Abstract
To identify the better volatile anaesthetic delivery system in an intensive care setting, we compared the circle breathing system and two models of reflection systems (AnaConDa™ with a dead space of 100 ml (ACD-100) or 50 ml (ACD-50)). These systems were analysed for the parameters like wash-in, consumption, and wash-out of isoflurane and sevoflurane utilising a test lung model. The test lung was connected to a respirator (circle breathing system: Aisys CS™; ACD-100/50: Puriton Bennett 840). Set parameters were volume-controlled mode, tidal volume-500 ml, respiratory rate-10/min, inspiration time-2 sec, PEEP-5 mbar, and oxygen-21%. Wash-in, consumption, and wash-out were investigated at fresh gas flows of 0.5, 1.0, 2.5, and 5.0 l/min. Anaesthetic target concentrations were 0.5, 1.0, 1.5, 2.0, and 2.5%. Wash-in was slower in ACD-100/-50 compared to the circle breathing system, except for fresh gas flows of 0.5 and 1.0 l/min. The consumption of isoflurane and sevoflurane in ACD-100 and ACD-50 corresponded to the fresh gas flow of 0.5-1.0 l/min in the circle breathing system. Consumption with ACD-50 was higher in comparison to ACD-100, especially at gas concentrations > 1.5%. Wash-out was quicker in ACD-100/-50 than in the circle breathing system at a fresh gas flow of 0.5 l/min, however, it was longer at all the other flow rates. Wash-out was comparable in ACD-100 and ACD-50. Wash-in and wash-out were generally quicker with the circle breathing system than in ACD-100/-50. However, consumption at 0.5 minimum alveolar concentration was comparable at flows of 0.5 and 1.0 l/min.
Highlights
There are two methods of administering volatile anaesthetics (VA) in the intensive care unit (ICU): a circle breathing system and reflection
The ACD-100 required significantly longer time to reach the ISO target concentration than the circle breathing system (p < 0.001), but 0.5% ISO was an exception, as it was comparable in both devices
Comparing ISO wash-in times for ACD-50 and ACD-100 across the different target concentrations, data revealed no differences for 0.5, 1.0, 1.5, and 2.0%, the ACD50 required roughly six minutes more to reach 2.5% compared to ACD-100
Summary
There are two methods of administering volatile anaesthetics (VA) in the intensive care unit (ICU): a circle breathing system and reflection. The circle breathing system consists of a Y-piece attached to the in- and expiratory valves, a. We studied ISO and SEVO lung wash-in, washout and consumption when administered via a circle breathing system with one of 4 different fresh gas flows, with the ACD-50, or with the ACD-100, all with a 5 L/min ventilation. We hypothesized lung wash-in and wash-out to be faster and agent consumption to be lower with the circle breathing system
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