Isoflurane cracks the polycarbonate connector of extra-corporeal circuit -A case report-

Abstract

Cardiopulmonary bypass (CPB) is widely used for cardiac surgery by virtue of its proven safety over the course of its use during the past half century. Even though perfusion is safer, incidents still occur. During the repair of a ventricular-septal defect in an 11-month-old infant, we experienced a critical incident related to the potential hazardous effect of volatile anesthetics on the polycarbonate connector of extra-corporeal circuit. The damage to the polycarbonate connector had occurred after spillage of isoflurane during the filling of the vaporizer, causing it to crack and leak. The incident was managed by replacement of the cracked connector during a temporary circulatory arrest. The patient was hypothermic and the time off bypass was less than 1.5 min. There were no neurologic sequelae, the patient made an uneventful recovery. In conclusion, the spillage of volatile anesthetics can cause cracks in the polycarbonate connector of the extra-corporeal circuit, leading to potentially interruption of CPB.

Volatile anaesthesia during cardiopulmonary bypass

“…Spillage of isoflurane onto the oxygenator causes cracking of the polycarbonate casing, so it is essential to position the vaporiser away from the oxygenator. 10 Removing the vaporiser from the CPB machine before filling with the anaesthetic agent eliminates the risk of damage resulting from potential spillages.…”

Use of Volatile Anesthetic Agent in Extracorporeal Circuit as a Cause of Break in Polycarbonate Connector–Lessons Learnt

“…During CPB, volatile anesthetics are generally administered through the oxygen inlet line using an anesthetic vaporizer to augment the level of sedation and control the blood pressure. However, volatile anesthetics are known to have an adverse physicochemical effect on polycarbonates (2). There are reports of damaged plastic anesthetic equipment and other medical devices (3-7), particularly, damaged CPB parts made from polycarbonate, such as membrane oxygenators (6,7).…”