Sunday, April 15, 2012

Inhaled Nitric Oxide Set-up for Cardiac Surgery

Another use for inhaled nitric oxide is for lowering pulmonary vascular resistance during cardiothoracic surgery. Administration is common during mitral valve replacements, heart transplants, and implantation of left ventricular assist devices.   

One concern is interfacing the INOVent with the anesthesia machine, primarily preventing "Nitric Dioxide" build up.

Here are the steps to interface the INOVent with the anesthesia machine:

  1. Perform all of the pre-operational checks before hooking the INOVent to the anesthesia machine (reference operators manual for more details). 
  2. A six inch piece of corrugated tubing & a 22 mm adapter is needed to place in-line with the anesthesia circuit. 

3. Place the gas injector device on the inspiratory side of the anesthesia ventilator. 

4. Place the gas sampling connector in-line on the inspiratory side of the anesthesia circuit, six inches before the wye (this is where the six inch piece of tubing & 22 mm adapter comes into use). 

Lastly, ensure that fresh gas flows are maintained equal to, or greater than the measured minute ventilation. This prevents re-breathing and the build up of nitric dioxide.