Isoflurane measurement error using short wavelength infrared techniques in horses: influence of fresh gas flow and pre-anaesthetic food deprivation

Comparison of an infrared anaesthetic agent analyser (Datex-Ohmeda) with refractometry for measurement of isoflurane, sevoflurane and desflurane concentrations

OBJECTIVE

To assess agreement between infrared (IR) analysers and a refractometer for measurements of isoflurane, sevoflurane and desflurane concentrations and to demonstrate the effect of customized calibration of IR analysers.

STUDY DESIGN

In vitro experiment.

SUBJECTS

Six IR anaesthetic monitors (Datex-Ohmeda) and a single portable refractometer (Riken).

METHODS

Both devices were calibrated following the manufacturer's recommendations. Gas samples were collected at common gas outlets of anaesthesia machines. A range of agent concentrations was produced by stepwise changes in dial settings: isoflurane (0-5% in 0.5% increments), sevoflurane (0-8% in 1% increments), or desflurane (0-18% in 2% increments). Oxygen flow was 2 L minute(-1) . The orders of testing IR analysers, agents and dial settings were randomized. Duplicate measurements were performed at each setting. The entire procedure was repeated 24 hours later. Bland-Altman analysis was performed. Measurements on day-1 were used to yield calibration equations (IR measurements as dependent and refractometry measurements as independent variables), which were used to modify the IR measurements on day-2.

RESULTS

Bias ± limits of agreement for isoflurane, sevoflurane and desflurane were 0.2 ± 0.3, 0.1 ± 0.4 and 0.7 ± 0.9 volume%, respectively. There were significant linear relationships between differences and means for all agents. The IR analysers became less accurate at higher gas concentrations. After customized calibration, the bias became almost zero and the limits of agreement became narrower.

CONCLUSIONS AND CLINICAL RELEVANCE

If similar IR analysers are used in research studies, they need to be calibrated against a reference method using the agent in question at multiple calibration points overlapping the range of interest.

Comparison of the effects of xylazine bolus versus medetomidine constant rate infusion on cardiopulmonary function and depth of anesthesia in horses anesthetized with isoflurane

OBJECTIVE

To compare the effects of xylazine bolus versus medetomidine constant rate infusion (MCRI) on cardiopulmonary function and depth of anesthesia in dorsally recumbent, spontaneously breathing, isoflurane-anesthetized horses.

DESIGN

Prospective, randomized crossover study.

ANIMALS

10 healthy adult Standardbreds.

PROCEDURES

Horses were premedicated with xylazine or medetomidine IV. Anesthesia was induced with diazepam and ketamine and maintained with isoflurane for 150 minutes. For the xylazine treatment, end-tidal isoflurane concentration was maintained at 1.7%, and xylazine (0.2 mg/kg [0.09 mg/lb], IV) was administered as a bolus at the end of anesthesia. For the MCRI treatment, end-tidal isoflurane concentration was maintained at 1.4%, and medetomidine (0.005 mg/kg/h [0.0023 mg/lb/h], IV) was infused throughout anesthesia. Physiologic data (ie, heart rate, respiratory rate, rectal temperature, bispectral index, and electromyographic values) were compared between treatments with xylazine bolus versus MCRI.

RESULTS

Heart rate was lower, but mean arterial blood pressure was higher from 20 to 40 minutes with MCRI treatment, compared with conventional treatment with xylazine. Respiratory rate and rectal temperature were greater with MCRI treatment. Bispectral index was lower with MCRI treatment from 80 to 150 minutes, and electromyographic values were lower with MCRI treatment from 30 to 150 minutes.

CONCLUSIONS AND CLINICAL RELEVANCE

In isoflurane-anesthetized horses, premedication with medetomidine followed by administration of medetomidine as a constant rate infusion resulted in decreased heart rate, higher arterial blood pressure from 20 through 40 minutes after induction of anesthesia, and better preserved body temperature, compared with conventional treatment with xylazine. Greater depth of anesthesia and muscle relaxation were seen with MCRI treatment, despite the lower isoflurane concentration.

Comparison of use of an infrared anesthetic gas monitor and refractometry for measurement of anesthetic agent concentrations

OBJECTIVE

To assess agreement between anesthetic agent concentrations measured by use of an infrared anesthetic gas monitor (IAGM) and refractometry. SAMPLE-4 IAGMs of the same type and 1 refractometer.

PROCEDURES

Mixtures of oxygen and isoflurane, sevoflurane, desflurane, or N(2)O were used. Agent volume percent was measured simultaneously with 4 IAGMs and a refractometer at the common gas outlet. Measurements obtained with each of the 4 IAGMs were compared with the corresponding refractometer measurements via the Bland-Altman method. Similarly, Bland-Altman plots were also created with either IAGM or refractometer measurements and desflurane vaporizer dial settings.

RESULTS

Bias ± 2 SD for comparisons of IAGM and refractometer measurements was as follows: isoflurane, -0.03 ± 0.18 volume percent; sevoflurane, -0.19 ± 0.23 volume percent; desflurane, 0.43 ± 1.22 volume percent; and N(2)O, -0.21 ± 1.88 volume percent. Bland-Altman plots comparing IAGM and refractometer measurements revealed nonlinear relationships for sevoflurane, desflurane, and N(2)O. Desflurane measurements were notably affected; bias ± limits of agreement (2 SD) were small (0.1 ± 0.22 volume percent) at < 12 volume percent, but both bias and limits of agreement increased at higher concentrations. Because IAGM measurements did not but refractometer measurements did agree with the desflurane vaporizer dial settings, infrared measurement technology was a suspected cause of the nonlinear relationships.

CONCLUSIONS AND CLINICAL RELEVANCE

Given that the assumption of linearity is a cornerstone of anesthetic monitor calibration, this assumption should be confirmed before anesthetic monitors are used in experiments.

Influence of two different ventilation modes on the function of an anaesthetic conserving device in sevoflurane anaesthetized piglets

OBJECTIVE

To investigate the influence of two ventilation modes on the performance of an anaesthetic conserving device (AnaConDa) in piglets.

STUDY DESIGN

Prospective randomized experimental trial.

ANIMALS

Eight female piglets weighing 24.7 +/- 2.2 kg.

METHODS

Anaesthesia was maintained with sevoflurane (in 60% oxygen) delivered from the AnaConDa placed between endotracheal tube (ETT) and Y-piece. Anaesthetic depth was guided using standard clinical parameters. Ventilation mode was volume controlled (VC) during the first and pressure support (PS) during the second period of anaesthesia in four piglets (group 1); the order was reversed in group 2. Anaesthetic gases were sampled before (at the proximal end of the ETT) and after the AnaConDa (Y-piece). Data were analysed using a model I anova, with treatment and group as fixed categorical effects. Using a paired t-test, partial pressures of carbon dioxide (Pe'CO(2)) on both sides of the device were compared.

RESULTS

Although the mean administration rate of sevoflurane was comparable in both groups (3.8 +/- 1.8 mL hour(-1)), E'Sevo was higher in group 1, more specifically during the first period (p = 0.035). Less sevoflurane escaped during VC (14.0 +/- 3.4%) compared with PS ventilation (17.2 +/- 5.7%) (p = 0.001). Pe'CO(2) was lower at the Y-piece (6.4 +/- 0.8 kPa, 48 +/- 6 mmHg) compared with the ETT (9.3 +/- 1.4 kPa, 70 +/- 11 mmHg) in both groups and ventilation modes. On average, inspiratory CO(2) tension was 2.0 +/-1.0 kPa (15 +/- 8 mmHg). Respiration rate was comparable in all piglets while tidal volume () and peak inspiratory pressure were lower during VC compared with PS (p < 0.001, p = 0.015 respectively).

CONCLUSIONS AND CLINICAL RELEVANCE

The observed differences in E'Sevo concentration and sevoflurane breakthrough were probably related to differences in . The observed high FiCO(2) indicated an excessive dead space with the AnaConDa for these piglets.

Determination of the minimum alveolar concentration of isoflurane in Shetland ponies using constant current or constant voltage electrical stimulation

OBJECTIVE

To determine the minimum alveolar concentration (MAC) of isoflurane in Shetland ponies using a sequence of three different supramaximal noxious stimulations at each tested concentration of isoflurane rather than a single stimulation.

STUDY DESIGN

Prospective, experimental trial.

ANIMALS

Seven 4-year-old, gelding Shetland ponies.

METHODS

The MAC of isoflurane was determined for each pony. Three different modes of electrical stimulation were applied consecutively (2 minute intervals): two using constant voltage (90 V) on the gingiva via needle- (CVneedle) or surface-electrodes (CVsurface) and one using constant current (CC; 40 mA) via surface electrodes applied to the skin over the digital nerve. The ability to clearly interpret the responses as positive, the latency of the evoked responses and the inter-electrode resistance were recorded for each stimulus.

RESULTS

Individual isoflurane MAC (%) values ranged from 0.60 to 1.17 with a mean (+/-SD) of 0.97 (+/-0.17). The responses were more clearly interpreted with CC, but did not reach statistical significance. The CVsurface mode produced responses with a longer delay. The CVneedle mode was accompanied by variable inter-electrode resistances resulting in uncontrolled stimulus intensity. At 0.9 MAC, the third stimulation induced more positive responses than the first stimulation, independent of the mode of stimulation used.

CONCLUSIONS

The MAC of isoflurane in the Shetland ponies was lower than expected with considerable variability among individuals. Constant current surface electrode stimulations were the most repeatable. A summation over the sequence of three supramaximal stimulations was observed around 0.9 MAC.

CLINICAL RELEVANCE

The possibility that Shetland ponies require less isoflurane than horses needs further investigation. Constant current surface-electrode stimulations were the most repeatable. Repetitive supramaximal stimuli may have evoked movements at isoflurane concentrations that provide immobility when single supramaximal stimulation was applied.

Portable mass spectrometry for measurement of anaesthetic agents and methane in respiratory gases

Monitoring the composition of gases breathed by anaesthetised patients requires measurement methods with fast responses, high accuracy and good reliability. There is also an increasing demand for systems to be able to monitor more than one target analyte simultaneously, but some gas analysers can be sensitive to the presence of methane gas in exhaled breath, consequently leading to inaccurate measurements of the anaesthetic agent. This study investigated the feasibility of employing portable quadrupole mass spectrometry to monitor volatile anaesthetic agents (halothane, isoflurane and sevoflurane), methane accumulation in anaesthetic rebreathing systems, and inspired and exhaled carbon dioxide and oxygen concentrations during equine anaesthesia in a clinical setting. The volatile anaesthetic agents were easily measurable and methane was detectable. The instrument had an advantage over short wavelength infrared absorption spectrometry analysers because it could monitor anaesthetic agents and other respiratory gases simultaneously and at extremely low concentrations, although further optimisation is required.