Time course of inhaled anaesthetic drug delivery using a new multifunctional closed-circuit anaesthesia ventilator. In vitro comparison with a classical anaesthesia machine.
BACKGROUND
The aim of this study was to detail the time-course, defined as the changes in end-tidal drug concentration with time, and consumption of inhaled anaesthetics when using a multifunctional closed-circuit anaesthesia machine in various drug delivery modes, and to compare it with a classical anaesthesia machine using an out-of-circle vaporizer under high and low fresh gas flow conditions.


METHODS
Using an artificial test lung, sevoflurane and desflurane time-course and consumption were compared when using the Zeus apparatus (Dräger, Lubeck, Germany) with direct injection of inhaled anaesthetics or the Primus apparatus (Dräger, Lubeck, Germany) using a classical out-of-circle vaporizer. Anaesthetics were targeted at 1 and 2 MAC end-tidal during 15 min. For both apparatus, out-of-circle high and low fresh gas control (FGC) and for Zeus, auto-control (AC) modes (fixed fresh gas flow at 6 and 1 litre min(-1) and uptake mode) were compared. Time to reach target, initial overshoot and stability at target, and wash-out times were compared.


RESULTS
In FGC, an initial overshoot in end-tidal drug concentration is seen when using 6 litre min(-1) fresh gas flow and a slower time course is observed when using only 1 litre min(-1) in both apparatus. In auto-control mode, the time course of both sevoflurane and desflurane was very fast and not influenced by the changes in fresh gas flow. No overshoot at target was seen. At all settings, the wash-out times were faster when using Zeus than Primus. Inhaled anaesthetic consumption was lowest with the Zeus ventilator in uptake AC mode.


CONCLUSIONS
A combination of the fastest time course and lowest consumption of sevoflurane and desflurane was found when using the Zeus apparatus in AC uptake mode.
Struys
M M R F
MM
Department of Anaesthesia, Ghent University Hospital, De Pintelaan 185, B-9000 Gent, Belgium. michel.struys@ugent.be
Kalmar
A F
AF
De Baerdemaeker
L E C
LE
Mortier
E P
EP
Rolly
G
G
Manigel
J
J
Buschke
W
W
D000764:Anesthesia, Closed-Circuit / Q000295:instrumentation*; D018685:Anesthetics, Inhalation / Q000008:administration & dosage*; D000077335:Desflurane; D004334:Drug Administration Schedule; D016503:Drug Delivery Systems / Q000295:instrumentation* / Q000379:methods; D004582:Electronics, Medical; D004867:Equipment Design; D006801:Humans; D007530:Isoflurane / Q000008:administration & dosage / Q000031:analogs & derivatives*; D008738:Methyl Ethers / Q000008:administration & dosage; D000077149:Sevoflurane; D012122:Ventilators, Mechanical
D018685:Anesthetics, Inhalation; D008738:Methyl Ethers; D000077149:Sevoflurane; D000077335:Desflurane; D007530:Isoflurane