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Closed-Circuit Xenon Delivery Using a Standard Anesthesia Workstation

Shilpa Rawat, John Dingley

Anesthesia & Analgesia, Volume: 110, Issue: 1, Pages: 101 - 109

Swansea University Author: John Dingley

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DOI (Published version): 10.1213/ANE.0b013e3181be0e17

Abstract

BACKGROUND:Xenon (Xe) is an anesthetic with minimal side effects, now also showing promise as a neuroprotectant both in vitro and in vivo. Although scarce and expensive, Xe is insoluble and patient uptake is low, making closed circuits the optimum delivery method. Although the future of Xe anesthesi...

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Published in: Anesthesia & Analgesia
ISSN: 0003-2999
Published: 2010
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URI: https://cronfa.swan.ac.uk/Record/cronfa27471
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fullrecord <?xml version="1.0"?><rfc1807><datestamp>2018-06-29T19:59:03.8664854</datestamp><bib-version>v2</bib-version><id>27471</id><entry>2016-04-26</entry><title>Closed-Circuit Xenon Delivery Using a Standard Anesthesia Workstation</title><swanseaauthors><author><sid>1283ffdd09b091ec57ec3e235a48cfcc</sid><firstname>John</firstname><surname>Dingley</surname><name>John Dingley</name><active>true</active><ethesisStudent>false</ethesisStudent></author></swanseaauthors><date>2016-04-26</date><deptcode>PMSC</deptcode><abstract>BACKGROUND:Xenon (Xe) is an anesthetic with minimal side effects, now also showing promise as a neuroprotectant both in vitro and in vivo. Although scarce and expensive, Xe is insoluble and patient uptake is low, making closed circuits the optimum delivery method. Although the future of Xe anesthesia is uncertain, effective neuroprotection is highly desirable even if moderately expensive. A factor limiting Xe research in all these fields may be the perceived need to purchase special Xe anesthesia workstations that are expensive and difficult to service. We investigated the practicality of 1) true closed-circuit Xe delivery using an unmodified anesthesia workstation with gas monitoring/delivery attachments restricted to breathing hoses only, 2) a Xe delivery protocol designed to eliminate wastage, and 3) recovering Xe from exhaled gas.METHODS:Sixteen ASA physical status I/II patients were recruited for surgery of &amp;#62; 2 h. Denitrogenation with 100% oxygen was started during induction and tracheal intubation under propofol/remifentanil anesthesia. This continued after operating room transfer for 30 min. All fresh gases were then temporarily stopped, metabolic oxygen consumption then being replaced with 250-mL Xe boluses until F(I)Xe = 50%. A basal oxygen fresh gas flow was thereafter restored with additional Xe given as required via the expiratory hose to maintain a F(I)Xe &amp;#62; or = 50%. At no time, apart from during circle flushes every 90 min, were the bellows allowed to completely fill and spill gas, ensuring the circle remained closed. On termination of anesthesia, the first 10 exhaled breaths were collected as was residual gas from the circle, allowing measurement of the Xe content of each.RESULTS:Total Xe consumption, including initial wash-in and circle flushes, was 12.62 (5.31) L or 4.95 (0.82) L/h, mean (sd). However, consumption during maintenance periods was lower: 3 L/h at 1 h and 2 L/h thereafter. Of the total Xe used, 8.98% (5.94%) could be recovered at the end of the procedure.CONCLUSIONS:We report that closed-circuit Xe delivery can be achieved with a modified standard anesthesia workstation with breathing hose alterations only and that the protocol was very gas efficient, especially during the normally wasteful Xe wash-in. A Xe mixture of &amp;#62; or = 50% was delivered for up to 341 min (5 h 41 min) and Xe consumption was 4.95 (0.82) L/h, maintenance being achieved with 2-3 L/h. With this degree of efficiency, Xe recovery/recycling at the end of anesthesia may be of little additional benefit.</abstract><type>Journal Article</type><journal>Anesthesia &amp; Analgesia</journal><volume>110</volume><journalNumber>1</journalNumber><paginationStart>101</paginationStart><paginationEnd>109</paginationEnd><publisher/><issnPrint>0003-2999</issnPrint><keywords/><publishedDay>31</publishedDay><publishedMonth>12</publishedMonth><publishedYear>2010</publishedYear><publishedDate>2010-12-31</publishedDate><doi>10.1213/ANE.0b013e3181be0e17</doi><url/><notes/><college>COLLEGE NANME</college><department>Medicine</department><CollegeCode>COLLEGE CODE</CollegeCode><DepartmentCode>PMSC</DepartmentCode><institution>Swansea University</institution><apcterm/><lastEdited>2018-06-29T19:59:03.8664854</lastEdited><Created>2016-04-26T22:43:52.4858431</Created><path><level id="1">Faculty of Medicine, Health and Life Sciences</level><level id="2">Swansea University Medical School - Medicine</level></path><authors><author><firstname>Shilpa</firstname><surname>Rawat</surname><order>1</order></author><author><firstname>John</firstname><surname>Dingley</surname><order>2</order></author></authors><documents/><OutputDurs/></rfc1807>
spelling 2018-06-29T19:59:03.8664854 v2 27471 2016-04-26 Closed-Circuit Xenon Delivery Using a Standard Anesthesia Workstation 1283ffdd09b091ec57ec3e235a48cfcc John Dingley John Dingley true false 2016-04-26 PMSC BACKGROUND:Xenon (Xe) is an anesthetic with minimal side effects, now also showing promise as a neuroprotectant both in vitro and in vivo. Although scarce and expensive, Xe is insoluble and patient uptake is low, making closed circuits the optimum delivery method. Although the future of Xe anesthesia is uncertain, effective neuroprotection is highly desirable even if moderately expensive. A factor limiting Xe research in all these fields may be the perceived need to purchase special Xe anesthesia workstations that are expensive and difficult to service. We investigated the practicality of 1) true closed-circuit Xe delivery using an unmodified anesthesia workstation with gas monitoring/delivery attachments restricted to breathing hoses only, 2) a Xe delivery protocol designed to eliminate wastage, and 3) recovering Xe from exhaled gas.METHODS:Sixteen ASA physical status I/II patients were recruited for surgery of &#62; 2 h. Denitrogenation with 100% oxygen was started during induction and tracheal intubation under propofol/remifentanil anesthesia. This continued after operating room transfer for 30 min. All fresh gases were then temporarily stopped, metabolic oxygen consumption then being replaced with 250-mL Xe boluses until F(I)Xe = 50%. A basal oxygen fresh gas flow was thereafter restored with additional Xe given as required via the expiratory hose to maintain a F(I)Xe &#62; or = 50%. At no time, apart from during circle flushes every 90 min, were the bellows allowed to completely fill and spill gas, ensuring the circle remained closed. On termination of anesthesia, the first 10 exhaled breaths were collected as was residual gas from the circle, allowing measurement of the Xe content of each.RESULTS:Total Xe consumption, including initial wash-in and circle flushes, was 12.62 (5.31) L or 4.95 (0.82) L/h, mean (sd). However, consumption during maintenance periods was lower: 3 L/h at 1 h and 2 L/h thereafter. Of the total Xe used, 8.98% (5.94%) could be recovered at the end of the procedure.CONCLUSIONS:We report that closed-circuit Xe delivery can be achieved with a modified standard anesthesia workstation with breathing hose alterations only and that the protocol was very gas efficient, especially during the normally wasteful Xe wash-in. A Xe mixture of &#62; or = 50% was delivered for up to 341 min (5 h 41 min) and Xe consumption was 4.95 (0.82) L/h, maintenance being achieved with 2-3 L/h. With this degree of efficiency, Xe recovery/recycling at the end of anesthesia may be of little additional benefit. Journal Article Anesthesia & Analgesia 110 1 101 109 0003-2999 31 12 2010 2010-12-31 10.1213/ANE.0b013e3181be0e17 COLLEGE NANME Medicine COLLEGE CODE PMSC Swansea University 2018-06-29T19:59:03.8664854 2016-04-26T22:43:52.4858431 Faculty of Medicine, Health and Life Sciences Swansea University Medical School - Medicine Shilpa Rawat 1 John Dingley 2
title Closed-Circuit Xenon Delivery Using a Standard Anesthesia Workstation
spellingShingle Closed-Circuit Xenon Delivery Using a Standard Anesthesia Workstation
John Dingley
title_short Closed-Circuit Xenon Delivery Using a Standard Anesthesia Workstation
title_full Closed-Circuit Xenon Delivery Using a Standard Anesthesia Workstation
title_fullStr Closed-Circuit Xenon Delivery Using a Standard Anesthesia Workstation
title_full_unstemmed Closed-Circuit Xenon Delivery Using a Standard Anesthesia Workstation
title_sort Closed-Circuit Xenon Delivery Using a Standard Anesthesia Workstation
author_id_str_mv 1283ffdd09b091ec57ec3e235a48cfcc
author_id_fullname_str_mv 1283ffdd09b091ec57ec3e235a48cfcc_***_John Dingley
author John Dingley
author2 Shilpa Rawat
John Dingley
format Journal article
container_title Anesthesia & Analgesia
container_volume 110
container_issue 1
container_start_page 101
publishDate 2010
institution Swansea University
issn 0003-2999
doi_str_mv 10.1213/ANE.0b013e3181be0e17
college_str Faculty of Medicine, Health and Life Sciences
hierarchytype
hierarchy_top_id facultyofmedicinehealthandlifesciences
hierarchy_top_title Faculty of Medicine, Health and Life Sciences
hierarchy_parent_id facultyofmedicinehealthandlifesciences
hierarchy_parent_title Faculty of Medicine, Health and Life Sciences
department_str Swansea University Medical School - Medicine{{{_:::_}}}Faculty of Medicine, Health and Life Sciences{{{_:::_}}}Swansea University Medical School - Medicine
document_store_str 0
active_str 0
description BACKGROUND:Xenon (Xe) is an anesthetic with minimal side effects, now also showing promise as a neuroprotectant both in vitro and in vivo. Although scarce and expensive, Xe is insoluble and patient uptake is low, making closed circuits the optimum delivery method. Although the future of Xe anesthesia is uncertain, effective neuroprotection is highly desirable even if moderately expensive. A factor limiting Xe research in all these fields may be the perceived need to purchase special Xe anesthesia workstations that are expensive and difficult to service. We investigated the practicality of 1) true closed-circuit Xe delivery using an unmodified anesthesia workstation with gas monitoring/delivery attachments restricted to breathing hoses only, 2) a Xe delivery protocol designed to eliminate wastage, and 3) recovering Xe from exhaled gas.METHODS:Sixteen ASA physical status I/II patients were recruited for surgery of &#62; 2 h. Denitrogenation with 100% oxygen was started during induction and tracheal intubation under propofol/remifentanil anesthesia. This continued after operating room transfer for 30 min. All fresh gases were then temporarily stopped, metabolic oxygen consumption then being replaced with 250-mL Xe boluses until F(I)Xe = 50%. A basal oxygen fresh gas flow was thereafter restored with additional Xe given as required via the expiratory hose to maintain a F(I)Xe &#62; or = 50%. At no time, apart from during circle flushes every 90 min, were the bellows allowed to completely fill and spill gas, ensuring the circle remained closed. On termination of anesthesia, the first 10 exhaled breaths were collected as was residual gas from the circle, allowing measurement of the Xe content of each.RESULTS:Total Xe consumption, including initial wash-in and circle flushes, was 12.62 (5.31) L or 4.95 (0.82) L/h, mean (sd). However, consumption during maintenance periods was lower: 3 L/h at 1 h and 2 L/h thereafter. Of the total Xe used, 8.98% (5.94%) could be recovered at the end of the procedure.CONCLUSIONS:We report that closed-circuit Xe delivery can be achieved with a modified standard anesthesia workstation with breathing hose alterations only and that the protocol was very gas efficient, especially during the normally wasteful Xe wash-in. A Xe mixture of &#62; or = 50% was delivered for up to 341 min (5 h 41 min) and Xe consumption was 4.95 (0.82) L/h, maintenance being achieved with 2-3 L/h. With this degree of efficiency, Xe recovery/recycling at the end of anesthesia may be of little additional benefit.
published_date 2010-12-31T03:33:18Z
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score 11.036334

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