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Elimination of sevoflurane is reduced in plasma-tight compared to conventional membrane oxygenators.

Abstract：

BACKGROUND AND OBJECTIVE:It has been demonstrated that volatile anaesthetics have cardioprotective properties during open-heart procedures, especially when administered continuously. European Council Directive 93/42/EEC concerning medical devices bans the supplementary incorporation of anaesthetic vaporizers in the bypass circuit. Since the uptake of volatile anaesthetics via diffusion membrane oxygenators is severely reduced, it is hypothesized that clinically relevant concentrations of sevoflurane will remain in the patients' blood following saturation with a volatile agent before start of cardiopulmonary bypass. This study was designed to compare conventional and diffusion membrane oxygenators regarding their in vivo elimination of sevoflurane. METHODS:Twenty patients undergoing elective coronary bypass surgery were randomly allocated to two groups, either using a conventional polypropylene membrane oxygenator or a plasma-tight poly-(4-methyl-1-pentene) membrane oxygenator in a miniaturized extracorporeal circuit. Anaesthesia was maintained with sevoflurane, which was stopped at the start of cardiopulmonary bypass. During cardiopulmonary bypass, sevoflurane concentration was measured in blood and in the exhausted gas from the oxygenator. RESULTS:The elimination of sevoflurane, expressed as the relative blood concentration, was significantly increased in polypropylene membrane oxygenators compared to poly-(4-methyl-1-pentene) membrane oxygenators. This resulted in an approximately threefold higher sevoflurane blood concentration in the poly-(4-methyl-1-pentene) group over the course of cardiopulmonary bypass. CONCLUSIONS:With the incorporation of a poly-(4-methyl-1-pentene) oxygenator in a miniaturized bypass circuit, relevant concentrations of a previously applied volatile agent can be maintained even without further supply throughout cardiopulmonary bypass. This might be an alternative approach to cardioprotection when sevoflurane cannot be administered through cardiopulmonary bypass.

journal_name

Eur J Anaesthesiol

journal_title

European journal of anaesthesiology

authors

Prasser C,Zelenka M,Gruber M,Philipp A,Keyser A,Wiesenack C

doi

10.1017/S0265021507001330

subject

Has Abstract

pub_date

2008-02-01 00:00:00

pages

152-7

issue

eissn

0265-0215

issn

1365-2346

pii

S0265021507001330

journal_volume

pub_type

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Elimination of sevoflurane is reduced in plasma-tight compared to conventional membrane oxygenators.