Evaluation of three transportable multigas anesthetic monitors: the Bruel & Kjaer Anesthetic Gas Monitor 1304, the Datex Capnomac Ultima, and the Nellcor N-2500

A new implementation of EN1839 method T mixture preparation to prepare calibration gas mixtures for anesthetic gas monitors

In this study different mixtures from anesthetic liquids vapours in air and O₂-sevoflurane/air, sevoflurane/O₂ and isoflurane/O₂-were prepared according to EN1839 method T. The gases mixtures were used to calibrate anesthetic gas monitors. The targeted concentrations (TCs) from sevoflurane and isoflurane in air and O₂ were 0 vol%, 0.15 vol%, 0.7 vol%, 1 vol%, 1.5 vol%, 2.5 vol%, 5 vol%, 6 vol% and 8 vol%. The values of liquids, air and O₂ flow rates which are corresponding theoretically to the TCs were calculated. The results showed that the measured concentrations by anesthetic gas monitor are in good agreement with TCs. Full validation was performed to assure the suitability of the method for preparing gas mixtures to calibrate anesthetic gas monitors. Linearity, limit of detection (LOD), limit of quantification (LOQ), precision, method robustness and uncertainty of measurement results were evaluated in the validation study. The results indicated that the method is valid for the purpose of analysis.

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 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.

Can Modern Infrared Analyzers Replace Gas Chromatography to Measure Anesthetic Vapor Concentrations?

Background

Gas chromatography (GC) has often been considered the most accurate method to measure the concentration of inhaled anesthetic vapors. However, infrared (IR) gas analysis has become the clinically preferred monitoring technique because it provides continuous data, is less expensive and more practical, and is readily available. We examined the accuracy of a modern IR analyzer (M-CAiOV compact gas IR analyzer (General Electric, Helsinki, Finland) by comparing its performance with GC.

Methods

To examine linearity, we analyzed 3 different concentrations of 3 different agents in O₂: 0.3, 0.7, and 1.2% isoflurane; 0.5, 1, and 2% sevoflurane; and 1, 3, and 6% desflurane. To examine the effect of carrier gas composition, we prepared mixtures of 1% isoflurane, 1 or 2% sevoflurane, or 6% desflurane in 100% O₂ (= O₂ group); 30%O₂+ 70%N₂O (= N₂O group), 28%O₂ + 66%N₂O + 5%CO₂ (= CO₂ group), or air. To examine consistency between analyzers, four different M-CAiOV analyzers were tested.

Results

The IR analyzer response in O₂ is linear over the concentration range studied: IR isoflurane % = -0.0256 + (1.006 * GC %), R = 0.998; IR sevoflurane % = -0.008 + (0.946 * GC %), R = 0.993; and IR desflurane % = 0.256 + (0.919 * GC %), R = 0.998. The deviation from GC calculated as (100*(IR-GC)/GC), in %) ranged from -11 to 11% for the medium and higher concentrations, and from -20 to +20% for the lowest concentrations. No carrier gas effect could be detected. Individual modules differed in their accuracy (p = 0.004), with differences between analyzers mounting up to 12% of the medium and highest concentrations and up to 25% of the lowest agent concentrations.

Conclusion

M-CAiOV compact gas IR analyzers are well compensated for carrier gas cross-sensitivity and are linear over the range of concentrations studied. IR and GC cannot be used interchangeably, because the deviations between GC and IR mount up to ± 20%, and because individual analyzers differ unpredictably in their performance.

[Ventilators for anesthesia. Models available in France. Criteria for choice]

This update article discusses the criteria for the choice of an anaesthetic machine and provides a short analysis of the main components of the models commercialized in France in 1994. The following items are considered: the design of the machine, the fresh gas delivery system, the anaesthesia breathing system(s), the ventilator and the waste gas scavenging system, the monitors associated with the machine and other criteria such as facility of learning to run the machine and of its daily use, ease of "in-house" maintenance and quality of after-sales service, cost of the machine and of its use (driving gas, disposable equipment).