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British Journal of Anaesthesia, 2002, Vol. 88, No. 1 46-55
© 2002 The Board of Management and Trustees of the British Journal of Anaesthesia

Clinical Investigations

Fresh gas flow is not the only determinant of volatile agent consumption: a multi-centre study of low-flow anaesthesia{dagger}

J. F. Coetzee*,1 and L. J. Stewart2

1Department of Anesthesiology, Faculty of Medicine, University of Stellenbosch, PO Box 19063, Tygerberg 7505, South Africa. 2Technology and Business Development Group, Medical Research Council of South Africa, PO Box 19070, Tygerberg 7505, South Africa*Corresponding author

*Supplementary material is available to subscribers with the on-line version of the journal at the journal website.

Methods. Seven academic centres studied 302 patients, using desflurane, enflurane, halothane, or isoflurane using circle-systems and Dräger Julian anaesthetic machines, with fresh gas flows (V·F) of 3, 1, and 0.5 litre min–1. Volatile agent partial pressures in the breathing system were recorded and agent consumptions measured by weighing.

Results. At these flows, desflurane consumption depended on V·F. In contrast, halothane consumption was not influenced by V·F. Isoflurane and enflurane showed differences in consumption between flows of 0.5 and 3 litre min–1. Stepwise linear regression suggested that besides V·F, other factors influenced consumption of the more soluble agents (sex, age, weight, height, altitude, and temperature). The partial pressure ratios were independent of V·F for desflurane (end-tidal to fresh gas=0.8), but the ratios of the more soluble agents varied with V·F (end-tidal to fresh gas=0.3–0.7).

Conclusions. At V·F that involves significant re-breathing, consumption of soluble agents depends only partially on V·F. These results can be explained using Mapleson’s hydraulic analogue model.

Br J Anaesth 2002; 88: 46–55


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