The Sevoflurane Washout Profile of Seven Recent Anesthesia Workstations for Malignant Hyperthermia-Susceptible Adults and Infants

Cottron, Nicolas; Larcher, Claire; Sommet, Agnès; Fesseau, Rose; Alacoque, Xavier; Minville, Vincent; Fourcade, Olivier; Kern, Delphine

doi:10.1213/ane.0000000000000208

Cited by 27 publications

(8 citation statements)

References 19 publications

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“…The key distinction appears to be that Prinzhausen et al did not perform an exchange of the ventilators diaphragm during preparation. Cottron et al also report long washout times for sevoflurane at a median of 42 minutes to reach concentrations below 5 ppm 7 . Fresh gas flow was identical with our approach at 18 L/minute, but the ventilators diaphragm was apparently unchanged.…”

Section: Discussionsupporting

confidence: 72%

“…A most probably safe threshold of 5 parts per million (ppm) was established based on expert opinions and a single study performed in swine 6 . So previous studies assessing the preparation of the Draeger Primus reported their results down to 5 ppm 7‐9 . We use the far more accurate technique of multicapillary column–ion mobility spectrometry (MCC‐IMS) which detects volatile anesthetics down to concentrations of several parts per billion (ppb), 10 thereby allowing us to reliably distinguish residual anesthetic concentrations after various preparation methods and identify the best.…”

Section: Introductionmentioning

confidence: 99%

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Residual volatile anesthetics after workstation preparation and activated charcoal filtration

Müller-Wirtz

Godsch

Sessler

et al. 2020

Acta Anaesthesiol Scand

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Background Volatile anesthetics potentially trigger malignant hyperthermia crises in susceptible patients. We therefore aimed to identify preparation procedures for the Draeger Primus that minimize residual concentrations of desflurane and sevoflurane with and without activated charcoal filtration. Methods A Draeger Primus test workstation was primed with 7% desflurane or 2.5% sevoflurane for 2 hours. Residual anesthetic concentrations were evaluated with five preparation procedures, three fresh gas flow rates, and three distinct applications of activated charcoal filters. Finally, non‐exchangeable and autoclaved parts of the workstation were tested for residual emission of volatile anesthetics. Concentrations were measured by multicapillary column–ion mobility spectrometry with limits of detection/quantification being <1 part per billion (ppb) for desflurane and <2.5 ppb for sevoflurane. Results The best preparation procedure included a flushing period of 10 minutes between removal and replacement of all parts of the ventilator circuit which immediately produced residual concentrations <5 ppm. A fresh gas flow of 10 L/minute reduced residual concentration as effectively as 18 L/minute, whereas flows of 1 or 5 L/minute slowed washout. Use of activated charcoal filters immediately reduced and maintained residual concentrations <5 ppm for up to 24 hours irrespective of previous workstation preparation. The fresh gas hose, circle system, and ventilator diaphragm emitted traces of volatile anesthetics. Conclusion In elective cases, presumably safe concentrations can be obtained by a 10‐minute flush at ≥10 L/minute between removal and replacement all components of the airway circuit. For emergencies, we recommend using an activated charcoal filter.

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Section: Discussionsupporting

confidence: 72%

Section: Introductionmentioning

confidence: 99%

Residual volatile anesthetics after workstation preparation and activated charcoal filtration

Müller-Wirtz

Godsch

Sessler

et al. 2020

Acta Anaesthesiol Scand

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“…Each member of the family should be advised that this information applies to them until it is proved otherwise using definitive diagnostic to achieve the target reduction in anaesthetic concentration depends on the individual anaesthetic machine. The times required have been published for several currently available machines [44], but it is our view that it is the manufacturer's responsibility to provide this information when they supply a new machine. The recent introduction of activated charcoal filters provides an alternative means for avoiding administration of trace quantities of inhalational agents to patients at increased risk of MH [30,45].…”

Section: Patient and Family Counsellingmentioning

confidence: 99%

Malignant hyperthermia 2020

et al. 2021

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“…Past recommendations included flushing machines with 10 L/min of fresh gas flow for 20 minutes to reduce concentrations of residual volatile agents to safe levels. Recent investigations using modern anesthesia machines have demonstrated that machine flushes of greater than 90 minutes may not be adequate to reduce volatile agent concentrations to safe levels, less than 5 ppm [27]. Current recommendations call for machine flushes based on manufacturer recommendations, placement of activated charcoal filters, or use of a machine or ventilator that has already been cleaned or is not capable of administering volatile agents.…”

Section: Preparation For Elective Anesthesiamentioning

confidence: 99%