System leaks and the loss of sevoflurane

IF 7.5 1区 医学 Q1 ANESTHESIOLOGY
Anaesthesia Pub Date : 2024-07-23 DOI:10.1111/anae.16386
Alain F. Kalmar, An Teunkens, Steffen Rex, Hugo Vereecke, Harold Mulier, Michel M. R. F. Struys
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引用次数: 0

Abstract

We thank Tokumine et al. for the valuable insights on the potential contribution of system leaks on the loss of sevoflurane [1]. If, as their findings convincingly suggest, the system leaks should be considered negligible, the question remains as to how the missing sevoflurane escaped the system [2]. Given that substantially higher systemic absorption is unlikely, incomplete capture by CONTRAfluran™ (Baxter International, Deerfield, IL, USA) appears to be one of the few plausible explanations.

Since the interaction between activated carbon and sevoflurane is driven by non-covalent forces (primarily Van der Waals interactions which are reversible) it is plausible that, particularly under high fresh gas flow and low partial pressure of sevoflurane, there is incomplete capture or even dissociation and re-release of sevoflurane. It is noteworthy that, to enable the recycling of the adsorbed volatile anaesthetics, the substrate of CONTRAfluran must be selected such that the molecular binding is not excessively strong, allowing desorption at a sufficiently low temperature to avoid degradation of the sevoflurane molecules [3].

In our study protocol, we aimed to achieve maximum elimination of sevoflurane with the patients' trachea intubated. Immediately after stopping sevoflurane administration, we maintained a fresh gas flow of 9 l.min-1 for a considerable duration until the patient was responsive. A certain amount of desorption and re-release may have occurred during this phase. A possible recommendation could be to use a lower fresh gas flow during the elimination phase of volatile anaesthesia to minimise desorption. This reflects that there is still considerable room for further optimisation of the technology.

系统泄漏和七氟烷损失。
我们感谢 Tokumine 等人就系统泄漏对七氟烷损失的潜在影响提出的宝贵见解[1]。如果正如他们的研究结果令人信服地表明,系统泄漏可以忽略不计,那么问题仍然是丢失的七氟烷是如何从系统中逃逸的[2]。由于活性炭与七氟醚之间的相互作用是由非共价作用力(主要是可逆的范德瓦耳斯相互作用)驱动的,因此,特别是在高新鲜气体流量和七氟醚分压较低的情况下,出现七氟醚的不完全捕获甚至解离和再释放是有可能的。值得注意的是,为了使吸附的挥发性麻醉剂能够循环利用,CONTRAfluran 的底物必须选择分子结合力不过强的物质,这样才能在足够低的温度下解吸附,避免七氟醚分子降解[3]。在停止使用七氟烷后,我们立即将新鲜气体流量保持在 9 升/分钟,持续相当长的时间,直到患者有反应为止。在这一阶段可能发生了一定量的解吸和再释放。可能的建议是在挥发性麻醉的消除阶段使用较低的新鲜气体流量,以尽量减少解吸。这反映出该技术仍有很大的进一步优化空间。
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来源期刊
Anaesthesia
Anaesthesia 医学-麻醉学
CiteScore
21.20
自引率
9.30%
发文量
300
审稿时长
6 months
期刊介绍: The official journal of the Association of Anaesthetists is Anaesthesia. It is a comprehensive international publication that covers a wide range of topics. The journal focuses on general and regional anaesthesia, as well as intensive care and pain therapy. It includes original articles that have undergone peer review, covering all aspects of these fields, including research on equipment.
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