Safe sedation management using volatile anesthetics during cardiopulmonary bypass
Safe sedation management using volatile anesthetics during cardiopulmonary bypass
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DOI：
10.1007/s00540-022-03054-7
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发表时间：
2022-03-10
影响因子：
2.8
通讯作者：
Nishiwaki，Kimitoshi
中科院分区：
文献类型：
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作者：
Tamura，Takahiro;Mori，Atsushi;Nishiwaki，Kimitoshi
多项证据表明，最初用作镇静剂的挥发性麻醉剂（VA）对心脏缺血再灌注损伤具有心肌保护作用。在欧洲和美国，VA在体外循环（CPB）期间的使用很广泛，2019年欧洲心胸外科协会（EACTS）/欧洲心胸麻醉协会/欧洲心血管灌注委员会、2011年美国心脏病学会/美国心脏协会和2017年EACTS指南根据其潜在的心肌功能推荐在心血管手术中使用VA。保护作用。在包括日本在内的其他国家，VA 的使用正在逐渐增加。因此，重要的是要了解 CPB 期间使用 VA 相关的风险和可能的不良事件，以确保安全的镇静管理。在此，我们详细描述了由于使用 VA 导致的术中意识、空气污染和氧合器损坏等问题，并提出了预防措施。
Several pieces of evidence suggest that volatile anesthetics (VAs), which were originally used as sedatives, have myocardial protective effects against cardiac ischemia–reperfusion injury. In Europe and the United States, the use of VAs during cardiopulmonary bypass (CPB) is widespread, as 2019 European Association for Cardio-Thoracic Surgery (EACTS)/European Association of Cardiothoracic Anaesthesiology/European Board of Cardiovascular Perfusion, 2011 American College of Cardiology/American Heart Association, and 2017 EACTS guidelines recommend their use in cardiovascular surgery, based on their potential myocardial protective effects. In other countries, including Japan, the use of VAs is gradually increasing. Therefore, it is important to be aware of the risks and possible adverse events associated with VA use during CPB to ensure safe sedation management. Herein, we describe in detail issues such as intraoperative awareness, air pollution, and damage to oxygenators due to VA use and propose precautions.