Population pharmacokinetics of sevoflurane in conjunction with the AnaConDa<sup>®</sup>: toward target‐controlled infusion of volatiles into the breathing system

Enlund, Mats; Kietzmann, D.; Bouillon, Thomas; Züchner, K.; Meineke, Ingolf

doi:10.1111/j.1399-6576.2008.01579.x

Cited by 14 publications

(5 citation statements)

References 27 publications

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“…Recently two studies evaluated the performance of pharmacokinetic models in patients in the operating theatre [ 11 ] and in the ICU [ 12 ]. This latter study evaluated the predictive performance of a simple pharmacokinetic model for the manually adjusted infusion of sevoflurane for use with the AnaConDa®.…”

Section: Discussionmentioning

confidence: 99%

Technical Performance and Reflection Capacity of the Anaesthetic Conserving Device—A Bench Study with Isoflurane and Sevoflurane

Meiser

Bellgardt

Röhm

et al. 2009

J Clin Monit Comput

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ABSTRACT. Objective. The anaesthetic conserving device (AnaConDa Ò , Sedana Medical, Sundbyberg, Sweden) facilitates administration of isoflurane or sevoflurane by liquid infusion. An anaesthetic reflector inside the device conserves exhaled anaesthetic and re-supplies it during inspiration. In this bench study, we examined the influence of infusion rates and ventilatory settings on the resulting anaesthetic concentrations on patient (C pat ) and ventilator side of the reflector (C loss ) to describe its technical performance. Methods. A Puritan Bennett 840 ICU ventilator (Pleasanton, US), AnaConDa Ò , and a test lung (3 l-chloroprene-bag) were assembled. Infusion rates (IR, 0.2-50 ml h -1 ), respiratory rates (RR, 5-40 breaths min -1 ), and tidal volumes (V T , 0.3, 0.5, and 1.0 l) were varied. C pat was measured via a thin catheter in the middle of the 3 l-bag in steady state (online data storage and averaging over >10 min). C loss was calculated from IR (to yield the volume of vapour per unit of time), and expired minute volume (in which the vapour is diluted) on the assumption that, in the steady state, input by liquid infusion equals output through the reflector. Results. At lower concentrations (C pat < 1 vol%) the ratio C loss /C pat was constant (R C = 0.096 ± 0.012) for all combinations of IR, RR and V T , both for isoflurane and sevoflurane. The device could efficiently reflect up to 10 ml vapour per breath (e.g. 2 vol% in 0.5 l). When exceeding this capacity, surplus vapour ''spilled over'' and R C markedly increased indicating decreased performance. Conclusions. The triple product minute volume times R C times C pat describes anaesthetic losses through the reflector. It can easily be calculated as long as the 10 ml reflection capacity is not exceeded and thus R C is constant. Increased minute ventilation necessitates increasing the IR to keep C pat constant. When using large V T and high C pat ''spill over'' occurs. This effect offers some protection against an inadvertent overdose.

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Section: Discussionmentioning

confidence: 99%

Technical Performance and Reflection Capacity of the Anaesthetic Conserving Device—A Bench Study with Isoflurane and Sevoflurane

Meiser

Bellgardt

Röhm

et al. 2009

J Clin Monit Comput

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“…En la AnaConDa TM , empleando el modelo de Enlund et al 44 , el MDAPE% fue más alto por varias razones: utilizaron circuito de reinhalación, rango amplio de concentraciones (0,5-8%), incluyeron a pacientes pediátricos y la inducción se realizó durante 30 s. A diferencia de Belda et al 45 y Soro et al 46 , encontraron menor MDAPE%, empleando circuitos de no-reinhalación, concentraciones fijas por grupos de pacientes, rangos de edad estrechos y la inducción la realizaron en 10 min. Soro et al 46 explicaron sus diferencias con el estudio de Belda et al 45 porque el tiempo de evaluación fue menor a una hora y sus mediciones fueron afectadas por el proceso temprano de captación del tejido graso.…”

Section: Discussionunclassified

Desempeño predictivo y clínico de un dispositivo target-controlled infusion para sevofluorano en una estación de trabajo convencional: correlación farmacocinética del modelo empleado

Arana¹,

Monzón²,

Gómez³

et al. 2014

Revista Colombiana de Anestesiología

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r e v c o l o m b a n e s t e s i o l . 2 0 1 4;4 2(4):255-264 Revista Colombiana de Anestesiología Colombian Journal of Anesthesiology w w w . r e v c o l a n e s t . c o m . c o Investigación científica y tecnológica Desempeño predictivo y clínico de un dispositivo target-controlled infusion para sevofluorano en una estación de trabajo convencional: correlación farmacocinética del modelo empleado

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“…Mittlerweile gibt es 2 klinische Studien, die belegen, dass durch einfache Dosierungsmodelle die endtidalen Konzentrationen weitaus genauer vorhergesagt werden können als die Serumkonzentrationen bei klassischen weit verbreiteten Dosierungsalgorithmen der "target controlled infusion" etwa für Propofol oder Remifentanil [17,18] [11,17]. Um das Abfluten der Anästhetika zu beschleunigen, empfiehlt es sich, das ACD aus dem Schlauchsystem zu entfernen und ggf.…”

Section: Infobox 3 Aufbau Des Anaconda-systemsunclassified

Funktionsweise des „Anaesthetic Conserving Device“

et al. 2010

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The new anaesthetic conserving device (ACD) allows the use of isoflurane and sevoflurane without classical anaesthesia workstations. Volatile anaesthetic exhaled by the patient is absorbed by a reflector and released to the patient during the next inspiration. Liquid anaesthetic is delivered via a syringe pump. Currently the use of the ACD is spreading among European intensive care units (ICU). This article focuses on the functioning of the device and on particularities which are important to consider. The ACD constantly reflects 90% of the exhaled anaesthetic back to the patient, but if one exhaled breath contains more than 10 ml of anaesthetic vapour (e.g. >1 vol% in 1,000 ml), the capacity of the reflector will be exceeded and relatively more anaesthetic will be lost to the patient. This spill over decreases efficiency but it also contributes to safety as very high concentrations are averted. Compared to classical anaesthesia systems the ACD used in conjunction with ICU ventilators offers advantages in the ICU setting: investment costs are low, carbon dioxide absorbent is not needed, breathing comfort is higher, anaesthetic consumption is low (equal to an anaesthesia circuit with a fresh gas flow of approximately 1 l/min) and anaesthetic concentrations can be controlled very quickly (increased by small boluses and decreased by removal of the ACD). On the other hand, case costs are higher (single patient use) and a dead space of 100 ml is added. There are pitfalls: by a process called auto-pumping, expansion of bubbles inside the syringe may lead to uncontrolled anaesthetic delivery. Auto-pumping is provoked by high positioning of the syringe pump, heat and prior cooling of the liquid anaesthetic. Inherent to the device is an early inspiratory concentration peak and an end-inspiratory dip which may mislead commonly used gas monitors. Workplace concentrations can be minimized by proper handling, a sufficient turnover of room air is important and gas from the expiration port of the ventilator should be scavenged. Inhalational compared to intravenous ICU sedation offers the advantages of better control of the sedation level, online drug monitoring, no accumulation in patients with renal or hepatic insufficiency and bronchodilation. With a lowered opioid dose spontaneous breathing and intestinal motility are well preserved. A clinical algorithm for the care of patients with respiratory insufficiency including inhalational sedation is proposed. Inhalational sedation with isoflurane has been widely used for more than 20 years in many countries and even for periods of up to several weeks. In the German S3 guidelines for the management of analgesia, sedation and delirium in intensive care (Martin et al. 2010), inhalational sedation is mentioned as an alternative sedation method for patients ventilated via an endotracheal tube or a tracheal cannula. Nevertheless, isoflurane is not officially licensed for ICU sedation and its use is under the responsibility of the prescribing physician.

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Population pharmacokinetics of sevoflurane in conjunction with the AnaConDa^®: toward target‐controlled infusion of volatiles into the breathing system

Cited by 14 publications

References 27 publications

Technical Performance and Reflection Capacity of the Anaesthetic Conserving Device—A Bench Study with Isoflurane and Sevoflurane

Technical Performance and Reflection Capacity of the Anaesthetic Conserving Device—A Bench Study with Isoflurane and Sevoflurane

Desempeño predictivo y clínico de un dispositivo target-controlled infusion para sevofluorano en una estación de trabajo convencional: correlación farmacocinética del modelo empleado

Funktionsweise des „Anaesthetic Conserving Device“

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Population pharmacokinetics of sevoflurane in conjunction with the AnaConDa®: toward target‐controlled infusion of volatiles into the breathing system

Cited by 14 publications

References 27 publications

Technical Performance and Reflection Capacity of the Anaesthetic Conserving Device—A Bench Study with Isoflurane and Sevoflurane

Technical Performance and Reflection Capacity of the Anaesthetic Conserving Device—A Bench Study with Isoflurane and Sevoflurane

Desempeño predictivo y clínico de un dispositivo target-controlled infusion para sevofluorano en una estación de trabajo convencional: correlación farmacocinética del modelo empleado

Funktionsweise des „Anaesthetic Conserving Device“

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Population pharmacokinetics of sevoflurane in conjunction with the AnaConDa^®: toward target‐controlled infusion of volatiles into the breathing system