title: Sevoflurane-enriched blood cardioplegia: the intramyocardial delivery of a volatile anesthetic.
abstract: Myocardial ischemia/reperfusion injury is a major problem in cardiac surgery, characterized by an enhanced inflammatory response postoperatively. Sevoflurane has anti-inflammatory effects and may attenuate this injury. This study describes a novel approach to using sevoflurane as a local anti-inflammatory drug and not as an anesthetic. Therefore, a pediatric oxygenator with a sevoflurane vaporizer was integrated into the blood cardioplegia system of an adult bypass system. In addition, a gas blender was implemented to regulate pO2 and pCO2 concentrations in the cardioplegia. This proof-of-principle study was tested in vivo and shows that it is feasible to deliver sevoflurane locally while regulating O2 and CO2 concentrations. Moreover, this set-up enables one to use only the specific cardioprotective features of sevoflurane. Inflammatory responses were attenuated, both locally (i.e. the heart) as well as systemically through intramyocardial delivery of sevoflurane.
authors.affiliation: Department of Cardiothoracic Surgery, Leiden University Medical Center, Leiden, The Netherlands a.van_der_baan@lumc.nl.
authors.forename: A
authors.initials: A
authors.lastname: van der Baan
authors.affiliation: Department of Cardiothoracic Surgery, Leiden University Medical Center, Leiden, The Netherlands.
authors.forename: K A
authors.initials: KA
authors.lastname: Kortekaas
authors.affiliation: Department of Cardiothoracic Surgery, Leiden University Medical Center, Leiden, The Netherlands.
authors.forename: E
authors.initials: E
authors.lastname: van Es
authors.affiliation: Department of Anesthesiology, Leiden University Medical Center, Leiden, The Netherlands.
authors.forename: S
authors.initials: S
authors.lastname: Meier
authors.affiliation: Department of Cardiothoracic Surgery, Leiden University Medical Center, Leiden, The Netherlands.
authors.forename: R J M
authors.initials: RJ
authors.lastname: Klautz
authors.affiliation: Department of Anesthesiology, Leiden University Medical Center, Leiden, The Netherlands.
authors.forename: F H M
authors.initials: FH
authors.lastname: Engbers
mesh_terms: D000368:Aged; D000777:Anesthetics / Q000008:administration & dosage*; D002314:Cardioplegic Solutions / Q000008:administration & dosage*; D005260:Female; D006324:Heart Arrest, Induced / Q000009:adverse effects / Q000379:methods*; D006801:Humans; D008297:Male; D008738:Methyl Ethers / Q000008:administration & dosage*; D008875:Middle Aged; D015428:Myocardial Reperfusion Injury / Q000517:prevention & control*; D000077149:Sevoflurane; D055549:Volatile Organic Compounds / Q000008:administration & dosage
chemical_list: D000777:Anesthetics; D002314:Cardioplegic Solutions; D008738:Methyl Ethers; D055549:Volatile Organic Compounds; D000077149:Sevoflurane
keywords: blood cardioplegia; cardiopulmonary bypass; inflammation; oxygenator; sevoflurane