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TECHNOLOGY, COMPUTING, AND SIMULATION

The Anesthetic Conserving Device Compared with Conventional Circle System Used Under Different Flow Conditions for Inhaled Anesthesia

Augusto Tempia, MD^*, Maddalena C. Olivei, MD, Eliana Calza, MD, Hans Lambert, MS^||, Luca Scotti, MD^*, Eugenio Orlando, MD, Sergio Livigni, MD, and Enrica Guglielmotti, MD

*Istituto di Anestesia e Rianimazione Ospedale San Luigi, Orbassano, Italy; Servizio di Anestesia A e B, Ospedale San Giovanni Bosco, Torino, Italy; Istituto di Anestesia e Rianimazione Ospedale San Giovanni Battista, Torino, Italy; and ||Hudson RCI, Upplands Väsby, Sweden

Address correspondence and reprint requests to Augusto Tempia, Istituto di Anestesia, Ospedale San Luigi di Orbassano, Orbassano (TO), Italy. Address e-mail to a.tempia{at}tiscalinet.it or madlein@ciaoweb.it.

The Anesthetic Conserving Device (ACD) is a high-flow anesthesia system closed to volatile anesthetics only. We compared the ACD with a circle system under different fresh gas flow (FGF) conditions. Eighty-one patients undergoing major surgery were randomly allocated to receive sevoflurane from a circle circuit combined either with the ACD placed at the Y-piece (n = 41) or with a vaporizer (n = 40). The FGF was set to 8 L/min in the ACD system, where the circle circuit served as a nonrebreather. In the conventional circle system without ACD, the vaporizer was supplied with 1-, 1.5-, 3-, and 6-L/min FGFs. We compared the ACD with the circle system under the four FGFs in terms of sevoflurane dosing, sevoflurane consumption, humidification efficiency, and environmental pollution. The ACD and the low-flow circle system (1.5- and 1-L/min FGFs) resulted in the smallest sevoflurane consumption. The increase in inspired sevoflurane concentration was faster with the circle system than with the ACD only with FGFs 3 L/min. The removal of ACD from the circuit allowed the fastest washout of sevoflurane. Respiratory gas humidification was always adequate. Sevoflurane ambient concentration with the ACD was 1–70 ppb. The ACD is a valid and simple alternative to low-flow systems.

IMPLICATIONS: The Anesthetic Conserving Device (ACD) is a new device for anesthetic vapor delivery. We demonstrated that the ACD reduces anesthetic consumption and environmental pollution similarly to a low-flow circle system, offering advantages such as simplicity, no toxicity from compounds produced in the absorber, and potential cost savings.

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