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Anestésicos volátiles en oxigenadores durante la circulación extracorpórea.

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Title: Anestésicos volátiles en oxigenadores durante la circulación extracorpórea.
Alternate Title: Volatile anesthetics in oxygenators during cardiopulmonary bypass.
Authors: Gutiérrez-Soriano, Laura1, Kling-Gómez, Juan Carlos1, Becerra-Zapata, Eduardo2 eduardo.becerra@urosario.edu.co, Quintero, Olga3, Maya-Trujillo, Nicolás2, Peña-Blanco, Laura2
Source: Colombian Journal of Anesthesiology / Revista Colombiana de Anestesiología. Jul-Sep2025, Vol. 53 Issue 3, p1-9. 9p.
Subjects: CARDIOPULMONARY bypass, OXYGENATORS, GAS dynamics, CARBON dioxide detectors, AUTOMATIC tracking, CARDIAC surgery, ANESTHETICS
Abstract (English): 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). Conclusions: Continuous monitoring of inhaled and exhaled gases during CPB should be mandatory to optimize anesthetic delivery and achieve targeted plasma concentrations. [ABSTRACT FROM AUTHOR]
Abstract (Spanish): Introducción: La monitorización continua de las concentraciones exhaladas y los niveles de CO2 a menudo falta durante la administración de anestésicos inhalados en la circulación extracorpórea (CEC), niveles que se ajustan de manera intermitente basándose en los valores de gases en sangre. Este enfoque no considera las variaciones en los flujos de gas fresco y circulatorio entre las muestras de sangre. Objetivo: Evaluar el comportamiento de los gases durante la circulación extracorpórea, evaluar la fiabilidad de los datos y analizar los gradientes a través del oxigenador de membrana. Métodos: Se realizó una monitorización en tiempo real de los anestésicos volátiles inhalados y exhalados, CO2 y oxígeno en las entradas y salidas del oxigenador durante la CEC. Se incluyeron 70 pacientes adultos sometidos a cirugía cardiaca con CEC para analizar el impacto del flujo circulatorio en diferentes oxigenadores. Resultados: Se encontró una fuerte correlación entre el CO2 al final de la espiración y el CO2 en los gases arteriales (Rho de Spearman = 0,74, p = 0,00). Los gradientes de isoflurano difirieron significativamente entre los oxigenadores Affinity, Fusion y Terumo (p = 0,015). El equilibrio para el isoflurano se alcanzó en 493,90 ± 164,98 segundos (IC 95 %: 454-532 segundos). Cuando el flujo circulatorio se redujo a 0,5 L/min, las concentraciones exhaladas aumentaron significativamente (T de Fisher, p = 0,07). El lavado de sevoflurano varió significativamente entre los oxigenadores al inicio de la CEC (media: 117,5 s). Conclusiones: La monitorización continua de los gases inhalados y exhalados durante la CEC debería ser obligatoria para optimizar la administración de anestésicos y alcanzar las concentraciones plasmáticas deseadas. [ABSTRACT FROM AUTHOR]
Copyright of Colombian Journal of Anesthesiology / Revista Colombiana de Anestesiología is the property of Sociedad Colombiana de Anestesiologia y Reanimacion and its content may not be copied or emailed to multiple sites without the copyright holder's express written permission. Additionally, content may not be used with any artificial intelligence tools or machine learning technologies. However, users may print, download, or email articles for individual use. This abstract may be abridged. No warranty is given about the accuracy of the copy. Users should refer to the original published version of the material for the full abstract. (Copyright applies to all Abstracts.)
Database: MedicLatina
Description
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). Conclusions: Continuous monitoring of inhaled and exhaled gases during CPB should be mandatory to optimize anesthetic delivery and achieve targeted plasma concentrations. [ABSTRACT FROM AUTHOR]
ISSN:01203347
DOI:10.5554/22562087.e1150