Articles: closed-circuit-anesthesia.
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The most proximal site to sample end-tidal CO2 with reasonable accuracy in infants during pulmonary ventilation using a Mapleson D circuit remains controversial. The utilisation of high fresh gas flow near the site of gas sampling dilutes the expired gas and causes an underestimation of end-tidal CO2. In this study a laboratory model was used to identify, qualitatively and quantitatively, the most proximal site in the Mapleson D circuit where the measurement of end-tidal CO2 is not influenced by mixing with fresh gas. ⋯ Secondly, fresh gas flow and expired gas flow were controlled and the end-tidal CO2 concentration was measured along the length of the anaesthetic circuit to identify the site of mixing of fresh gas and expired gas during steady-state conditions. Three expired gas flows were studied at six fresh gas flows. In all our studies, the rate of fresh gas flow and expired gas flow influenced the site of mixing and degree of dilution but no mixing was observed distal to the point at which the endotracheal tube connector narrows to the diameter of the endotracheal tube (P < 0.05).(ABSTRACT TRUNCATED AT 250 WORDS)
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There are compelling reasons why the closed carbon dioxide filtration method for inhalation anaesthesia deserves serious reconsideration. Use of the closed absorption system today can provide all the benefits recognised by those who introduced it seventy to eighty years ago. A most important benefit is the increased opportunity of learning afforded the user, which leads either neophyte or senior clinician to improvement of both concept and clinical skills. The current resurgence of interest is fully appropriate for all physicians who aspire to be true specialists in the care of patients during clinical anaesthesia.