Document Detail


Preparation of the Drager Fabius CE and Drager Zeus anaesthetic machines for patients susceptible to malignant hyperthermia.
MedLine Citation:
PMID:  22388705     Owner:  NLM     Status:  Publisher    
Abstract/OtherAbstract:
CONTEXT: Malignant hyperthermia may follow exposure to trace quantities of inhalational anaesthetics. In susceptible patients, the complete avoidance of these triggers is advised when possible; however, failing this, it is essential to washout or purge the anaesthesia machine of residual inhalational anaesthetics. OBJECTIVE: This study examined the washout profile of sevoflurane from the Drager Fabius CE and the Drager Zeus machines. DESIGN: The washout profile of sevoflurane was measured from the Fabius CE and Zeus anaesthesia machines following a standard period of exposure. The disposable tubing, CO2 absorber and other components of each machine were then replaced to examine their impact on the retention of sevoflurane. The effect of autoclaving the ventilator diaphragm and non-disposable ventilator tube or substituting for a new diaphragm and ventilation tube were examined in later parts of this study. SETTING: University teaching hospital. MAIN OUTCOME MEASURE: Time taken to reach 5 parts per million of sevoflurane when machines underwent standard washout with fresh gas flush. RESULTS: The concentration of sevoflurane reached 5 parts per million in the Fabius CE machines after an mean (SD) of 140 min (46) at a fresh gas flow (FGF) of 10 l min. The time taken for sevoflurane to reach 5 parts per million was significantly reduced when the ventilator diaphragm and non-disposable tube were replaced with either new or autoclaved components [14 or 22 min, respectively (P = 0.017, P = 0.031)]. The concentration of sevoflurane reached 5 parts per million in the Zeus machines after an mean (SD) of 85 min (6) at a fresh gas flow of 10 l min. When the fresh gas flow was increased to 18 l min (the maximum allowable), the time to reach 5 parts per million was reduced to 16 min. CONCLUSION: When preparing the Fabius CE for the malignant hyperthermia susceptible patient, remove the vaporiser, replace the disposable tubing, the reservoir bag and the CO2 absorber. Replace the ventilator diaphragm and non-disposable ventilator tube with new or autoclaved components and flush the machine at 10 l min for at least 36 min. When preparing the Zeus, remove the vaporiser, replace the disposable tubing, the reservoir bag and CO2 absorber and flush at a fresh gas flow of 10 l min for at least 90 min. In both the Fabius and Zeus, continue at a fresh gas flow of 10 l min for the duration of the operation.
Authors:
Hiliary Shanahan; Rory O'Donoghue; Patrick O'Kelly; Aidan Synnott; James O'Rourke
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Publication Detail:
Type:  JOURNAL ARTICLE     Date:  2012-3-1
Journal Detail:
Title:  European journal of anaesthesiology     Volume:  -     ISSN:  1365-2346     ISO Abbreviation:  -     Publication Date:  2012 Mar 
Date Detail:
Created Date:  2012-3-5     Completed Date:  -     Revised Date:  -    
Medline Journal Info:
Nlm Unique ID:  8411711     Medline TA:  Eur J Anaesthesiol     Country:  -    
Other Details:
Languages:  ENG     Pagination:  -     Citation Subset:  -    
Affiliation:
From the St James' Hospital, Dublin, Ireland (HS), Department of Cardiothoracic Anesthesiology, Cleveland Clinic, Cleveland, Ohio, USA (RO) and Department of Nephrology (PO) and Department of Anaesthesia and Intensive Care Medicine (AS, JO), Beaumont Hospital, Dublin, Ireland.
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