Optimal settings to adjust volatile end-tidal fraction: fresh gas flow or delivered fraction?

An ADARPEF survey on respiratory management in pediatric anesthesia

“…For induction, the circle system was used by a majority of respondents for every age-group ( Figure 1). The Accessory Breathing System (ABS)-consisting of a [15][16][17][18][19][20][21][22][23][24][25][26][27][28] preferred it because of its small size and light weight compared to the circle system. Breathing system and ventilation mode chosen for maintenance of an anesthesia in spontaneous ventilation are presented in Figure 2.…”

“…The reasons for choosing the circle system in Man/Spont or in PSV mode are described in table 3. When laryngospasm occurred during the use of circle system (n = 184), 24% [17][18][19][20][21][22][23][24][25][26][27][28][29] of respondents directly took the ABS; 75% [69-81] kept using the circle system but half of them (36% [31-40]) would switch to the ABS if they failed to reverse the spasm. Regarding PSV (n = 176), almost 68% [61-75] of respondents used it frequently, 16% [11][12][13][14][15][16][17][18][19][20][21][22] do not have any ventilator with this breathing mode, and 12% [8][9][10][11][12][13][14][15][16][17][18] expressed a lack of training or no interest in using PSV.…”

“…Duration of delivery should be carefully considered during anesthesia management. In adults, Quenet et al (21) demonstrated that overshooting of delivered halogenated is faster and cheaper than increasing FGF alone. In emergency, our results highlight that the two strategies are associated, suggesting that speed and safety are more important than economic concerns.…”

“…In an emergency (MCQ) (n = 190), many respondents increased the fresh gas flow (78% [71-84]) to 7 lÁmin À1 either to increase or decrease the inspired concentration of oxygen or volatile agent (7 AE 3 lÁmin À1 and 7 AE 4 lÁmin À1 respectively). 'Overshooting'-that is to say increasing or decreasing the inspired concentration over the one desired for a limited period of time-was more frequently used in case of emergency (49% [42-56] vs 27% [21][22][23][24][25][26][27][28][29][30][31][32][33][34] in nonemergency, respectively), whatever the institution's type.…”

“…When performed, <65% chose a FiO 2 higher than 80%. Inhalational induction with sevoflurane is the preferred mode of induction set at 6% or 8%, respectively, 69% [62-75] vs 25% [18][19][20][21][22][23][24][25][26][27][28][29][30][31]. For induction, the circle system was the most popular circuit used in all ages.…”