Practical experience with more than 60,000 closed circuit anesthesias. Traditional and future implications of the closed circuit concept.

In a twelve year period, over 60,000 anesthesias were administered using a completely closed anesthesia system. Our results show that even in these days, when the cost of anesthetic gasses and vapours are small compared to the total cost of operative medical treatment, a substantial reduction in cost is still possible by using Closed Circuit Anesthesia (CCA). During normal anesthetic practice using semi open or semi closed anesthesia systems 70% to 95% of the anesthetic gases and vapours are wasted, though this medical contribution to the environmental pollution with halogenated hydrocarbons is small compared to industrial and domestic output, we have a firm ideological standpoint in this matter, and we believe that also from this point of view we should minimise our "anesthetic wastes" as much as possible. Probably the most important reason to use CCA however is the optimal conditioning of the inspired gasses, and the increased monitoring possibilities. New promising anesthesia machines are under development, which will be able to administer CCA in a completely automatic fashion, this in contrast to the classic manually controlled and ventilated CCA systems.