Washout times of desflurane, sevoflurane and isoflurane from the GE Healthcare Aisys® and Avance®, Carestation®, and Aestiva® anesthesia system.
OBJECTIVE
Malignant hyperthermia susceptible patients may experience a fatal reaction to volatile anesthetic gases. This study sought to determine the washout characteristics of desflurane, sevoflurane, and isoflurane from the Aisys® , Avance® , and Aestiva® anesthesia machines. (GE Healthcare, Madison, WI, USA).


METHODS
All machines were inspected by a GE Healthcare engineer prior to testing. The machines were primed with desflurane 7 vol%, sevoflurane 2.5 vol%, and isoflurane 1.2 vol% on three separate occasions for 2 h each with each gas. The Aisys® and Avance® were tested with and without an Advanced Breathing System (ABS™ , GE Healthcare, Madison, WI, USA). The Aestiva® was tested without modification to its breathing system. Additionally, the Aisys was evaluated with desflurane 1.2 vol% and the Avance with a preflushed fresh gas line was tested with an autoclaved ABS. After priming, disposable components of the patient breathing system were replaced. The fresh gas flow was increased to 15 lpm. Gas measurements were recorded until the concentration was 4 parts per million (p.p.m).


RESULTS
The fastest median washout time was achieved by the Avance in 3 min or less without an ABS or with an autoclaved ABS. The longest median time was 35 min for the Aestiva® . Clearance of desflurane was the most time consuming for all machines.


CONCLUSIONS
This study demonstrates that saturated vapor pressure and priming concentration exert a greater effect on washout times than gas solubility. The Aisys utilizes an electronic vaporizer system that may expose the breathing system to retained saturated vapor. The breathing systems for all machines may hinder washout of gases.
Department of Anesthesiology and Critical Care Medicine, Johns Hopkins Hospital, Baltimore, MD, USA.
Tae W
TW
Kim
Jamie R
JR
Wingate
Allison M
AM
Fernandez
Emmett
E
Whitaker
Robert Q
RQ
Tham
D000776:Anesthesiology / Q000295:instrumentation*; D018685:Anesthetics, Inhalation / Q000032:analysis*; D000077335:Desflurane; D005740:Gases / Q000737:chemistry; D007530:Isoflurane / Q000031:analogs & derivatives* / Q000032:analysis*; D008738:Methyl Ethers / Q000032:analysis*; D012121:Respiration, Artificial / Q000295:instrumentation; D000077149:Sevoflurane; D012995:Solubility; D055548:Vapor Pressure
D018685:Anesthetics, Inhalation; D005740:Gases; D008738:Methyl Ethers; D000077149:Sevoflurane; D000077335:Desflurane; D007530:Isoflurane
anesthesia; general; hyperthermia; machine; malignant; preoperative