Prospective validation of gas man simulations of sevoflurane in O2/air over a wide fresh gas flow range

• Published in: Journal of clinical monitoring and computing 2022-12, Vol.36 (6), p.1881-1890
• Main Authors: Candries, Esther, De Wolf, Andre M., Hendrickx, Jan F. A.
• Format: Article
• Language: English
• Subjects: Anesthesia; Anesthesiology; Anesthetics; Cardiac output; Critical Care Medicine; Environmental effects; Environmental impact; Error analysis; Gas flow; Gas mixtures; Health Sciences; Intensive; Maintenance; Medicine; Medicine & Public Health; Original Research; Patients; Simulation; Statistics for Life Sciences; Vaporizers; Workstations
• ISSN: 1387-1307; 1573-2614
• DOI: 10.1007/s10877-022-00842-0

The use of inhaled anesthetics has come under increased scrutiny because of their environmental effects. This has led to a shift where sevoflurane in O 2 /air has become the predominant gas mixture to maintain anesthesia. To further reduce environmental impact, lower fresh gas flows (FGF) should be used. An accurate model of sevoflurane consumption allows us to assess and quantify the impact of the effects of lowering FGFs. This study therefore tested the accuracy of the Gas Man® model by determining its ability to predict end-expired sevoflurane concentrations (F ET sevo) in patients using a protocol spanning a wide range of FGF and vaporizer settings. After IRB approval, 28 ASA I-II patients undergoing a gynecologic or urologic procedure under general endotracheal anesthesia were enrolled. Anesthesia was maintained with sevoflurane in O 2 /air, delivered via a Zeus or FLOW-i workstation (14 patients each). Every fifteen min, FGF was changed to randomly selected values ranging from 0.2 to 6 L/min while the sevoflurane vaporizer setting was left at the discretion of the anesthesiologist. The F ET sevo was collected every min for 1 h. For each patient, a Gas Man® simulation was run using patient weight and the same FGF, vaporizer and minute ventilation settings used during the procedure. For cardiac output, the Gas Man default setting was used (= Brody formula). Gas Man®’s performance was assessed by comparing measured with Gas Man® predicted F ET sevo using linear regression and Varvel’s criteria [median performance error (MDPE), median absolute performance error (MDAPE), and divergence]. Additional analysis included separating performance for the wash-in (0–15 min) and maintenance phase (15–60 min). For the FLOW-i, MDPE, MDAPE and divergence were 1% [− 6, 8], 7% [3, 15] and − 0.96%/h [− 1.14, − 0.88], respectively. During the first 15 min, MDPE and MDAPE were 18% [1, 51] and 21% [8, 51], respectively, and during the last 45 min 0% [− 7, 5] and 6% [2, 10], respectively. For the Zeus, MDPE, MDAPE and divergence were 0% [− 5, 8], 6% [3, 12] and − 0.57%/h [− 0.85, − 0.16], respectively. During the first 15 min, MDPE and MDAPE were 7% [− 6, 28] and 13% [6, 32], respectively, and during the last 45 min − 1% [− 5, 5] and 5% [2, 9], respectively. In conclusion, Gas Man® predicts F ET sevo in O 2 /air in adults over a wide range of FGF and vaporizer settings using different workstations with both MDPE and MDAPE