Have you ever wondered why we never change things....what I came to know by meeting a great anesthetist was ... Well we never want to change so we never change. We continue with what we have been taught over the centuries . Same goes for using gas flows during general anesthesia - classically > 3-4 l / min of flow. And out of this 80% is lost as waste gases along with the vapour anesthetic uses. This has many implications -
1) Theatre pollution with healthcare personnel exposure
2) Environmental Green house effect
3) Economical loss
4) Heat and moisture loss from patient
And I wonder why I never thought of all this before shifting over to a closed circuit low flow system which has none of these problems. And this is how I started it.
To use the low gas flow you just shut off the APL valve of the closed circuit on any anesthesia machine and use the CO2 circle absorber to take care of the exhaled CO2 . And then keep the gas flow to only 1 l/min in case of low flow or 500 ml / min in case of minimal flow . However before starting the low flow anesthesia 10 min of high flow anesthesia need to be given to achieve denitrogenation and reach sufficient depth of anesthesia ( you can read about why ). Same goes the case at reversal - shut down the anesthetic 15-20 min earlier . The vaporizer needs to put at 1.5 % isoflurane for initial high flow phase and then at 2% during low flow.
As far as the monitoring goes - well CO2 monitoring is a must to prevent hypercapnea as a result of non functioning absorber. Rest standard monitoring to prevent hypoxia etc is enough.
Till now I have faced no problems but yes I have seen that PONV seems a little more frequent with this technique . But I guess that might be because the patient is better anesthetized with this rather than semi-closed circuit systems.
I am inclined to believe that we need a change the classical anesthesia to a modern and better system.
"TRY IT TO BELIEVE IT"
Any comments would be a great honor.
1) Theatre pollution with healthcare personnel exposure
2) Environmental Green house effect
3) Economical loss
4) Heat and moisture loss from patient
And I wonder why I never thought of all this before shifting over to a closed circuit low flow system which has none of these problems. And this is how I started it.
To use the low gas flow you just shut off the APL valve of the closed circuit on any anesthesia machine and use the CO2 circle absorber to take care of the exhaled CO2 . And then keep the gas flow to only 1 l/min in case of low flow or 500 ml / min in case of minimal flow . However before starting the low flow anesthesia 10 min of high flow anesthesia need to be given to achieve denitrogenation and reach sufficient depth of anesthesia ( you can read about why ). Same goes the case at reversal - shut down the anesthetic 15-20 min earlier . The vaporizer needs to put at 1.5 % isoflurane for initial high flow phase and then at 2% during low flow.
As far as the monitoring goes - well CO2 monitoring is a must to prevent hypercapnea as a result of non functioning absorber. Rest standard monitoring to prevent hypoxia etc is enough.
Till now I have faced no problems but yes I have seen that PONV seems a little more frequent with this technique . But I guess that might be because the patient is better anesthetized with this rather than semi-closed circuit systems.
I am inclined to believe that we need a change the classical anesthesia to a modern and better system.
"TRY IT TO BELIEVE IT"
Any comments would be a great honor.
