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British Journal of Anaesthesia, Vol 76, Issue 5 668-672, Copyright © 1996 by The Board of Management and Trustees of the British Journal of Anaesthesia

CLINICAL INVESTIGATIONS

Accumulation of foreign gases during closed-system anaesthesia

L. Versichelen, G. Rolly and H. Vermeulen
Department of Anaesthesia, University Hospital, De Pintelaan, 185, B-9000 Ghent, Belgium

In a previous study, accumulation of methane was found at the end of closed-system ventilation. As on-line analysis of gas concentrations is now available, we examined the progressive increase in concentrations of methane, carbon monoxide and acetone during modern, closed-system conditions, and their influence on infrared halothane analysis, in 26 non-pregnant, gynaecological patients. A computer-controlled closed- system anaesthesia apparatus (PhysioFlex) was used for ventilation during total i.v. anaesthesia (excluding nitrous oxide or potent inhalation anaesthetics) for gynaecological laparoscopy. Methane, carbon monoxide and acetone concentrations were analysed every 15 min in a photoacoustic infrared monitor and halothane concentrations by built-in infrared spectrometry. Mean methane concentrations increased progressively after 105 min to 941 (SD 1094) ppm, but concentrations of carbon monoxide and acetone did not increase significantly. In 18 patients, the infrared measurement falsely indicated 0.79 (0.52)% "halothane" after 60 min, but no reading appeared in the other eight patients. We conclude that methane accumulated progressively under strict closed-system conditions in higher concentrations than reported previously. In two-thirds of patients it induced false "halothane" readings.
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