Residual volatile anesthetics after workstation preparation and activated charcoal filtration
© 2020 The Authors. Acta Anaesthesiologica Scandinavica published by John Wiley & Sons Ltd on behalf of Acta Anaesthesiologica Scandinavica Foundation..
BACKGROUND: Volatile anesthetics potentially trigger malignant hyperthermia crises in susceptible patients. We therefore aimed to identify preparation procedures for the Draeger Primus that minimize residual concentrations of desflurane and sevoflurane with and without activated charcoal filtration.
METHODS: A Draeger Primus test workstation was primed with 7% desflurane or 2.5% sevoflurane for 2 hours. Residual anesthetic concentrations were evaluated with five preparation procedures, three fresh gas flow rates, and three distinct applications of activated charcoal filters. Finally, non-exchangeable and autoclaved parts of the workstation were tested for residual emission of volatile anesthetics. Concentrations were measured by multicapillary column-ion mobility spectrometry with limits of detection/quantification being <1 part per billion (ppb) for desflurane and <2.5 ppb for sevoflurane.
RESULTS: The best preparation procedure included a flushing period of 10 minutes between removal and replacement of all parts of the ventilator circuit which immediately produced residual concentrations <5 ppm. A fresh gas flow of 10 L/minute reduced residual concentration as effectively as 18 L/minute, whereas flows of 1 or 5 L/minute slowed washout. Use of activated charcoal filters immediately reduced and maintained residual concentrations <5 ppm for up to 24 hours irrespective of previous workstation preparation. The fresh gas hose, circle system, and ventilator diaphragm emitted traces of volatile anesthetics.
CONCLUSION: In elective cases, presumably safe concentrations can be obtained by a 10-minute flush at ≥10 L/minute between removal and replacement all components of the airway circuit. For emergencies, we recommend using an activated charcoal filter.
| Errataetall: |
CommentIn: Acta Anaesthesiol Scand. 2020 Oct;64(9):1383-1384. - PMID 32686079 |
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| Medienart: |
E-Artikel |
| Erscheinungsjahr: |
2020 |
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| Erschienen: |
2020 |
| Enthalten in: |
Zur Gesamtaufnahme - volume:64 |
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| Enthalten in: |
Acta anaesthesiologica Scandinavica - 64(2020), 6 vom: 09. Juli, Seite 759-765 |
| Sprache: |
Englisch |
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| Beteiligte Personen: |
Müller-Wirtz, Lukas M [VerfasserIn] |
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| Links: |
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| Anmerkungen: |
Date Completed 10.08.2021 Date Revised 10.08.2021 published: Print-Electronic CommentIn: Acta Anaesthesiol Scand. 2020 Oct;64(9):1383-1384. - PMID 32686079 Citation Status MEDLINE |
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| doi: |
10.1111/aas.13571 |
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| funding: |
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| Förderinstitution / Projekttitel: |
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| PPN (Katalog-ID): |
NLM307413225 |
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| 245 | 1 | 0 | |a Residual volatile anesthetics after workstation preparation and activated charcoal filtration |
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| 500 | |a CommentIn: Acta Anaesthesiol Scand. 2020 Oct;64(9):1383-1384. - PMID 32686079 | ||
| 500 | |a Citation Status MEDLINE | ||
| 520 | |a © 2020 The Authors. Acta Anaesthesiologica Scandinavica published by John Wiley & Sons Ltd on behalf of Acta Anaesthesiologica Scandinavica Foundation. | ||
| 520 | |a BACKGROUND: Volatile anesthetics potentially trigger malignant hyperthermia crises in susceptible patients. We therefore aimed to identify preparation procedures for the Draeger Primus that minimize residual concentrations of desflurane and sevoflurane with and without activated charcoal filtration | ||
| 520 | |a METHODS: A Draeger Primus test workstation was primed with 7% desflurane or 2.5% sevoflurane for 2 hours. Residual anesthetic concentrations were evaluated with five preparation procedures, three fresh gas flow rates, and three distinct applications of activated charcoal filters. Finally, non-exchangeable and autoclaved parts of the workstation were tested for residual emission of volatile anesthetics. Concentrations were measured by multicapillary column-ion mobility spectrometry with limits of detection/quantification being <1 part per billion (ppb) for desflurane and <2.5 ppb for sevoflurane | ||
| 520 | |a RESULTS: The best preparation procedure included a flushing period of 10 minutes between removal and replacement of all parts of the ventilator circuit which immediately produced residual concentrations <5 ppm. A fresh gas flow of 10 L/minute reduced residual concentration as effectively as 18 L/minute, whereas flows of 1 or 5 L/minute slowed washout. Use of activated charcoal filters immediately reduced and maintained residual concentrations <5 ppm for up to 24 hours irrespective of previous workstation preparation. The fresh gas hose, circle system, and ventilator diaphragm emitted traces of volatile anesthetics | ||
| 520 | |a CONCLUSION: In elective cases, presumably safe concentrations can be obtained by a 10-minute flush at ≥10 L/minute between removal and replacement all components of the airway circuit. For emergencies, we recommend using an activated charcoal filter | ||
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| 650 | 4 | |a multicapillary column-ion mobility spectrometry | |
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| 700 | 1 | |a Kreuer, Sascha |e verfasserin |4 aut | |
| 700 | 1 | |a Hüppe, Tobias |e verfasserin |4 aut | |
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