Clinical use of a small soda lime canister in a low-flow to-and-fro system

It may be possible to overcome the classical disadvantages of a to-and-fro system by the use of a small soda lime canister. We report our experience of such a system in a series of 13 adult patients requiring mechanical ventilation of the lungs during surgery. The system was found to be convenient to use and the charge of soda lime had sufficient absorptive capacity to last throughout the great majority of surgical cases. Using a fresh gas flow of 1 l.min-1, the ratio of inspired isoflurane concentration to isoflurane vaporizer setting was found to be approximately one half after 10 min of anaesthesia. This ratio was maintained throughout the procedure, except for a few minutes following each change in vaporizer setting. A to-and-fro system using a small soda lime canister is a convenient alternative to the circle system for low-flow anaesthesia.