Sevoflurane Consumption During Cardiac Surgery With Extracorporeal Circulation: The Effect of Carbon Dioxide Field Flooding.

OBJECTIVES: To determine whether carbon dioxide (CO2) field flooding during extracorporeal circulation (ECC) is associated with increased hourly sevoflurane consumption. Secondary objectives evaluated consumption differences between nonflooded procedures and nonflooding periods and the impact of surgical approach (open v minimally invasive). DESIGN: Prospective observational study using routinely collected clinical data. SETTING: Major teaching hospital. PARTICIPANTS: Data from 76 patients undergoing ECC procedures between March and April 2026. Procedure types included coronary artery bypass grafting (CABG; 53.9%), valve surgery (36.8%), combined CABG/valve procedures (7.9%), and resternotomy (1.3%). INTERVENTIONS: Use of CO2 field flooding (applied in 46.1% of procedures) versus standard care without flooding, used to prevent cerebral air embolism. MEASUREMENTS AND MAIN RESULTS: Sevoflurane consumption was calculated using mean fresh gas flow, perfusion time (median: 92 minutes), and mean agent concentration. The median CO2 equivalent per hour was significantly higher during the flooding period (4.6 kg) compared to the nonflooding period (3.7 kg). CONCLUSIONS: CO2 field flooding significantly increases hourly sevoflurane consumption during ECC. The findings highlight a potential trade-off between embolic protection and environmental sustainability in cardiac surgery.