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

Published online by Cambridge University Press:  01 February 2008

C. Prasser ,
M. Zelenka ,
M. Gruber ,
A. Philipp ,
A. Keyser  and
C. Wiesenack
C. Prasser*
Affiliation:
Department of Anaesthesiology, University Hospital of Regensburg, Franz-Josef-Strauss-Allee, Regensburg, Germany
M. Zelenka
Affiliation:
Department of Anaesthesiology, University Hospital of Regensburg, Franz-Josef-Strauss-Allee, Regensburg, Germany
M. Gruber
Affiliation:
Department of Anaesthesiology, University Hospital of Regensburg, Franz-Josef-Strauss-Allee, Regensburg, Germany
A. Philipp
Affiliation:
Department of Cardiothoracic and Vascular Surgery, University Hospital of Regensburg, Franz-Josef-Strauss-Allee, Regensburg, Germany
A. Keyser
Affiliation:
Department of Cardiothoracic and Vascular Surgery, University Hospital of Regensburg, Franz-Josef-Strauss-Allee, Regensburg, Germany
C. Wiesenack
Affiliation:
Department of Anaesthesiology, University Hospital of Regensburg, Franz-Josef-Strauss-Allee, Regensburg, Germany
*
Correspondence to: Christopher Prasser, Department of Anaesthesiology, University Hospital, Franz-Josef-Strauss-Allee 11, 93052 Regensburg, Germany. E-mail: christopher.prasser@klinik.uni-regensburg.de; Tel: +49 941 944 7801; Fax: +49 941 944 7802
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Summary

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.

Keywords

CARDIAC SURGICAL PROCEDURESEXTRACORPOREAL CIRCULATIONREPERFUSIN INJURYSEVOFLURANEOXYGENATORSMEMBRANE
Type
Original Article
Information
European Journal of Anaesthesiology , Volume 25 , Issue 2 , February 2008 , pp. 152 - 157
Copyright
Copyright © European Society of Anaesthesiology 2007

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References

1.De Hert, SG, Van der Linden, PJ, Cromheecke, S et al. . Cardioprotective properties of sevoflurane in patients undergoing coronary surgery with cardiopulmonary bypass are related to the modalities of its administration. Anesthesiology 2004; 101: 299–310.CrossRefGoogle Scholar
2. Council Directive 93/42/EEC of 14 June 1993 concerning medical devices [http://eur-lex.europa.eu/LexUriServ/site/en/consleg/1993/L/01993L0042-20031120-en.pdf].Google Scholar
3.Smul, T, Lange, M, Redel, A, Roewer, N, Kehl, F. Propofol blocks desflurane-induced preconditioning, but not ischemic preconditioning. Anesthesiology 2005; 103ASA abstract A462.Google Scholar
4.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: 133–138.CrossRefGoogle ScholarPubMed
5.Wiesenack, C, Liebold, A, Philipp, A et al. . Four years’ experience with a miniaturized extracorporeal circulation system and its influence on clinical outcome. Artif Organs 2004; 28: 1082–1088.CrossRefGoogle ScholarPubMed
6.Calafiore, AM, Teodori, G, Mezzetti, A et al. . Intermittent antegrade warm blood cardioplegia. Ann Thorac Surg 1995; 59: 398–402.CrossRefGoogle ScholarPubMed
7.Suzuki, T, Uchida, I, Mashimo, T. Sorptive loss of volatile and gaseous anesthetics from in vitro drug application systems. Anesth Analg 2005; 100: 427–430.CrossRefGoogle ScholarPubMed
8.De Hert, SG, Turani, F, Mathur, S, Stowe, DF. Cardioprotection with volatile anesthetics: mechanisms and clinical implications. Anesth Analg 2005; 100: 1584–1593.CrossRefGoogle ScholarPubMed
9.Mullenheim, J, Frassdorf, J, Preckel, B, Thamer, V, Schlack, W. Ketamine, but not S(+)-ketamine, blocks ischemic preconditioning in rabbit hearts in vivo. Anesthesiology 2001; 94: 630–636.CrossRefGoogle Scholar