• Anesthesia and analgesia · Apr 2021

    Randomized Controlled Trial Comparative Study

    Reflection Versus Rebreathing for Administration of Sevoflurane During Minor Gynecological Surgery.

    Use of the AnaConDa (Anaesthetic Conserving Device, Sedana Medical) is feasible for short procedures utilising open circuits & high FGF, and yet still allows low volatile consumption.

    pearl
    • Azzeddine Kermad, Madeleine Appenzeller, Emanuela Morinello, Sven Oliver Schneider, Stefan Kleinschmidt, Brian O'Gara, Thomas Volk, and Andreas Meiser.
    • From the Department of Anesthesiology, Intensive Care Medicine and Pain Medicine, Saarland University Hospital Medical Center, Homburg/Saar, Germany.
    • Anesth. Analg. 2021 Apr 1; 132 (4): 1042-1050.

    BackgroundContemporary anesthetic circle systems, when used at low fresh gas flows (FGF) to allow rebreathing of anesthetic, lack the ability for rapid dose titration. The small-scale anesthetic reflection device Anaesthetic Conserving Device (50mL Version; AnaConDa-S) permits administration of volatile anesthetics with high-flow ventilators. We compared washin, washout, and sevoflurane consumption using AnaConDa-S versus a circle system with low and minimal FGF.MethodsForty patients undergoing breast surgery were randomized to receive 0.5 minimal alveolar concentration (MAC) sevoflurane with AnaConDa-S (21 patients, reflection group) or with a circle system (low flow: FGF = 0.2 minute ventilation [V'E], 9 patients; or minimal flow: 0.1 V'E, 10 patients). In the reflection group, syringe pump boluses were given for priming and washin; to simulate an open system, the FGF of the anesthesia ventilator was set to 18 L·min-1 with the soda lime removed. In the other groups, the FGF was increased for washin (1 V'E for 8 minutes) and washout (3 V'E). For all patients, tidal volume was 7 mL·kg-1 and the respiratory rate adjusted to ensure normoventilation. Analgesia was attained with remifentanil 0.3 µg·kg-1·min-1. Sevoflurane consumption was compared between the reflection group and the low- and minimal-flow groups, respectively, using a post hoc test (Fisher Least Significant Difference). To compare washin and washout (half-life), the low- and minimal-flow groups were combined.ResultsSevoflurane consumption was reduced in the reflection group (9.4 ± 2.0 vs 15.0 ± 3.5 [low flow, P < .001] vs 11.6 ± 2.3 mL·MAC h-1 [minimal flow, P = .02]); washin (33 ± 15 vs 49 ± 12 seconds, P = .001) and washout (28 ± 15 vs 55 ± 19 seconds, P < .001) times were also significantly shorter.ConclusionsIn this clinical setting with short procedures, low anesthetic requirements, and low tidal volumes, AnaConDa-S decreased anesthetic consumption, washin, and washout times compared to a circle system.Copyright © 2021 International Anesthesia Research Society.

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    Notes

    pearl
    1

    Use of the AnaConDa (Anaesthetic Conserving Device, Sedana Medical) is feasible for short procedures utilising open circuits & high FGF, and yet still allows low volatile consumption.

    Daniel Jolley  Daniel Jolley
    comment
    0

    Note that the researchers used a relatively low sevoflurane target (MAC 0.5) enabled by concurrent use of remifentanil (0.3 mg/kg/min) and a surgical site readily amendable to local infiltration.

    Daniel Jolley  Daniel Jolley
     
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