Hi all,
it was suggested to us at The Alfred that adding anaesthetic
vaporisers to heart-lung bypass machines is a common practice and occurs
in many other hospitals - is any other hospital in Aus/NZ really doing
this?
By adding I mean in-lining an Isoflurane vaporiser canister into the
air/oxygen mix downstream of the blender, before the oxygenator, with
only separate standalone gas monitoring, no safety cut-outs, no feedback
etc ... and using a BIS (either mounted within an anaesthetic machine
not connected to the setup I describe, or standalone as a single BIS
unit) to monitor the effect on the patient. Obviously other
physiological measurements (ECG, SpO2, EtCO2 etc .. ) don't always make
sense when you are on bypass with a highly cooled patient. Blood gas
analysis is performed constantly and the perfusionists are very adept at
picking up problems with the patient.
The potential risks with this setup that I see are:* unmonitored agent leakage into the theatre - potentially harming the perfusionist's ability to monitor both the system and the patient * unmonitored inhalation and exhalation concentrations - then creating very negative outcomes * no automatic vaporiser shut-off - not inherently safe, no fail safe mode. The suggested intention of doing this is to replace intravenous Propofol delivered by a syringe driver with Isoflurane delivered via the bypass machine. This is suggested to be cost effective and also give better cardiac outcomes. I'd be very happy to hear from anyone who has this kind of setup active in their hospital, or anyone who has a bit of experience with anaesthetics and heart-lung bypass machines used together. Are there setups that achieve the same thing using the whole anaesthetic machine in-line instead? thanks, Jono. p.s if you're in VICTORIA please fill out the APESMA EBA survey by this FRIDAY 28th August - http://www.apesma.asn.au/vsurveys/biomed/ Jono Nevile Biomedical Engineer Biomedical Engineering t 03 90765119 e j.nev...@alfred.org.au The Alfred 55 Commercial Road PO Box 315 Prahran Victoria 3181 Australia Alfred Health incorporates The Alfred, Caulfield Hospital and Sandringham Hospital www.alfred.org.au
<<TheAlfred.bmp>>
