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BJA Advance Access published online on February 25, 2009
British Journal of Anaesthesia, doi:10.1093/bja/aep019
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© The Board of Management and Trustees of the British Journal of Anaesthesia 2009. All rights reserved. For Permissions, please e-mail: journals.permissions@oxfordjournals.org

Wash-in kinetics for sevoflurane using a disposable delivery system (AnaConDa®) in cardiac surgery patients

L. W. Sturesson, A. Johansson, M. Bodelsson* and G. Malmkvist

Section of Anaesthesiology and Intensive Care, Department of Clinical Sciences, Lund University, University Hospital, SE-221 85 Lund, Sweden

* Corresponding author. E-mail: mikael.bodelsson{at}med.lu.se

Background: The use of volatile anaesthetics has increased in situations where conventional anaesthetic machines are inadequate or unavailable, for example, cardiac surgery and intensive care. The disposable anaesthetic conserving device, AnaConDa®, allows vaporization of liquid volatile anaesthetics from a syringe pump and rebreathing of exhaled anaesthetic. Clinical use requires understanding of device-specific anaesthetic agent kinetics, which are not fully known. We compared the wash-in kinetics for sevoflurane administered by a conventional vaporizer in a non-rebreathing system and the AnaConDa® and evaluated if a standard anaesthesia gas monitor gave accurate readings while using the AnaConDa®.

Methods: Cardiac surgery patients were randomized to maintenance of anaesthesia with sevoflurane either via a vaporizer or via the AnaConDa® (n=8 in each group). Sevoflurane in arterial blood and airway gas was measured with gas chromatography and standard gas monitoring.

Results: The initial increase in arterial sevoflurane tension was greater with the vaporizer than with the AnaConDa®, but the time to reach 80% of maximum sevoflurane tension was close to 8 min in both groups. End-tidal sevoflurane tension mirrored arterial tension in both groups, whereas measured inspired tension was lower than expired and arterial tensions with the use of the AnaConDa®.

Conclusions: The wash-in kinetics for sevoflurane delivered by the AnaConDa® are similar to a vaporizer. End-tidal sevoflurane tension accurately reflects arterial tension whereas inspired tension may be underestimated using an AnaConDa®.

Keywords: anaesthetics volatile; pharmacokinetics, model


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