NDLI: Anaesthetic conserving device $AnaConDa^{®}:$ dead space effect and significance for lung protective ventilation

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Anaesthetic conserving device $AnaConDa^{®}:$ dead space effect and significance for lung protective ventilation

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Anaesthetic conserving device $AnaConDa^{®}:$ dead space effect and significance for lung protective ventilation

Content Provider	World Health Organization (WHO)-Global Index Medicus
Author	Sturesson, L. W. Bodelsson, M. Jonson, B. Malmkvist, G.
Description	Country affiliation: Sweden Author Affiliation: Sturesson LW ( Section of Anaesthesiology and Intensive Care, Lund University and Skane University Hospital, SE-221 85 Lund, Sweden louise.walther_sturesson@med.lu.se.); Bodelsson M ( Section of Anaesthesiology and Intensive Care, Lund University and Skane University Hospital, SE-221 85 Lund, Sweden.); Jonson B ( Section of Clinical Physiology, Department of Clinical Sciences Lund, Lund University and Skane University Hospital, SE-221 85 Lund, Sweden.); Malmkvist G ( Section of Anaesthesiology and Intensive Care, Lund University and Skane University Hospital, SE-221 85 Lund, Sweden.)
Abstract	Background The anaesthetic conserving device $AnaConDa^{®}$ (ACD) reflects exhaled anaesthetic agents thereby facilitating the use of inhaled anaesthetic agents outside operating theatres. Expired $CO_{2}$ is, however, also reflected causing a dead space effect in excess of the ACD internal volume. $CO_{2}$ reflection from the ACD is attenuated by humidity. This study tests the hypothesis that sevoflurane further attenuates reflection of $CO_{2}.$ An analysis of clinical implications of our findings was performed. Methods Twelve postoperative patients received mechanical ventilation using a conventional heat and moisture exchanger (HME, internal volume 50 ml) and an ACD (100 ml), the latter with or without administration of sevoflurane. The ACD was also studied with a test lung at high sevoflurane concentrations. Reflection of $CO_{2}$ and dead space effects were evaluated with the single-breath test for $CO_{2}.$ Results Sevoflurane reduced but did not abolish $CO_{2}$ reflection. In patients, the mean dead space effect with 0.8% sevoflurane was 88 ml larger using the ACD compared with the HME (P<0.001), of which 38 ml was due to $CO_{2}$ reflection. Our calculations show that with the use of the ACD, normocapnia cannot be achieved with tidal volume <6 ml $kg^{−1}$ even when respiratory rate is increased. Conclusions An ACD causes a dead space effect larger than its internal volume due to reflection of $CO_{2},$ which is attenuated but not abolished by sevoflurane administration. $CO_{2}$ reflection from the ACD limits its use with low tidal volume ventilation, such as with lung protection ventilation strategies. Clinical trial registration Clinical Trials NCT01699802.
File Format	HTM / HTML
ISSN	00070912
e-ISSN	14716771
Journal	British Journal of Anaesthesia
Issue Number	3
Volume Number	113
Language	English
Publisher	Oxford University Press
Publisher Date	2014-09-01
Publisher Place	Great Britain (UK)
Access Restriction	Open
Subject Keyword	Discipline Anesthesiology Anesthesia, Inhalation Instrumentation Anesthetics, Inhalation Administration & Dosage Respiration, Artificial Respiratory Dead Space Drug Effects Carbon Dioxide Equipment Design Methyl Ethers Postoperative Care Pulmonary Gas Exchange Tidal Volume Evaluation Studies Research Support, Non-u.s. Gov't
Content Type	Text
Resource Type	Article
Subject	Anesthesiology and Pain Medicine

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