title: Tricks, tips, and literature review on the adapted vaporize system to deliver volatile agents during cardiopulmonary bypass.
abstract: 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.
  
  
  OBJECTIVE
  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.
  
  
  METHODS
  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.
  
  
  CONCLUSIONS
  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.
authors.forename: Caetano
authors.initials: C
authors.lastname: Nigro Neto
authors.forename: Francesco
authors.initials: F
authors.lastname: De Simone
authors.forename: Luigi
authors.initials: L
authors.lastname: Cassara
authors.forename: Carlos Gustavo
authors.initials: CG
authors.lastname: Dos Santos Silva
authors.forename: Thiago Augusto Azevedo
authors.initials: TA
authors.lastname: Marãnhao Cardoso
authors.forename: Francesco
authors.initials: F
authors.lastname: Carco
authors.forename: Alberto
authors.initials: A
authors.lastname: Zangrillo
authors.affiliation: Department of Anesthesia and Intensive Care, IRCCS San Raffaele Scientific Institute; Department of Anesthesia and Intensive Care, Vita-Salute San Raffaele University, Milan, Italy.
authors.forename: Giovanni
authors.initials: G
authors.lastname: Landoni
mesh_terms: D000769:Anesthesia, Inhalation / Q000295:instrumentation* / Q000379:methods*; D018685:Anesthetics, Inhalation / Q000008:administration & dosage*; D002315:Cardiopulmonary Bypass / Q000379:methods*; D006801:Humans; D014835:Volatilization
chemical_list: D018685:Anesthetics, Inhalation