St James' Hospital, Dublin, Ireland.
Eur J Anaesthesiol. 2012 May;29(5):229-34. doi: 10.1097/EJA.0b013e328351b521.
Malignant hyperthermia may follow exposure to trace quantities of inhalational anaesthetics. In susceptible patients, the complete avoidance of these triggers is advised when possible; however, failing this, it is essential to washout or purge the anaesthesia machine of residual inhalational anaesthetics.
This study examined the washout profile of sevoflurane from the Drager Fabius CE and the Drager Zeus machines.
The washout profile of sevoflurane was measured from the Fabius CE and Zeus anaesthesia machines following a standard period of exposure. The disposable tubing, CO2 absorber and other components of each machine were then replaced to examine their impact on the retention of sevoflurane. The effect of autoclaving the ventilator diaphragm and non-disposable ventilator tube or substituting for a new diaphragm and ventilation tube were examined in later parts of this study.
University teaching hospital.
Time taken to reach 5 parts per million of sevoflurane when machines underwent standard washout with fresh gas flush.
The concentration of sevoflurane reached 5 parts per million in the Fabius CE machines after an mean (SD) of 140 min (46) at a fresh gas flow (FGF) of 10 l min(-1). The time taken for sevoflurane to reach 5 parts per million was significantly reduced when the ventilator diaphragm and non-disposable tube were replaced with either new or autoclaved components [14 or 22 min, respectively (P = 0.017, P = 0.031)]. The concentration of sevoflurane reached 5 parts per million in the Zeus machines after an mean (SD) of 85 min (6) at a fresh gas flow of 10 l min(-1). When the fresh gas flow was increased to 18 l min(-1) (the maximum allowable), the time to reach 5 parts per million was reduced to 16 min.
When preparing the Fabius CE for the malignant hyperthermia susceptible patient, remove the vaporiser, replace the disposable tubing, the reservoir bag and the CO2 absorber. Replace the ventilator diaphragm and non-disposable ventilator tube with new or autoclaved components and flush the machine at 10 l min(-1) for at least 36 min. When preparing the Zeus, remove the vaporiser, replace the disposable tubing, the reservoir bag and CO2 absorber and flush at a fresh gas flow of 10 l min(-1) for at least 90 min. In both the Fabius and Zeus, continue at a fresh gas flow of 10 l min(-1) for the duration of the operation.
恶性高热可能会在接触痕量吸入麻醉剂后发生。在易感患者中，建议尽可能避免这些诱因；然而，如果做不到这一点，就必须冲洗或清除麻醉机中残留的吸入麻醉剂。
本研究检测了七氟醚从 Dräger Fabius CE 和 Dräger Zeus 麻醉机中的冲洗曲线。
在标准暴露期后，从 Fabius CE 和 Zeus 麻醉机中测量七氟醚的冲洗曲线。然后更换一次性管道、CO2 吸收器和每台机器的其他部件，以检查它们对七氟醚保留的影响。在本研究的后期部分，还检查了对呼吸机膜片进行高压灭菌和不使用一次性呼吸机管或更换新的膜片和呼吸机管的影响。
大学教学医院。
新鲜气流冲洗时，机器标准冲洗后达到 5 百万分之几的七氟醚所需的时间。
在新鲜气流流量为 10 L/min 时，Fabius CE 机器中的七氟醚浓度达到 5 百万分之平均（SD）为 140 分钟（46）。当呼吸机膜片和非一次性管分别用新的或高压灭菌的部件更换时，达到 5 百万分之平均时间分别缩短 14 或 22 分钟（P = 0.017，P = 0.031）。在新鲜气流流量为 10 L/min 时，Zeus 机器中的七氟醚浓度达到 5 百万分之平均（SD）为 85 分钟（6）。当新鲜气流流量增加到 18 L/min（最大允许值）时，达到 5 百万分之平均时间缩短至 16 分钟。
为恶性高热易感患者准备 Fabius CE 时，移除蒸发器，更换一次性管道、储气囊和 CO2 吸收器。用新的或高压灭菌的部件更换呼吸机膜片和非一次性呼吸机管，以 10 L/min 的流速冲洗机器至少 36 分钟。准备 Zeus 时，移除蒸发器，更换一次性管道、储气囊和 CO2 吸收器，以 10 L/min 的新鲜气流冲洗至少 90 分钟。在 Fabius 和 Zeus 中，在手术过程中都以 10 L/min 的新鲜气流流量继续。
