Leak of anesthetic gases inside the anesthesia machine

We experienced the leak of anesthetic gases inside the anesthesia machine in spite of performing the leak test before its use. After induction of anesthesia, a laryngeal mask airway was inserted and the patient was ventilated manually. At the beginning we could not find any signs of machine troubles. High airway pressure occurred immediately after switching to the mechanical ventilation. Because we could not detect the details of the machine trouble, tidal volume was set lower and the surgery was continued. After surgery, we found a crack in a fresh gas circuit valve. We have to check the anesthesia machine regularly and know its duration of use.     

Humidification and heating of anesthetic gases during pediatric anesthesia using the Cicero Anesthesia Workstation]

A series of 52 infants underwent general or urological surgery; all were ventilated with the CICERO. Two different flows of fresh gas were used. In group I (n = 21) the fresh gas flow was set exactly at the level of the minute volume, representing a half-open, non-rebreathing system. In group II (n = 31) the fresh gas flow was adjusted to 10% of the required minute volume. Temperature and relative humidity of the inspired gas were measured continuously close to the tracheal tube. Anaesthesia was accomplished with 2 vol% isoflurane, 21-30 vol% oxygen in nitrous oxide. The results were compared with those achieved with our time-tested paediatric equipment, a SERVO 900D ventilator with a Fisher-Paykel humidifier (Group III, n = 35). Using a high fresh gas flow, no increase in relative humidity in the inspired gas could be detected. The values varied between 12% and 25% (group I). Reducing the flow of fresh gas as indicated above resulted in an increase in the relative humidity (group II). Over the evaluated period of 2 h, humidity increased slowly from an initial mean value of 20% to a maximum of something over 70%. Using the SERVO 900D ventilator combined with the Fisher-Paykel humidifier, humidity reached a value of greater 90% within 10 min after activation of the heated cascade. Humidity in the inspired gas should exceed 70% to avoid damage to infant airways. This will not be attained until after more than 2 h with unaided breathing systems, by when most operations performed on paediatric patients will already be over. Condensed water may aspirated by small infants. This potentially dangerous situation was only encountered in the CICERO circuit, and not in the system protected by the Fisher-Paykel cascade. Dry gases can result in thickened mucous and in obstruction of a small tracheal tube, which requires emergency reintubation. With artificial airways dry gases damage the ciliated epithelia of the trachea and cause loss of water and body heat. The temperature of the "cold" gases varied within a range of 21-33 degrees C and could not be adjusted by the anaesthetist. In the CICERO system, heating the gases at the valve only prevents mechanical failure caused by water condensation. In pediatric anaesthesia, variable heating and non-condensing humidity are essential. The dry and heated gases of the CICERO are not acceptable in the daily practice of paediatric anaesthesia.     

Chromatographic analysis of multiple tracer inert gases in the presence of anesthetic gases.

A gas chromatographic method for simultaneous analysis of multiple tracer inert gases in blood and expired gas samples is described. The method enables determination of the distribution of ventilation-perfusion ratios in the lungs during anesthesia with nitrous oxide and halothane. In addition, simultaneous analysis of anesthetic gas concentration in blood permits calculation of the amount of uptake or elimination of anesthetic gases from the Fick principle.     

Special article: general anesthetic gases and the global environment

General anesthetics are administered to approximately 50 million patients each year in the United States. Anesthetic vapors and gases are also widely used in dentists' offices, veterinary clinics, and laboratories for animal research. All the volatile anesthetics that are currently used are halogenated compounds destructive to the ozone layer. These halogenated anesthetics could have potential significant impact on global warming. The widely used anesthetic gas nitrous oxide is a known greenhouse gas as well as an important ozone-depleting gas. These anesthetic gases and vapors are primarily eliminated through exhalation without being metabolized in the body, and most anesthesia systems transfer these gases as waste directly and unchanged into the atmosphere. Little consideration has been given to the ecotoxicological properties of gaseous general anesthetics. Our estimation using the most recent consumption data indicates that the anesthetic use of nitrous oxide contributes 3.0% of the total emissions in the United States. Studies suggest that the influence of halogenated anesthetics on global warming will be of increasing relative importance given the decreasing level of chlorofluorocarbons globally. Despite these nonnegligible pollutant effects of the anesthetics, no data on the production or emission of these gases and vapors are publicly available. The primary goal of this article is to critically review the current data on the potential effects of general anesthetics on the global environment and to describe possible alternatives and new technologies that may prevent these gases from being discharged into the atmosphere.