Department of Anesthesia and Pain Management, Toronto General Hospital/University Health Network, ON, Canada.
Can J Anaesth. 2013 Jan;60(1):38-43. doi: 10.1007/s12630-012-9814-5. Epub 2012 Nov 7.
The use of volatile-based sedation within critical care environments has been limited by difficulties of drug administration and safety concerns over environment pollution and staff exposure in an intensive care unit (ICU) with no scavenging. The aim of this study was to develop a simple scavenging system to be used with the Anesthesia Conserving Device (AnaConDa(®)) and to determine whether or not ambient concentrations of residual anesthetic are within current acceptable limits.
The scavenging system consists of two Deltasorb(®) canisters attached to the ICU ventilator in series. AnaConDa is a miniature vaporizer designed to provide volatile-based sedation within an ICU. The first ten patients recruited into a larger randomized trial assessing outcomes after elective coronary graft bypass surgery were sedated within the cardiac ICU using either isoflurane or sevoflurane. Sedation was guided by the Sedation Agitation Scale, resulting in an end-tidal minimum anesthetic concentration of volatile agent ranging from 0.1-0.3. At one hour post ICU admission, infrared photometric analysis was used to assess environmental contamination at four points along the ventilator circuit and scavenging system and around the patient's head. All measurements taken within the patient's room were below 1 part per million, which satisfies criteria for occupational exposure.
This study shows that volatile agents can be administered safely within critical care settings using a simple scavenging system. Our scavenging system used in conjunction with the AnaConDa device reduced the concentration of environmental contamination to a level that is acceptable to Canadian standards and standards in most Western countries and thus conforms to international safety standards. The related clinical trial was registered at www.clinicaltrials.gov (NCT01151254).
在重症监护环境中使用基于挥发性的镇静剂受到限制，因为在没有清除设备的重症监护病房（ICU）中，药物给药困难，环境污染和工作人员暴露的安全问题令人担忧。本研究的目的是开发一种简单的清除系统，与麻醉保持设备（AnaConDa(®)）一起使用，并确定环境中残留麻醉剂的浓度是否在当前可接受的范围内。
清除系统由两个串联连接到 ICU 呼吸机的 Deltasorb(®)罐组成。AnaConDa 是一种微型蒸发器，旨在为 ICU 内提供基于挥发性的镇静。前 10 名招募到更大的随机试验中评估择期冠状动脉搭桥手术后结局的患者在心脏 ICU 中使用异氟烷或七氟醚镇静。镇静由镇静躁动评分指导，导致挥发性麻醉剂的呼气末最小麻醉浓度在 0.1-0.3 之间。在 ICU 入住后 1 小时，使用红外光度分析评估呼吸机回路和清除系统以及患者头部周围四个点的环境污染。患者房间内的所有测量值均低于百万分之一，符合职业暴露标准。
这项研究表明，在重症监护环境中，使用简单的清除系统可以安全地给予挥发性药物。我们的清除系统与 AnaConDa 设备一起使用，将环境污染的浓度降低到加拿大标准和大多数西方国家标准都可以接受的水平，因此符合国际安全标准。相关临床试验在 www.clinicaltrials.gov 注册（NCT01151254）。
