Mapleson′s breathing systems

Kaul, Tej K; Mittal, Geeta

doi:10.4103/0019-5049.120148

Cited by 22 publications

(12 citation statements)

References 32 publications

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“…This flow rate was chosen to overcome circuit resistance, prevent rebreathing, and unify the process throughout the extubation period (i.e., washout). [ 11 ] Therefore, it was necessary to increase the desflurane concentration by 1%–2% above the initial setting due to the high-flow rate. [ 12 ] Thus, the accelerated HR was most likely due to β-adrenergic activation occurring due to the stimulation of rapidly adapting upper airway receptors caused by inspired desflurane, which led to significant tachycardia and hypertension.…”

Section: Discussionmentioning

confidence: 99%

Effect of intravenous lidocaine on the incidence of postextubation laryngospasm: A double-blind, placebo-controlled randomized trial

Aljonaieh

2018

Saudi J Anaesth

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Objectives:The study aimed to test the effect of intraoperative intravenous (IV) lidocaine on the incidence of postextubation laryngospasm in adult patients.Methods:The prospective randomized clinical trial was conducted at tertiary care hospital in Riyadh, between January and December 2012. Seventy-two patients undergoing laparoscopic cholecystectomy were randomly assigned to receive either placebo (n = 36) or IV lidocaine (n = 36), 1 mg/kg bolus after desflurane was discontinued. Laryngospasm was graded from 0 to 3 based on the absence or presence of signs and the severity of postextubation laryngospasm.Results:The study was terminated early by the data monitoring committee because of safety concerns due to an increased incidence of postextubation laryngospasm. Patient demographics were similar for both groups. The incidence of postextubation laryngospasm was 19.5% in the placebo group and 0% in the treatment (lidocaine) group; this difference was statistically significant (P = 0.017; 95% confidence interval, 4.6% to 36.0%).Conclusions:The cause of laryngospasm in our study was most likely the rapid increase in the concentration of inspired desflurane, which might have caused airway irritation. Therefore, we believe that pretreating patients at risk of developing laryngospasm with IV lidocaine could be effective.

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Section: Discussionmentioning

confidence: 99%

Effect of intravenous lidocaine on the incidence of postextubation laryngospasm: A double-blind, placebo-controlled randomized trial

Aljonaieh

2018

Saudi J Anaesth

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“…The basic economic calculations for the open circuit were conducted assuming standard condition that the fresh gas flow through an open circuit should be three times higher than the minute ventilation of a patient in order to avoid rebreathing of expired gas [ 11 ]. Considering the average minute ventilation in a healthy adult of 7.5 L/min [ 12 ], the basic fresh gas flow through the open circuit was assumed to be 22.5 L/min.…”

Section: Discussionmentioning

confidence: 99%

Delivery of heliox with a semi-closed circuit during spontaneous breathing: a comparative economic theoretical study

2015

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BackgroundHeliox is a mixture of oxygen and helium which reduces airway resistance in patients with airway obstruction. In clinical practice, patients breathing spontaneously receive heliox via an open circuit. Recently, a semi-closed circuit for heliox administration has been proposed which minimizes consumption of heliox and therefore cost of the heliox therapy; although, the semi-closed circuit is associated with additional costs. The aim of the study is to conduct an economical analysis comparing total cost of heliox therapy using an open versus a semi-closed circuit in spontaneously breathing patients with airway obstruction.MethodsFour different systems for heliox administration were analyzed: an open circuit and three alternatives of a semi-closed circuit involving a custom made semi-closed circuit and two standard anesthesia machines. Total costs of heliox therapy were calculated for all the systems. For calculation of gas consumption, the clinical procedures limiting continuous heliox therapy including the aerosol therapy, personal hygiene and nutrition were taken into account. A sensitivity analysis was conducted for main input variables that may influence the results of the study.ResultsPrice of gases consumed by a semi-closed system represents less than 20 % of price of gases when a standard open circuit is used. This represents a saving of approximately 540 EUR per patient. The initial cost of the custom-made semi-closed circuit recuperates after treatment of 18 patients. The corresponding number of patients is 32 when a low-cost anesthesia machine is initially acquired and rises to 69 when a highly advanced anesthesia machine is considered.ConclusionsHeliox therapy in spontaneously breathing patients using a semi-closed circuit becomes more cost-effective compared to the open circuit, currently used in clinical practice, when applied in a sufficient number of cases. The impact of finding a cheaper way of heliox administration on the clinical practice needs to be ascertained.

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“…The recommended fresh gas flow (FGF) is 1.5 to 2 times minute ventilation, and that of tidal volume and frequency is 10 mL/kg and 12–14/min, respectively. [ 2 ] However, during the transportation of suspected or confirmed COVID-19 cases, there is a substantial risk of aerosol exposure to the operator through the adjustable pressure-limiting (APL) valve, making this arrangement purposeless during the current scenario. Taking this into account, we modified the Bain's circuit for the safety of the healthcare provider by connecting heat and moisture exchange filter (HMEF) (HMEF 1000 Straight, Vincent Medical, Hung Hom, Kowloon, Hong Kong)[ 3 ] both at the patient end and just before the APL valve [ Figure 1 ], maintaining the FGF rate around 1.5–2 times the minute ventilation to prevent rebreathing.…”

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confidence: 99%