Department of Anesthesiology, Nagoya University Graduate School of Medicine, 65 Tsurumai-cho, Showa-Ku, Nagoya, 466-8550, Japan.
Department of Perioperative Management System, Nagoya University Graduate School of Medicine, Nagoya, Japan.
J Anesth. 2020 Dec;34(6):904-911. doi: 10.1007/s00540-020-02844-1. Epub 2020 Aug 26.
Volatile anesthetics (VAs) protect myocardial cells in cardiovascular surgery. A recent clinical trial of cardiopulmonary bypass (CPB) surgery reported no significant difference in mortality rates between the use of VAs and total intravenous anesthetics at 1 year postoperatively. However, oxygenator function may affect the VA pharmacokinetics. Thus, we measured the VA blood concentrations during CPB in patients managed with four different microporous polypropylene hollow fiber membrane oxygenators.
Twenty-four patients scheduled for elective CPB were randomly allocated to one of the two VA groups (desflurane and sevoflurane groups) and, then, randomly divided into one of four oxygenator groups: Terumo, LivaNova, Medtronic, and Senko (n = 3). Additionally, in each VA group, three patients were randomly selected and redundantly allocated to the human lung group (for control blood VA concentration without oxygenator). Blood samples collected 20 min after starting 6.0 vol% desflurane or 1.7 vol% sevoflurane were analyzed using gas chromatography. Oxygenator-related complications and structural changes in the membrane surface of each oxygenator after surgery were evaluated.
The mean (standard deviation) concentrations of desflurane and sevoflurane in the human lung were 182.4 (23.2) and 54.0 (9.6) μg/ml, respectively; not significantly different from those in the four oxygenator groups. No oxygenator-related complications occurred. Structural changes in membrane fibers did not occur after clinical use, except for difficulty in image acquisition with Senko products.
Our results demonstrated that the blood concentrations of desflurane and sevoflurane passing through oxygenators used during CPB were similar to those in the human lung control.
挥发性麻醉剂（VAs）可保护心血管手术中心肌细胞。最近一项心肺转流术（CPB）的临床试验报道，在术后 1 年时，使用 VAs 与全静脉麻醉之间的死亡率无显著差异。然而，氧合器功能可能会影响 VA 的药代动力学。因此，我们在使用四种不同微孔聚丙烯中空纤维膜氧合器的 CPB 患者中测量 VA 的血药浓度。
24 例择期 CPB 患者随机分为两组 VA（地氟烷和七氟烷组），然后随机分为四组氧合器：泰尔茂、利瓦诺瓦、美敦力和森科（每组 n=3）。此外，在每组 VA 中，随机选择三名患者并重复分配到人的肺组（用于无氧合器的控制血 VA 浓度）。在开始 6.0 体积%地氟烷或 1.7 体积%七氟烷 20 分钟后采集血样，并用气相色谱法分析。评估每个氧合器的氧合器相关并发症和膜表面结构变化。
人肺中的地氟烷和七氟烷的平均（标准差）浓度分别为 182.4（23.2）和 54.0（9.6）μg/ml，与四个氧合器组无显著差异。未发生与氧合器相关的并发症。除森科产品的图像采集困难外，临床使用后膜纤维的结构变化未发生。
我们的结果表明，通过 CPB 期间使用的氧合器的地氟烷和七氟烷的血药浓度与人类肺控制相似。
