British Journal of Anaesthesia, 1986, Vol. 58, No. 10 1167-1180
© 1986 The Board of Management and Trustees of the British Journal of Anaesthesia
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GASEOUS HOMEOSTASIS AND THE CIRCLE SYSTEM
Factors Influencing Anaesthetic Gas Exchange
Department of Anaesthetics, Charing Cross & Westminster Medical School Westminster Hospital, London SW1P 2AP
A mathematical model of a subject breathing from a circle system has been used to follow the course of anaesthetic uptake during the simulated administration of 60% nitrous oxide, 2% halo-thane and 2% methoxyflurane, under non-re-breathing conditions and with fresh gas flows to the circle system of between 8 and 0.25 litre min–. Compared with the non-rebreathing state, the use of a circle system reduced the initial rate of increase of alveolar towards fresh gas anaesthetic concentration, and the rate of increase in body anaesthetic content. The degree of reduction became more marked as fresh gas flow was reduced, and as agents of increasing blood solubility were used. These effects of a circle system were influenced by the volume of the circle system and the composition of gas initially present within the system. When the circle system was in use there were increases in the magnitude of both the concentration effect and the second gas effect which were related to the magnitude of fresh gas flow. The use of a circle system augmented the effects of changes in cardiac output and reduced the effects of changes in ventilation on the alveolar concentrations of the anaesthetic. These influences of a circle system were also dependent on the magnitude of fresh gas flow. The degree of augmentation of the effects of cardiac output decreased with increasing blood solubility of the agent in use, whilst the limitation of the effects of ventilation was greatest with the agent of highest blood solubility. Both under non-rebreathing conditions and with the circle system in use, the effects of cardiac output and ventilation were greater with 2% nitrous oxide than with 60% nitrous oxide, and were also greater when gases were given separately than when administered in combination.
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