11):1048-55. https://doi.org/10.1111/j.1365-2044.1997.229-az0364.x
8. AmSECT. Standards and Guidelines for Perfusion Practice 2023 [citado: 2023 jun 20]. Disponible en: https://www.amsect.org/Policy-Practice/AmSECTs-Standards-and-Guidelines.
9. Kunst G, Milojevic M, Boer C, et al. 2019 eacts/EACTA/EBCP guidelines on cardiopulmonary bypass in adult cardiac surgery. Br J Anaesth. 2019;123(6):713-57. https://doi.org/10.1016/j.bja.2019.09.012
10. Medtronic. Affinity Fusion® Oxygenator [Internet]. [citado: 2017 jul]. Disponible en: https://europe.medtronic.com/xden/healthcareprofessionals/products/cardiovascular/cardiopulmonary/affinity-fusion-oxygenation-system.html.
11. Nigro Neto C, Landoni G, Cassar L, et al. Use of volatile anesthetics during cardiopulmonary bypass: A systematic review of adverse events. J Cardiothorac Vasc Anesth. 2014;28(1):84-9. https://doi.org/10.1053/j.jvca.2013.05.030
12. Srey R, Rance G, Handrahan J, Smith T, Leissner KB, Zenati MA. Fraction of expired oxygen: An additional safety approach to monitor oxygen delivery to the Heart Lung Machine Oxygenator. Perfusion. 2021;37(4):331-3. https://doi.org/10.1177/02676591211001594
13. Caruso LJ, Gravenstein N, Janelle GM, Gabrielli A. Detection of oxygen delivery failure during cardiopulmonary bypass: An even earlier warning technique. J Cardiothorac Vasc Anesth. 2002;16(6):789. https://doi.org/10.1016/S1053-0770(02)90000-1
14. Zia M, Davies FW, Alston RP. Oxygenator exhaust capnography. A method of estimating arterial carbon dioxide tension during CPB. JCVA. 1992;6:42-5. https://doi.org/10.1016/1053-0770(91)90043-S
15. Potger KC, McMillan D, Southwell J, Dando H, O'Shaughnessy K. Membrane oxygenator exhaust capnography for continuously estimating arterial carbon dioxide tension during cardiopulmonary bypass. J Extra Corpor Technol. 2003;35(3):218-23. https://doi.org/10.1051/ject/2003353218
16. Baraka A, El-Khatib M, Muallem E, Jamal S, Haroun-Bizri S, Aouad M. Oxygenator exhaust capnography for prediction of arterial carbon dioxide tension during hypothermic cardiopulmonary bypass. J Extra Corpor Technol. 2005;37:192-5. https://doi.org/10.1051/ject/200537192
17. Graham JM, Gibbs NM, Weightman WM, Sheminant MR. The relationship between oxygenator exhaust PCO2 and arterial PCO2 during hypothermic cardiopulmonary bypass. Anaesth Intensive Care. 2005;33:457-61. https://doi.org/10.1177/0310057X0503300406
Downloads
Copyright (c) 2025 Sociedad Colombiana de Anestesiología y Reanimación (S.C.A.R.E.)
This work is licensed under a Creative Commons Attribution-NonCommercial-NoDerivatives 4.0 International License.
| Article metrics | |
|---|---|
| Abstract views | |
| Galley vies | |
| PDF Views | |
| HTML views | |
| Other views | |
