A survey and analysis of peri-operative quality indicators promoted by National Societies of Anaesthesiologists in Europe: The EQUIP project.

Background: To capture preventable peri-operative patient harm and guide improvement initiatives, many quality indicators (QIs) have been developed. Several National Anaesthesiologists Societies (NAS) in Europe have implemented quality indicators. To date, the definitions, validity and dissemination of such quality indicators, and their comparability with validated published indicators are unknown.

In Vitro Model of Prepacked Carbon Dioxide Absorber Use: Development and Testing.

Background: Carbon dioxide absorbers allow the use of fresh gas flow below minute ventilation (V˙E). Models are developed and tested in vitro to quantify their performance with variable carbon dioxide load (V˙CO2), fresh gas flow, V˙E, end-tidal carbon dioxide (ETco2) fraction, and the type of workstation used.

Methods: First principles are used to derive a linear relationship between fresh gas flow and fractional canister usage or FCU0.

The science behind banning desflurane: A narrative review.

Potent inhaled anaesthetics are halogenated hydrocarbons with a large global warming effect. The use of fluorinated hydrocarbons (most are not anaesthetics) are being restricted but volatile anaesthetics have been exempted from legislation, until now: the EU has formulated a proposal to ban or at least severely restrict the use of desflurane starting January 2026. This narrative review addresses the implications of a politics-driven decision - without prior consultation with major stakeholders, such as the European Society of Anaesthesiology and Intensive Care (ESAIC) - on daily anaesthesia practice and reviews the potential scientific arguments that would support stopping the routine use of desflurane in anaesthetic practice.

Arterial to end-tidal CO gradients during isocapnic hyperventilation.

Isocapnic hyperventilation (ICHV) is occasionally used to maintain the end-expired CO partial pressure (PCO) when the inspired CO (PCO) rises. Whether maintaining PCO with ICHV during an increase of the PCO also maintains arterial PCO (PCO) remains poorly documented. 12 ASA PS I-II subjects undergoing a robot-assisted radical prostatectomy (RARP) (n = 11) or cystectomy (n = 1) under general endotracheal anesthesia with sevoflurane in O/air (40% inspired O) were enrolled.

Development and validation of a model to calculate anesthetic agent consumption from inspired and end-expired concentrations, minute ventilation, fresh gas flow and dead space ventilation.

Anesthetic agent consumption is often calculated as the product of fresh gas flow (FGF) and vaporizer dial setting (F). Because F of conventional vaporizers is not registered in automated anesthesia records, retrospective agent consumption studies are hampered. The current study examines how F can be retrospectively calculated from the agent's inspired (F) and end-expired concentration (F), FGF, and minute ventilation (MV).

Prospective validation of gas man simulations of sevoflurane in O/air over a wide fresh gas flow range.

The use of inhaled anesthetics has come under increased scrutiny because of their environmental effects. This has led to a shift where sevoflurane in O/air has become the predominant gas mixture to maintain anesthesia. To further reduce environmental impact, lower fresh gas flows (FGF) should be used.

Memsorb™, a novel CO removal device part II: in vivo performance with the Zeus IE.

Memsorb™ (DMF Medical, Halifax, Canada) is a novel device based upon membrane oxygenator technology designed to eliminate CO from exhaled gas when using a circle anesthesia circuit. Exhaled gases pass through semipermeable hollow fibers and sweep gas flowing through these fibers creates a diffusion gradient for CO removal. In vivo Memsorb™ performance was tested during target-controlled closed-circuit anesthesia (TCCCA) with desflurane in O/air using a Zeus IE® anesthesia workstation (Dräger, Lübeck, Germany).

Memsorb™, a novel CO removal device part I: in vitro performance with the Zeus IE®.

Soda lime-based CO absorbents are safe, but not ideal for reasons of ecology, economy, and dust formation. The Memsorb™ is a novel CO removal device that uses cardiopulmonary bypass oxygenator technology instead: a sweep gas passes through semipermeable hollow fibers, adding or removing gas from the circle breathing system. We studied the in vitro performance of a prototype Memsorb™ used with a Zeus IE® anesthesia machine when administering sevoflurane and desflurane in O/air mixtures.

Ten years of the Helsinki Declaration on patient safety in anaesthesiology: An expert opinion on peri-operative safety aspects.

: Patient safety is an activity to mitigate preventable patient harm that may occur during the delivery of medical care. The European Board of Anaesthesiology (EBA)/European Union of Medical Specialists had previously published safety recommendations on minimal monitoring and postanaesthesia care, but with the growing public and professional interest it was decided to produce a much more encompassing document. The EBA and the European Society of Anaesthesiology (ESA) published a consensus on what needs to be done/achieved for improvement of peri-operative patient safety.

End of year summary 2019: anaesthesia and airway management.

This end of the year summary reviews anesthesia related manuscripts that have been published in the Journal of Clinical Monitoring and Computing in 2019. Anesthesia is currently defined as being composed of unconsciousness, immobility, and autonomic nervous system (ANS) control (Br J Anaesth;122:e127-e135135, Egan 2019). Pain is a postoperative issue, because by definition unconsciousness implies pain cannot be experienced.

The effect of isocapnic hyperventilation on early recovery after remifentanil/sevoflurane anesthesia in O /air: A randomized trial.

Background: Isocapnic hyperventilation (ICHV) may hasten emergence from general anesthesia but remains inadequately studied. We prospectively determined emergence time after sevoflurane anesthesia of variable duration with and without ICHV.

Methods: In 25 ASA I-II patients, general anesthesia was maintained with one age-adjusted MAC sevoflurane in O /air and target-controlled remifentanil delivery.

The Anesthesia Workstation: Quo Vadis?

Ensuring adequate ventilation and oxygenation and delivering inhaled anesthetic agent to the patient remain core responsibilities of the anesthesia provider during general anesthesia. Because of the emphasis placed on physiology, pharmacology, clinical sciences, and administrative duties, the stellar anesthesia workstation technology may be underutilized by the anesthesia community. Target-controlled O2 and agent delivery and automated end-expired CO2 control have entered the clinical arena, with only cost, luddism, and administrative hurdles preventing their more widespread use.

In vitro performance of prefilled CO absorbers with the Zeus®.

Low fresh gas flows (FGFs) decrease the use of anesthetic gases, but increase CO absorbent usage. CO absorbent usage remains poorly quantified. The goal of this study is to determine canister life of 8 commercially available CO absorbent prepacks with the Zeus.

Desflurane usage during anesthesia with and without NO using FLOW-i Automatic Gas Control with three different wash-in speeds.

AGC (Automatic Gas Control) is the FLOW-i's automated low flow tool (Maquet, Solna, Sweden) that target controls the inspired O (FO) and end-expired desflurane concentration (Fdes) while (by design) exponentially decreasing fresh gas flow (FGF) during wash-in to a maintenance default FGF of 300 mL min. It also offers a choice of wash-in speeds for the inhaled agents. We examined AGC performance and hypothesized that the use of lower wash-in speeds and NO both reduce desflurane usage (Vdes).

Journal of clinical monitoring and computing 2016 end of year summary: anesthesia.

Clinical monitoring and computing are essential during general anesthesia. As a result it would be impossible to review all the articles published in the Journal of Clinical Monitoring and Computing that are relevant to anesthesia. We therefore will limit this summary to those articles that are uniquely related to anesthesia.