Frequent sampling allows detection of short and rapid surges of exhaled ethane during cardiac surgery

Abstract

During cardiopulmonary bypass (CPB), hypoperfusion and reperfusion may cause oxidative stress and lipid peroxidation that generates ethane. The aim of this pilot study was to assess the feasibility of frequent sampling of exhaled ethane during cardiac surgery. After approval of the Research Ethics Committee, 10 patients undergoing combined aortic valve and coronary artery bypass surgery were enrolled. Breath samples were drawn in the perioperative period and analyzed by a rapid, sensitive and validated gas-chromatographic method. Increased exhaled ethane was regularly seen following sternotomy, after the start of CPB and after aortic clamp removal, whereas no change was seen after termination of bypass. In one patient, the maximum increase in exhaled ethane was 30-fold. Peak durations lasted only 2–4 min. This study demonstrates that frequent sampling of breath ethane is feasible in a clinical setting, allowing detection of rapid ethane surges of short duration.

Keywords

Ethane cardiopulmonary bypass lipid peroxidation gas chromatography

Get full access to this article

View all access options for this article.

References

1 Riely CA Cohen G Lieberman M . Ethane evolution: a new index of lipid peroxidation. Science 1974 Jan 18; 183: 208 – 210 .

2 Risby TH Sehnert SS . Clinical application of breath biomarkers of oxidative stress status. Free Radic Biol Med 1999; 27: 1182 – 1192 .

3 Filser JG Bolt HM Muliawan H Kappus H . Quantitative evaluation of ethane and n-pentane as indicators of lipid peroxidation in vivo. Arch Toxicol 1983; 52: 135 – 147 .

4 Van Gossum A Decuyper J . Breath alkanes as an index of lipid peroxidation. Eur Respir J 1989; 2: 787 – 791 .

5 Aghdassi E Allard JP . Breath alkanes as a marker of oxidative stress in different clinical conditions. Free Radic Biol Med 2000; 28: 880 – 886 .

6 Ohri SK Bjarnason I Pathi V . Cardiopulmonary bypass impairs small intestinal transport and increases gut permeability. Ann Thorac Surg 1993; 55: 1080 – 1086 .

7 Kumle B Boldt J Suttner SW Piper SN Lehmann A Blome M . Influence of prolonged cardiopulmonary bypass times on splanchnic perfusion and markers of splanchnic organ function. Ann Thorac Surg 2003; 75: 1558 – 1564 .

8 Andreoni KA Kazui M Cameron DE . Ethane: a marker of lipid peroxidation during cardiopulmonary bypass in humans. Free Radic Biol Med 1999; 26: 439 – 445 .

9 Dale O Bergum H Lund T Nilsen T Aadahl P Stenseth R . A validated method for rapid analysis of ethane in breath and its application in kinetic studies in human volunteers. Free Radical Research 2003; 37: 815 – 821 .

10.

10 Berg K Haaverstad R Astudillo R . Oxidative stress during coronary artery bypass operations: importance of surgical trauma and drug treatment. Scand Cardiovasc J 2006; 40: 291 – 297 .

11.

11 Ulus AT Aksoyek A Ozkan M Katircioglu SF Basu S . Cardiopulmonary bypass as a cause of free radical-induced oxidative stress and enhanced blood-borne isoprostanes in humans. Free Radic Biol Med 2003; 34: 911 – 917 .

12.

12 Laffey JG Boylan JF Cheng DC . The systemic inflammatory response to cardiac surgery: implications for the anesthesiologist. Anesthesiology 2002; 97: 215 – 252 .

13.

13 Levy JH Tanaka KA . Inflammatory response to cardiopulmonary bypass. Ann Thorac Surg 2003; 75: S715 – S720 .

14.

14 Prasad K Kalra J Bharadwaj B Chaudhary AK . Increased oxygen free radical activity in patients on cardiopulmonary bypass undergoing aortocoronary bypass surgery. Am Heart J 1992; 123: 37 – 45 .

15.

15 Kazui M Andreoni KA Williams GM . Visceral lipid peroxidation occurs at reperfusion after supraceliac aortic cross-clamping. J Vasc Surg 1994; 19: 473 – 477 .

16.

16 Kazui M Andreoni KA Norris EJ . Breath ethane: a specific indicator of free-radical-mediated lipid peroxidation following reperfusion of the ischemic liver. Free Radic Biol Med 1992; 13: 509 – 515 .

17.

17 Risby TH Maley W Scott RP . Evidence for free radical-mediated lipid peroxidation at reperfusion of human orthotopic liver transplants. Surgery 1994; 115: 94 – 101 .

18.

18 Mythen MG Webb AR . The role of gut mucosal hypoperfusion in the pathogenesis of post-operative organ dysfunction. Intensive Care Med 1994; 20: 203 – 209 .

19.

19 Riddington DW Venkatesh B Boivin CM . Intestinal permeability, gastric intramucosal pH, and systemic endotoxemia in patients undergoing cardiopulmonary bypass. JAMA 1996; 275: 1007 – 1012 .

20.

20 Sicsic JC Duranteau J Corbineau H . Gastric mucosal oxygen delivery decreases during cardiopulmonary bypass despite constant systemic oxygen delivery. Anesth Analg 1998; 86: 455 – 460 .

21.

21 Speziale G Ferroni P Ruvolo G . Effect of normothermic versus hypothermic cardiopulmonary bypass on cytokine production and platelet function. J Cardiovasc Surg 2000; 41: 819 – 827 .

22.

22 Skeldon KD McMillan LC Wyse CA . Application of laser spectroscopy for measurement of exhaled ethane in patients with lung cancer. Respir Med 2006; 100: 300 – 306 .