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Closed system anaesthesia – historical aspects and recent developments

Published online by Cambridge University Press:  19 June 2006

P. Schober  and
S. A. Loer
P. Schober
Affiliation:
Vu Medisch Centrum, Department of Anaesthesiology, Amsterdam, The Netherlands
S. A. Loer
Affiliation:
Vu Medisch Centrum, Department of Anaesthesiology, Amsterdam, The Netherlands
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Abstract

Summary

Closed circuit anaesthesia was described decades ago but did not achieve wide popularity among anaesthesiologists mainly because reliable control of inspiratory gas concentrations was not possible. Recent innovations including fast gas analysers, electronically controlled dosage systems and algorithms for feedback control have made possible the development of sophisticated closed circuit ventilators designed for routine clinical practice. The main advantages comprise economic use of medical gases and volatile anaesthetics, reduction of anaesthetic gas loss into the atmosphere, improved airway acclimatization as well as estimations of oxygen consumption. This article reviews historical aspects, recent developments as well as advantages and limitations of closed system anaesthesia.

Keywords

ANAESTHESIA GENERALANAESTHESIA CLOSED-CIRCUITRESPIRATION ARTIFICIALMONITORING PHYSIOLOGIC, ventilation, inspired gasesHISTORY OF MEDICINE
Type
Review
Information
European Journal of Anaesthesiology , Volume 23 , Issue 11 , November 2006 , pp. 914 - 920
Copyright
2006 European Society of Anaesthesiology

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References

Barton F, Nunn JF. Totally closed circuit nitrous oxide/oxygen anaesthesia. Br J Anaesth 1975; 47: 350–357.Google Scholar
Bushman JA, Enderby DH, Al Abrak MH, Askill S. Closed circuit anaesthesia. A new approach. Br J Anaesth 1977; 49: 575–587.Google Scholar
Droh R. Das geschlossene Narkose–Kreissystem. Anasthesiol Intensivmed Prax 1975; 11: 27–32.Google Scholar
Foster PA. ‘Closed circuit’ anaesthesia. S Afr Med J 1974; 48: 701–704.Google Scholar
Mapleson WW. The concentration of anaesthetics in closed circuits, with special reference to halothane. 1. Theoretical study. Br J Anaesth 1960; 32: 298–309.Google Scholar
Mostert JW. Closed-circle systems – a new direction in the practice of anaesthesia. S Afr Med J 1980; 57: 391–395.Google Scholar
Vesalius A. De Humani Corporis Fabrica.Basel, Switzerland: Ex officina Joannis Oporini, 1543.
Lower R. Tractatus De Corde.London, UK: Typis Jo Redmayne, impensis Jacobi Allestery, 1669.
Mayow J. De Respiratione.Oxford, UK: Excudebat Hen. Hall, impensis Ric. Davis, 1668.
Foregger R. Joseph Black and the identification of carbon dioxide. Anesthesiology 1957; 18: 257–264.Google Scholar
Priestley J. Experiments and Observations on Different Kinds of Air.London, UK: Printed for J. Johnson, 1775.
Scheele CW. Chemische Abhandlung von der Luft und dem Feuer.Upsala, Sweden and Leipzig, Germany: Verlegt von Magn. Swederus, zu finden bey S.L. Crusius, 1777.
Morris LE. Closed carbon dioxide filtration revisited. Anaesth Intens Care 1994; 22: 345–358.Google Scholar
Reinhold H. Theodore Schwann and the invention of closed circuit breathing. In: Rupreht J, van Liebig MG, Lee JA, Erdmann W, eds. Anaesthesia – Essays on its History.Berlin, Heidelberg, New York: Springer Verlag, 1985.
Clover JT. Portable regulating ether inhaler. Br Med J 1877; I: 69–70.Google Scholar
Wawersik J. Die Geschichte des Narkoseapparates in Grundzügen. Anaesthesist 1982; 31: 541–548.Google Scholar
Waters RM. Clinical scope and utility of carbon dioxide filtration in inhalation anaesthesia. Anesth Analg 1924; 3: 20.Google Scholar
Brody S. Bioenergetics and Growth.Baltimore, USA: Waverly Press, 1945.
Severinghaus JW. The rate of uptake of nitrous oxide in man. J Clin Invest 1954; 33: 1183–1189.Google Scholar
Lowe HJ, Ernst EA. The Quantitative Practice of Anesthesia – Use of Closed Circuit.Baltimore, USA: Williams & Wilkins, 1981.
Couto da Silva JM, Mapleson WW, Vickers MD. Quantitative study of Lowe's square-root-of-time method of closed-system anaesthesia. Br J Anaesth 1997; 79: 103–112.Google Scholar
Hendrickx JF, Soetens M, Van der DA, Meeuwis H, Smolders F, de Wolf AM. Uptake of desflurane and isoflurane during closed-circuit anesthesia with spontaneous and controlled mechanical ventilation. Anesth Analg 1997; 84: 413–418.Google Scholar
Weir HM, Kennedy RR. Infusing liquid anaesthetics into a closed circuit. Anaesth Intens Care 1994; 22: 376–379.Google Scholar
Simmerer T. Was können Anästhesiesysteme in der Zukunft leisten am Beispiel der Sauerstoff-Dosierung und -Messung. Anasthesiol Intensivmed Notfallmed Schmerzther 2004; 39 (Suppl 1): S44–S47.Google Scholar
Westenskow DR, Wallroth CF. Closed-loop control for anesthesia breathing systems. J Clin Monit 1990; 6: 249–256.Google Scholar
Verkaaik AP, Van Dijk G. High flow closed circuit anaesthesia. Anaesth Intens Care 1994; 22: 426–434.Google Scholar
Struys MM, Kalmar AF, De Baerdemaeker LEet al. Time course of inhaled anaesthetic drug delivery using a new multifunctional closed-circuit anaesthesia ventilator. In vitro comparison with a classical anaesthesia machine. Br J Anaesth 2005; 94: 306–317.Google Scholar
Hargasser S, Breinbauer B, Kling Met al. Anästhesie mit dem geschlossenen System PhysioFlex im Vergleich zu konventionellen Anästhesieverfahren. Anaesthesiol Reanim 1994; 19: 149–154.Google Scholar
Wauer H, Schädlich M, Verkaaik AP, Erdmann W. Intra-anesthetic on-line monitoring of oxygen consumption using a closed circuit system. Adv Exp Med Biol 1992; 317: 863–867.Google Scholar
Wissing H, Kuhn I, Kessler P. Atemgasklimatisierung mit dem Narkosegerät Physioflex. Anaesthesist 1997; 46: 613–615.Google Scholar
Wissing H, Kuhn I, Kessler P. Das Wärme-Feuchte-Profil des PhysioFlex. Untersuchungen am Modell. Anaesthesist 1997; 46: 201–206.Google Scholar
Johansson A, Lundberg D, Luttropp HH. The effect of heat and moisture exchanger on humidity and body temperature in a low-flow anaesthesia system. Acta Anaesthesiol Scand 2003; 47: 564–568.Google Scholar
Wappler F. Malignant hyperthermia. Eur J Anaesthesiol 2001; 18: 632–652.Google Scholar
Bacher A, Mayer N, Mittlboeck M, Zadrobilek E. Anaesthesia and systemic oxygenation. Acta Anaesthesiol Scand 1996; 40: 869–875.Google Scholar
Hausmann D, Stoeckel H, Krajewski W, Schuttler J. O2 uptake and CO2 production during total intravenous propofol–alfentanil anesthesia under steady-state conditions. Is O2 uptake a parameter for assessing the depth of anesthesia? Anasthesiol Intensivmed Notfallmed Schmerzther 1991; 26: 12–16.Google Scholar
Hausmann D, Ebeling B, Nadstawek J, Muller W. Muscle relaxation with no effect on oxygen uptake during isoflurane anesthesia? Anasthesiol Intensivmed Notfallmed Schmerzther 1992; 27: 469–472.Google Scholar
Peyton PJ, Robinson GJ. Measured pulmonary oxygen consumption: difference between systemic oxygen uptake measured by the reverse Fick method and indirect calorimetry in cardiac surgery. Anaesthesia 2005; 60: 146–150.Google Scholar
Ferderbar PJ, Kettler RE, Jablonski J, Sportiello R. A cause of breathing system leak during closed circuit anesthesia. Anesthesiology 1986; 65: 661–663.Google Scholar
Mizuno K, Sumiyoshi R. Air contamination of a closed anesthesia circuit. Acta Anaesthesiol Scand 1998; 42: 128–130.Google Scholar
Morita S, Latta W, Hambro K, Snider MT. Accumulation of methane, acetone, and nitrogen in the inspired gas during closed-circuit anesthesia. Anesth Analg 1985; 64: 343–347.Google Scholar
Rolly G, Versichelen LF, Mortier E. Methane accumulation during closed-circuit anesthesia. Anesth Analg 1994; 79: 545–547.Google Scholar
Versichelen L, Rolly G, Vermeulen H. Accumulation of foreign gases during closed-system anaesthesia. Br J Anaesth 1996; 76: 668–672.Google Scholar
Soro M, Garcia-Perez ML, Ferrandis R, Aguilar G, Belda EJ. Closed-system anaesthesia for laparoscopic surgery: is there a risk for carbon monoxide intoxication? Eur J Anaesthesiol 2004; 21: 483–488.Google Scholar
Bito H, Suzuki A, Sanjo Y, Katoh T, Sato S. Comparison of compound A concentrations with sevoflurane anaesthesia using a closed system with a PhysioFlex anaesthesia machine vs. a low-flow system with a conventional anaesthesia machine. Br J Anaesth 2000; 84: 350–353.Google Scholar
Funk W, Gruber M, Jakob W, Hobbhahn J. Compound A does not accumulate during closed circuit sevoflurane anaesthesia with the Physioflex. Br J Anaesth 1999; 83: 571–575.Google Scholar
Versichelen LF, Rolly G, Bouche MPet al. In vitro compound A formation in a computer-controlled closed-circuit anesthetic apparatus. Comparison with a classical valve circuit. Anesthesiology 2000; 93: 1064–1068.Google Scholar