Articles: closed-circuit-anesthesia.
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When volatile anaesthetics are used in a closed breathing system it is usually assumed that inflow of anaesthetic to the system matches uptake by the patient. Early laboratory reports on the interactions between sevoflurane and soda lime cast doubt on that assumption. We have measured the loss of sevoflurane, desflurane and isoflurane from a closed breathing system and found no differences of consequences.
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Randomized Controlled Trial Comparative Study Clinical Trial
New agents, the circle system and short procedures.
Sevoflurane, desflurane and isoflurane were compared using a circle system in 97 patients undergoing short surgical procedures. Using initial high flows, the time intervals to equilibration between inspired and end-expired agent concentrations were measured; equilibration was defined as FE/FI = 0.8. ⋯ After equilibration total flow were reduced to 500 ml.min-1; at these flows the initial decline in end-expired agent concentration was minimal with desflurane, intermediate with sevoflurane and greatest with isoflurane. Both desflurane and sevoflurane are appropriate for efficient use of the circle system during short anaesthetics.
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Closed-system anaesthesia provides the best prerequisites for optimal warming and humidification of anaesthetic gases. The PhysioFlex anaesthesia machine fascilitates quantitative closed-system anaesthesia. Furthermore, its design may improve the climatization of the anaesthetic gases by revolving the system volume at 70 l/min, using a small soda-lime canister to allow optimal usage of the heat and moisture generated by CO2 absorption and by integrating all system components in thermally isolating housing. To determine the capacity of the PhysioFlex to climatize anaesthetic gases, we evaluated the heat and humidity profile at four characteristic places in the anaesthetic circuit under standardised conditions in a model. ⋯ With the PhysioFlex anaesthesia machine employing closed-system conditions, minimal climatization of anaesthetic gases was reached within 10 min. After a period of 120 min, the anaesthetic gases were nearly climatized to the extent recommended for long-term respiratory therapy. To date, no comparable temperature and humidity level has been reported with conventional anaesthesia machines. The time course of the gradient between M1 and M2 may give an opportunity for further optimising the system in reducing heat loss after the soda-lime canister, the active heat and moisture source in the circuit. At about 32 degrees C, the temperature in the soda-lime canister is 10-15 degrees C less than in conventional anaesthesia machines. Thus, the use of thermally instable volatile anaesthetics in the PhysioFlex under closed-system conditions may be less critical than in conventional anaesthesia machines under minimal-flow conditions.
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Anesthesia and analgesia · Feb 1997
Randomized Controlled Trial Clinical TrialUptake of desflurane and isoflurane during closed-circuit anesthesia with spontaneous and controlled mechanical ventilation.
Although theoretical models predict uptake of inhaled anesthetics during closed-circuit anesthesia (CCA), clinical data for most anesthetics are conflicting or non-existent. In addition, the effects of patient characteristics and mode of ventilation on anesthetic uptake are unclear. Forty-one ASA physical status I or II adult patients undergoing a variety of 1-1.5 h surgical procedures were randomly allocated to receive CCA with desflurane or isoflurane with ventilation being either spontaneous or controlled. ⋯ Patient characteristics (age, height, weight, weight3/4, and body surface area) were comparable between groups and did not correlate with uptake. The virtually constant uptake after wash-in of desflurane and isoflurane contrasts with the square root of time model of Lowe and Ernst. These findings may greatly simplify CCA.