title: Use of volatile anesthetics during cardiopulmonary bypass: a systematic review of adverse events.
abstract: OBJECTIVE
  Recently, evidence of reduction in mortality due to the use of volatile agents during cardiac surgery led to an increase in their use during cardiopulmonary bypass (CPB). Because this technique could be beneficial to patients, but might present several hazards to new users, the authors decided to perform a systematic review of the main problems and complications.
  
  
  METHODS
  Systematic literature review.
  
  
  METHODS
  Hospital.
  
  
  METHODS
  Adults undergoing cardiac surgery with use of volatile anesthetic agents during CPB.
  
  
  METHODS
  Several databases were searched for pertinent studies to identify all reports on the adverse events of using volatile agents during CPB and all randomized controlled trials using volatile agents during CPB.
  
  
  RESULTS
  Six nonrandomized trials reporting adverse events or complications with the use of volatile agents during CPB for cardiac surgery were identified: 2 reporting low transfer of isoflurane to the blood with diffusion membrane oxygenators; 2 reporting iatrogenic causes of damage after spilling liquid isoflurane onto the surface of the membrane oxygenators while filling the vaporizer; and 2 suggesting that the use of volatile agents during CPB increased the pollution of the room and the risk of occupational exposure of the operating room staff. On the other hand, no adverse event was reported in 19 studies that randomized 1,195 patients to receive isoflurane, desflurane, or sevoflurane during CPB.
  
  
  CONCLUSIONS
  It is mandatory for industry to provide safe and easy-to-use devices to administer volatile agents during CPB with the standard membrane oxygenators.
authors.affiliation: Department of Anesthesia and Intensive Care, Dante Pazzanese Institute of Cardiology and San Raffaele Scientific Institute, Milan, Italy.
authors.forename: Caetano
authors.initials: C
authors.lastname: Nigro Neto
authors.affiliation: Department of Anesthesia and Intensive Care, Dante Pazzanese Institute of Cardiology and San Raffaele Scientific Institute, Milan, Italy. Electronic address: landoni.giovanni@hsr.it.
authors.forename: Giovanni
authors.initials: G
authors.lastname: Landoni
authors.affiliation: Department of Anesthesia and Intensive Care, Dante Pazzanese Institute of Cardiology and San Raffaele Scientific Institute, Milan, Italy.
authors.forename: Luigi
authors.initials: L
authors.lastname: Cassarà
authors.affiliation: Department of Anesthesia and Intensive Care, Dante Pazzanese Institute of Cardiology and San Raffaele Scientific Institute, Milan, Italy.
authors.forename: Francesco
authors.initials: F
authors.lastname: De Simone
authors.affiliation: Department of Anesthesia and Intensive Care, Dante Pazzanese Institute of Cardiology and San Raffaele Scientific Institute, Milan, Italy.
authors.forename: Alberto
authors.initials: A
authors.lastname: Zangrillo
authors.affiliation: Department of Anesthesia and Intensive Care, Dante Pazzanese Institute of Cardiology and San Raffaele Scientific Institute, Milan, Italy.
authors.forename: Maria Angela
authors.initials: MA
authors.lastname: Tardelli
mesh_terms: D018685:Anesthetics, Inhalation / Q000009:adverse effects*; D002315:Cardiopulmonary Bypass; D006801:Humans; D010107:Oxygenators, Membrane; D016032:Randomized Controlled Trials as Topic
chemical_list: D018685:Anesthetics, Inhalation
keywords: anesthesia; cardiac surgery; cardiopulmonary bypass; desflurane; isoflurane; safety; sevoflurane; volatile anesthetic