title: Accelerating the washout of inhalational anesthetics from the Dräger Primus anesthetic workstation: effect of exchangeable internal components.
abstract: BACKGROUND
  To establish guidelines for the preparation of the Primus anesthetic workstation (Dräger, Lübeck, Germany) for malignant hyperthermia-susceptible patients, the authors evaluated the effect of replacing the workstation's exchangeable internal components on the washout of isoflurane.
  
  
  METHODS
  Primus workstations were exposed to isoflurane, and contaminated internal components were replaced as follows: group 1, no replacement; group 2, new ventilator diaphragm; group 3, autoclaved ventilator diaphragm; group 4, autoclaved integrated breathing system; group 5, flushed integrated breathing system; group 6, autoclaved ventilator diaphragm and integrated breathing system. The fresh gas flow was set at 10 l/min, and subsequently reduced to 3 l/min when a concentration of 5 ppm was achieved. Isoflurane concentration was measured in the inspiratory limb of the circle circuit every minute.
  
  
  RESULTS
  Washout times for isoflurane decreased in the following order: group 1 (67 +/- 6.5 min) > groups 2 and 3 (50 +/- 4.1 and 50 +/- 5.7 min, respectively) > group 5 (43 +/- 9.5 min) > group 4 (12 +/- 1.5 min) > group 6 (3.2 +/- 0.4 min). Isoflurane concentration increased approximately threefold when the fresh gas flow was reduced to 3 l/min.
  
  
  CONCLUSIONS
  Washout of isoflurane increased 20-fold with the use of an autoclaved ventilator diaphragm and integrated breathing system. To prepare the Primus for malignant hyperthermia-susceptible patients, the authors recommend replacing the ventilator diaphragm and integrated breathing system with autoclaved components, flushing the workstation for 5 min at a fresh gas flow of 10 l/min, and maintaining this flow for the duration of anesthesia.
authors.affiliation: Department of Anesthesia, The Hospital for ick Children, University of Toronto, Canada. mark.crawford@sickkids.ca
authors.forename: Mark W
authors.initials: MW
authors.lastname: Crawford
authors.forename: Heike
authors.initials: H
authors.lastname: Prinzhausen
authors.forename: Guy C
authors.initials: GC
authors.lastname: Petroz
mesh_terms: D000769:Anesthesia, Inhalation / Q000295:instrumentation*; D018685:Anesthetics, Inhalation / Q000032:analysis*; D004866:Equipment Contamination / Q000517:prevention & control*; D006801:Humans; D007530:Isoflurane / Q000032:analysis*; D008305:Malignant Hyperthermia / Q000517:prevention & control*; D012122:Ventilators, Mechanical
chemical_list: D018685:Anesthetics, Inhalation; D007530:Isoflurane