The Influence of Anaesthetics on Systemic Vascular Resistance During Cardiopulmonary Bypass

Nordén, Ingrid

doi:10.3109/14017437409130738

Cited by 19 publications

(4 citation statements)

References 30 publications

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“…The explanation for such undesirable effect would be an in- crease in systemic vascular resistance leading to a decreased tissue perfusion with a simultaneous increase in anaerobic metabolism and building up of acid metabolytes 12 . Even without statistical analysis, peripheral vascular resistance in this study was higher during CPB in the hypothermia group.…”

Section: Discussionmentioning

confidence: 99%

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Temperatura e alterações no equilíbrio ácido-base de pacientes submetidos à cirurgia cardíaca com circulação extracorpórea, sob normotermia e hipotermia

Luz¹,

Auler²

2002

Rev. Bras. Anestesiol.

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Mild hypothermia does not seem to substantially change acid-base balance as compared to normal temperature during CPB. Plasma lactate, however, has significantly increased in patients under hypothermia, suggesting inadequate oxygen transport to periphery during the proposed observation period. Low temperature, although mild, does not seem to offer the expected degree of cell protection to CPB blood flow.

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Section: Discussionmentioning

confidence: 99%

“…O nível de significância utilizado foi de 5%. lismo anaeróbio e acúmulo de metabólitos ácidos 12 . Mesmo sem análise estatística, os valores obtidos de resistência vascular periférica nesse trabalho mostraram-se mais elevados durante a CEC no grupo hipotermia.…”

Section: Métodounclassified

Temperatura e alterações no equilíbrio ácido-base de pacientes submetidos à cirurgia cardíaca com circulação extracorpórea, sob normotermia e hipotermia

Luz¹,

Auler²

2002

Rev. Bras. Anestesiol.

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“…Los halogenados fueron utilizados por primera vez en CPB en 1974, y se han convertido en los hipnóticos más utilizados en CC [9]. Existe abundante evidencia a favor del efecto cardioprotector de los halogenados debido al pre-acondicionamiento farmacológico [10].…”

Section: Introductionunclassified

Mantención de la anestesia general y monitorización de la profundidad anestésica en cirugía cardíaca con bypass cardiopulmonar

2022

Rev. chil. anest.

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The cardiovascular anesthesiologist must frequently assume the care of high-risk patients who will undergo complex and invasive surgeries. In order to ensure patient safety and facilitate decision making, great technological advances have been made to monitor them extensively, such as transesophageal echocardiography and sophisticated hemodynamic monitors. Although hypnotics used during general anesthesia act on the brain, the monitoring of this organ was not considered standard behavior for a long time. The classic electroencephalogram (EEG) appeared as a useful tool to evaluate the changes in neuronal electrical activity induced by general anesthesia and thus detect the different states of consciousness during general anesthesia, i.e., to evaluate the depth of anesthesia (DoA). However, its difficult intraoperative interpretation and the scarce evidence available in its favor were the main limitations for the use of this tool as a hypnosis monitor. Processed EEG (pEEG), derived from EEG decomposition, emerges as an easy-to-interpret alternative for anesthesiologists and useful for assessing anesthetic depth. In cardiac surgery, and especially in cardiopulmonary bypass (CPB), achieving safe and stable hypnosis is a great challenge, since there are critical periods that involve a series of changes in the physiology of the patients and in the administration of hypnotics. Given the above, the monitoring of anesthetic depth in this surgical scenario is currently supported by many authors, the main objectives being to reduce the incidence of awareness with intraoperative recall (AWR) due to hypnotic underdosing, to avoid hemodynamic and neurological adverse effects secondary to hypnotic overdosing, and to collaborate in the evaluation of cerebral perfusion during critical periods.

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“…The use of volatile anesthetic agents during cardiopulmonary bypass (CPB) was described for the 1 st time about 40 years ago. [ 1 ] Originally, volatile agents were vaporized and administered in the early-generation bubble oxygenators. Today, most cardiac surgery interventions are performed with standard membrane oxygenators.…”

Section: Introductionmentioning

confidence: 99%

Tricks, tips, and literature review on the adapted vaporize system to deliver volatile agents during cardiopulmonary bypass

Neto¹,

Simone

Cassarà

et al. 2016

Ann Card Anaesth

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Background:Recently, evidence of cardio-protection and reduction in mortality due to the use of volatile agents during cardiac surgery led to an increase in their use during cardiopulmonary bypass (CPB). These findings seem to be enhanced when the volatile agents are used during all the surgical procedure, including the CPB period.Aims:Since the administration of volatile agents through CPB can be beneficial to the patients, we decided to review the use of volatile agents vaporized in the CPB circuit and to summarize some tricks and tips of this technique using our 10-year experience of Brazilian and Italian centers with a large volume of cardiac surgeries.Study Setting:Hospital.Methods:A literature review.Results:During the use of the volatile agents in CPB, it is very important to analyze all gases that come in and go out of the membrane oxygenators. The proper monitoring of inhaled and exhaled fraction of the gas allows not only monitoring of anesthesia level, but also the detection of possible leakage in the circuit. Any volatile agent in the membrane oxygenator is supposed to pollute the operating theater. This is the major reason why proper scavenging systems are always necessary when this technique is used.Conclusion:While waiting for industry upgrades, we recommend that volatile agents should be used during CPB only by skilled perfusionists and physicians with the aim to reduce postoperative morbidity and mortality.

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The Influence of Anaesthetics on Systemic Vascular Resistance During Cardiopulmonary Bypass

Cited by 19 publications

References 30 publications

Temperatura e alterações no equilíbrio ácido-base de pacientes submetidos à cirurgia cardíaca com circulação extracorpórea, sob normotermia e hipotermia

Temperatura e alterações no equilíbrio ácido-base de pacientes submetidos à cirurgia cardíaca com circulação extracorpórea, sob normotermia e hipotermia

Mantención de la anestesia general y monitorización de la profundidad anestésica en cirugía cardíaca con bypass cardiopulmonar

Tricks, tips, and literature review on the adapted vaporize system to deliver volatile agents during cardiopulmonary bypass

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