Education  |   August 2017
Clinical Complications with the Delivery of Inhaled Epoprostenol in the Operating Room
Author Notes
  • From the Division of Cardiothoracic Anesthesiology, Department of Anesthesiology, Ohio State University Wexner Medical Center, Columbus, Ohio.
  • Address correspondence to Dr. Bhatt: Amar.bhatt@osumc.edu
Article Information
Education / Images in Anesthesiology / Cardiovascular Anesthesia
Education   |   August 2017
Clinical Complications with the Delivery of Inhaled Epoprostenol in the Operating Room
Anesthesiology 8 2017, Vol.127, 383. doi:10.1097/ALN.0000000000001611
Anesthesiology 8 2017, Vol.127, 383. doi:10.1097/ALN.0000000000001611
INHALED epoprostenol is used perioperatively in patients with pulmonary hypertension or right ventricular dysfunction to decrease pulmonary vascular resistance.1 The image on the left depicts the intraoperative setup for administration of inhaled epoprostenol through the ventilator circuit of the anesthesia machine with the following labels: (A) endotracheal tube; (B) miniHEART jet nebulizer (Westmed Inc., USA); (C) oxygen tubing for bypass flow; (D) heat and moisture exchange filter; and (E) Y-piece connecting filter to expiratory and inspiratory limbs of anesthesia machine breathing circuit. The clinical challenge arises due to epoprostenol commonly being reconstituted with glycine, an inherently viscous diluent, which leads the filter to become clogged.2  We also recommended that the level of the nebulizer be lower than the filter to allow drainage by gravity of the condensate. The image on the right shows a clogged ventilator circuit filter, which typically presents with significant droplet accumulation (arrows) in conjunction with elevated expiratory resistance and may include unexplained hypoxia, hypercapnia, and capnography changes.
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