Wash-in kinetics for sevoflurane using a disposable delivery system (AnaConDa®) in cardiac surgery patients

Sturesson, Louise Walther; Johansson, Anders; Bodelsson, Mikael; Malmkvist, Gunnar

doi:10.1093/bja/aep019

Cited by 19 publications

(10 citation statements)

References 18 publications

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“…In dieser Untersuchung lagen die arteriellen CO 2 -Partialdrücke um 20% höher als in der Kontrollgruppe, die mit gleichen körpergewichts-adaptierten Einstellungen beatmet wurde (abzüglich der Totraumdifferenz; [12]). …”

Section: Allgemeinunclassified

“…verglichen [12]: Um eine Zielkonzentration von 1 Vol.-% Sevofluran zu erreichen, wurde der Narkosemittelverdunster auf 1,2 Vol.-% eingestellt (und so belassen); beim ACD wurde die Infusionsrate wie vom Hersteller empfohlen für die ersten 10 min höher und danach niedriger eingestellt nach einem klinisch evaluierten Dosierungsschema [17]. In der ACD-Gruppe wurde die Zielkonzentration nach 10 min erreicht, in der AR-Gruppe dagegen erst nach 20 min.…”

Section: Infobox 3 Aufbau Des Anaconda-systemsunclassified

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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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Funktionsweise des „Anaesthetic Conserving Device“

et al. 2010

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“…The wash-in kinetics of sevo urane using the AnaConDa ® proved to be less than that observed with a normal vaporiser, but 80% of maximum tension was reached after 8 minutes in both groups. 46 The end-tidal fraction (Fet) of the volatile anaesthetic can be monitored, a precise indicator of the drug's concentration in the target organ which is much more reliable than any target-controlled infusion algorithm. [47][48][49][50][51] End-tidal tension in the AnaConDa ® and vaporiser mirror arterial tension in both groups.…”

Section: Inhalational Anaesthesiamentioning

confidence: 99%

“…[47][48][49][50][51] End-tidal tension in the AnaConDa ® and vaporiser mirror arterial tension in both groups. 52 Volatile anaesthetics accumulate very little, and elimination is less dependent on liver and kidney function. With the exception of halothane, volatile anaesthetics interfere very little with haemodynamics, especially in low concentrations.…”

Section: Inhalational Anaesthesiamentioning

confidence: 99%

Anaesthesia for ICU-based procedures: the advantages of and options available for inhalational anaesthesia

Kruger

2010

Southern African Journal of Anaesthesia and Analgesia

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“…Other methods of vapourising volatile anaesthetic agents include using an injector system, for example, in the Flow-i anaesthetic machine (Maquet Cardiovascular LLC, Wayne, NJ, USA), or the DIVA cassette used by the Zeus anaesthesia machine (Drager, L€ ubeck, Germany). Alternatively, the liquid anaesthetic can be vapourised close to the patient, as in the AnaConDa device [2].…”

Section: Introductionmentioning

confidence: 99%

Laboratory evaluation of a novel anaesthesia delivery device

et al. 2016

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SummaryHere, we describe proof of concept of a novel method for delivering volatile anaesthetics, where the liquid anaesthetic (sevoflurane or isoflurane) is formulated into an emulsion that is contained in a compact, lightweight device through which carrier gas flows. Release of anaesthetic is achieved by stirring of the formulation, allowing controlled and responsive release of anaesthetic at a variety of fixed flow rates between 0.5 l.min À1 and 5 l.min À1, with ventilated, non-ventilated and draw-over breathing systems. Anaesthetic release was evaluated using target anaesthetic concentrations ranging from 0.5% v/v to 8% v/v to mimic those typically required for induction and maintenance of anaesthesia, and lower concentrations suitable for sedation. Under all conditions, output could be maintained within 0.1% v/v of the intended setting, and the device could deliver a controlled level of anaesthetic for at least 60 min, with compensation for different ambient temperatures (10-30°C) and carrier gas flow rates. This device offers a simple, inexpensive method of delivering safe concentrations of volatile anaesthetics for a wide range of applications.

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Wash-in kinetics for sevoflurane using a disposable delivery system (AnaConDa®) in cardiac surgery patients

Abstract: The wash-in kinetics for sevoflurane delivered by the AnaConDa are similar to a vaporizer. End-tidal sevoflurane tension accurately reflects arterial tension whereas inspired tension may be underestimated using an AnaConDa.

Cited by 19 publications

References 18 publications

Funktionsweise des „Anaesthetic Conserving Device“

Funktionsweise des „Anaesthetic Conserving Device“

Anaesthesia for ICU-based procedures: the advantages of and options available for inhalational anaesthesia

Laboratory evaluation of a novel anaesthesia delivery device

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