Anaesthetic uptake and washout characteristics of patient circuit tubing with special regard to current decontamination techniques

Gilly, H.; Weindlmayr-Goettel, M.; Köberl, Gerald; Steinbereithner, K

doi:10.1111/j.1399-6576.1992.tb03532.x

Cited by 15 publications

(8 citation statements)

References 14 publications

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“…Whereas flushing is effective in removing volatile anesthetics from latex and polysulfone tubing, only autoclaving has been found to be effective in removing volatile anesthetics from silicone. 8 This is consistent with our observation that autoclaving, but not forced air flushing, accelerated the washout of isoflurane. Slow washout, despite the use of an autoclaved ventilator diaphragm and ventilator hose, may be attributed Another factor influencing washout may be fresh gas decoupling, 11 a mechanism that is utilized in the Dräger Fabius GS TM to prevent the dependency of tidal volume on FGF.…”

Section: Discussionsupporting

confidence: 81%

“…Anesthetic solubility in rubber, including silicone, exceeds that in most plastics. [8][9][10] The breathing system circuitry internal to the Dräger Fabius GS TM workstation comprises silicone and is probably a site of considerable anesthetic absorption. Whereas flushing is effective in removing volatile anesthetics from latex and polysulfone tubing, only autoclaving has been found to be effective in removing volatile anesthetics from silicone.…”

Section: Discussionmentioning

confidence: 99%

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Preparation of the Dräger Fabius GS™ workstation for malignant hyperthermia-susceptible patients

Whitty

Wong

Petroz

et al. 2009

Can J Anesth/J Can Anesth

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Section: Discussionsupporting

confidence: 81%

Section: Discussionmentioning

confidence: 99%

Preparation of the Dräger Fabius GS™ workstation for malignant hyperthermia-susceptible patients

Whitty

Wong

Petroz

et al. 2009

Can J Anesth/J Can Anesth

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“…Non-depolarizing muscle relaxants and all intravenous inducing agents are safe to use. Laryngeal mask airways are safe to reuse if an idle period of 15 h [ 167 ] has been observed but the major use of these airways is now single use.…”

Section: Reviewmentioning

confidence: 99%

Malignant hyperthermia: a review

Rosenberg

Pollock

Schiemann

et al. 2015

Orphanet J Rare Dis

432

529

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Malignant hyperthermia (MH) is a pharmacogenetic disorder of skeletal muscle that presents as a hypermetabolic response to potent volatile anesthetic gases such as halothane, sevoflurane, desflurane, isoflurane and the depolarizing muscle relaxant succinylcholine, and rarely, in humans, to stressors such as vigorous exercise and heat. The incidence of MH reactions ranges from 1:10,000 to 1: 250,000 anesthetics. However, the prevalence of the genetic abnormalities may be as great as one in 400 individuals. MH affects humans, certain pig breeds, dogs and horses. The classic signs of MH include hyperthermia, tachycardia, tachypnea, increased carbon dioxide production, increased oxygen consumption, acidosis, hyperkalaemia, muscle rigidity, and rhabdomyolysis, all related to a hypermetabolic response. The syndrome is likely to be fatal if untreated. An increase in end-tidal carbon dioxide despite increased minute ventilation provides an early diagnostic clue. In humans the syndrome is inherited in an autosomal dominant pattern, while in pigs it is autosomal recessive. Uncontrolled rise of myoplasmic calcium, which activates biochemical processes related to muscle activation leads to the pathophysiologic changes. In most cases, the syndrome is caused by a defect in the ryanodine receptor. Over 400 variants have been identified in the RYR1 gene located on chromosome 19q13.1, and at least 34 are causal for MH. Less than 1 % of variants have been found in CACNA1S but not all of these are causal. Diagnostic testing involves the in vitro contracture response of biopsied muscle to halothane, caffeine, and in some centres ryanodine and 4-chloro-m-cresol. Elucidation of the genetic changes has led to the introduction of DNA testing for susceptibility to MH. Dantrolene sodium is a specific antagonist and should be available wherever general anesthesia is administered. Increased understanding of the clinical manifestation and pathophysiology of the syndrome, has lead to the mortality decreasing from 80 % thirty years ago to <5 % in 2006.

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“…Volatile agents may also leak through the wall of conductive rubber tubing and contaminate the operating theatre environment. The magnitude of this leakage has been shown to be so low that it does not produce significant pollution of the theatre environment [3, 7]. Our study showed that all three plastic‐tube types leaked significantly less volatile through their walls than conductive rubber and thus are not liable to cause significant atmospheric pollution.…”

Section: Discussionmentioning

confidence: 71%

Leakage and absorption of isoflurane by different types of anaesthetic circuit and monitoring tubing

Smith¹,

Flynn²,

Wardall³

et al. 2002

Anaesthesia

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SummaryConductive rubber anaesthetic circuit tubing both absorbs volatile agents and leaks these agents through its walls. We quantified the leakage and absorption properties of the most commonly used plastic materials used to make breathing circuit tubing, relative to conductive rubber. We then compared two different types of plastic tubes used to carry gas to volatile agent monitors; one made of polyvinyl chloride, the other made of polyvinyl chloride lined internally with a thin layer of polyethylene. We found that the three commonly used plastic types used to make anaesthetic circuit tubing all leak less volatile anaesthetic through their walls than conductive rubber. Polyethylene and polypropylene tubing absorb significantly less volatile anaesthetic than conductive rubber; however, this is not the case with polyvinyl chloride tubing. Differences in the leakage and absorption properties of polyvinyl chloride monitoring tubing are not significantly changed by the addition of a thin internal layer of polyethylene. It is therefore not worthwhile incorporating this feature into production.

show abstract

Anaesthetic uptake and washout characteristics of patient circuit tubing with special regard to current decontamination techniques

Cited by 15 publications

References 14 publications

Preparation of the Dräger Fabius GS™ workstation for malignant hyperthermia-susceptible patients

Preparation of the Dräger Fabius GS™ workstation for malignant hyperthermia-susceptible patients

Malignant hyperthermia: a review

Leakage and absorption of isoflurane by different types of anaesthetic circuit and monitoring tubing

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