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British Journal of Anaesthesia, 2003, Vol. 90, No. 2 118-121
© 2003 The Board of Management and Trustees of the British Journal of Anaesthesia

Editorial

Editorial II

Which anaesthetic agent for maintenance during normothermic cardiopulmonary bypass?

R. R. D. Marks1

1 The Northern General Hospital, Herries Road, Sheffield S5 7AU, UK E-mail: richardmarks@doctors.org.uk

The first 150 words of the full text of this article appear below.

The choice of agent for anaesthetic maintenance during cardiopulmonary bypass has developed in an arbitrary manner. As a result, strong personal preferences for i.v. or volatile agent anaesthesia are frequently expressed, with a dearth of carefully considered evidence to support either argument. The process of cardiopulmonary bypass itself has complex effects on the pharmacokinetics of i.v. anaesthetic agents, because of haemodilution and altered visceral perfusion.1 The relatively advanced age of the patient population undergoing heart surgery may also increase the variability of effect of i.v. anaesthetics. The coexistence of systemic atheroma further reduces visceral perfusion and may affect the clearance of these drugs. Extracorporeal circulation effectively substitutes for the patient’s own heart and lungs, and during bypass, gas exchange is achieved via an artificial oxygenator. The normal route of administration of volatile agents by inhalation is not possible. As a result, the administration of volatile anaesthetic agents during bypass must . . . [Full Text of this Article]


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