Sevoflurane Anaesthesia with the Komesaroff Vaporizer inside the Circle System

Dhara, S. S.; Liu, E. H. C.

doi:10.1177/0310057x0002800111

Cited by 5 publications

(16 citation statements)

References 12 publications

(9 reference statements)

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“…As a consequence, basal flow anaesthesia and VIC anaesthesia have become safe provided meticulous monitoring is applied. Dhara and Liu in their study of VIC sevoflurane anaesthesia using the Komesaroff vaporizer found that it was simple and safe during both controlled and spontaneous ventilation, provided that sevoflurane concentrations were continuously monitored 3 . The present study has demonstrated that it is S. P. NaNdalaN, R. J. EltRiNgham, Q. W. FaN possible to achieve both induction and maintenance of sevoflurane anaesthesia using basal flow from the outset with a VIC technique after an intravenous induction.…”

Section: Discussionmentioning

confidence: 99%

“…No difficulty in maintaining adequate sevoflurane concentrations was encountered. Dhara and Liu pointed out that the sevoflurane concentrations were steady when the volume of liquid sevoflurane in the vaporizer was between 15 to 30 ml 3 . When the residual volume was less than 15 ml higher vaporizer settings were needed.…”

Section: Discussionmentioning

confidence: 99%

“…At both the 'on' and 'off' settings it offers minimal resistance. It has a glass bowl that is calibrated to 30 ml in 2 ml steps diagonally around the bowl 1,3 .…”

mentioning

confidence: 99%

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Cost-effectiveness of Basal Flow Sevoflurane Anaesthesia Using the Komesaroff Vaporizer inside the Circle System

2005

Anaesth Intensive Care

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After ethics committee approval, 51 consenting ASA physical status 1 or 2 adult patients were given basal flow sevoflurane anaesthesia using fresh gas flows of 150 to 300 ml.min-1 oxygen. A Komesaroff vaporizer was placed on the inspiratory limb of the circle system. Basal flows were introduced immediately following intravenous induction of anaesthesia. The vaporizer was set to deliver the maximum concentration until the inspired sevoflurane concentration (FSI) reached 3%. The dial was then adjusted to maintain the FSI at 3%. After every 60 minutes, the circuit was washed out with 100% oxygen at a flow rate of 10 l.min-1 for one minute. The FSI reached 3% after an average of 8.5 (3.8) [mean (SD)] minutes. The trends in FSI and the expired sevoflurane concentrations were significantly different (P<0.05) between the mechanically ventilated patients (n=21) and the spontaneously ventilating patients (n=30) and demonstrated a more gradual build-up in the former group. The consumption of sevoflurane was found to be 9.2 (2.8) ml.h-1. This represented a 52.5% cost saving over the clinical application of the Mapleson's ideal fresh gas flow sequence for low-flow anaesthesia.

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Section: Discussionmentioning

confidence: 99%

Section: Discussionmentioning

confidence: 99%

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Cost-effectiveness of Basal Flow Sevoflurane Anaesthesia Using the Komesaroff Vaporizer inside the Circle System

2005

Anaesth Intensive Care

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“…Previous studies have shown that the Komesaroff machine can safely delivery halothane, isoflurane or sevoflurane to anaesthetise dogs breathing spontaneously (Laredo and others 1997, 1998, 2001, Straker and others 2004). Increasing the depth of anaesthesia depresses the dogs' rate of ventilation and limits the uptake of anaesthetic vapour, which might otherwise lead to overdosage (Dhara and Liu 2000). However, this safety factor may be lost, and a dangerously high concentration of anaesthetic vapour may be delivered, when mechanical ventilation is applied (Jordan and Bushman 1981, White 1985, Dhara and Liu 2000).…”

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confidence: 99%

Mechanical ventilation of six dogs anaesthetised with isoflurane or sevoflurane delivered by a Komesaroff anaesthetic machine

2009

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After intravenous induction, six beagles were connected to a Komesaroff machine provided with a single in-circuit vaporiser and ventilated mechanically at either nine or 14 breaths/minute while anaesthetised with either isoflurane or sevoflurane. The vaporiser was initially set at position 4/4 (fully open) and the anaesthetic concentrations were measured after one and five minutes; the vaporiser was then set at the lowest setting able to maintain anaesthesia. Cardiorespiratory variables were measured throughout the study. In most cases anaesthesia was maintained at setting 1/4 with isoflurane and at setting 1.5/4 or 2/4 with sevoflurane.

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“…The use of a draw-over vaporiser positioned in-circuit (VIC) has been well described [1][2][3][4][5][6] , but when controlled ventilation is used there are significant concerns about the risk of an unpredictable output leading to overdose. Most VIC and low-flow studies have been done using Komesaroff or Goldman vaporisers.…”

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confidence: 99%

Evaluation of an Oxford Miniature Vaporizer Placed in-Circuit during the Maintenance Phase of Low-Flow Anaesthesia

Beck

Boesel²,

Seppelt

2008

Anaesth Intensive Care

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The aim of the study was to assess Oxford Miniature Vaporizer output when mounted in-circuit during the maintenance phase of anaesthesia, using isoflurane, controlled ventilation and a fresh gas flow rate less than 1 l/min. Twenty patients of ASA Physical Status I and II were recruited from routine general surgical lists. All patients were paralysed and ventilated. An out-of-circuit isoflurane vaporiser was used during the induction period (first 20 to 30 minutes). Anaesthesia was maintained using an Oxford Miniature Vaporizer placed in-circuit, using a fresh gas flow of 500 ml/min. The end-tidal isoflurane concentration was recorded for 90 minutes at five-minute intervals using a sidestream agent analyser. Two groups were compared, with the Oxford Miniature Vaporizer dial setting at either the 0.5 mark (low output setting) or at the 1.0 mark (higher output setting).At a dial setting of 0.5, the Oxford Miniature Vaporizer produced a steady end-tidal isoflurane of 0.63% (95% confidence interval 0.60 to 0.66). However, when the dial was turned to 1.0 the output was almost always excessive and had to be reduced.These findings indicate that a stable, predictable and clinically useful output can be achieved when the Oxford Miniature Vaporizer is positioned in-circuit using low-flow and controlled ventilation.

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Sevoflurane Anaesthesia with the Komesaroff Vaporizer inside the Circle System

Cited by 5 publications

References 12 publications

Cost-effectiveness of Basal Flow Sevoflurane Anaesthesia Using the Komesaroff Vaporizer inside the Circle System

Cost-effectiveness of Basal Flow Sevoflurane Anaesthesia Using the Komesaroff Vaporizer inside the Circle System

Mechanical ventilation of six dogs anaesthetised with isoflurane or sevoflurane delivered by a Komesaroff anaesthetic machine

Evaluation of an Oxford Miniature Vaporizer Placed in-Circuit during the Maintenance Phase of Low-Flow Anaesthesia

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