A compromise for closed system anesthesia

Closed system anesthesia is economical, minimally, polluting, and conserves a patient's airway heat and moisture. Yet this method of anesthesia is not widely used because it is considered dangerous by many clinicians. We review the origins of that belief and then test the application of 2 schemes for administering potent agents in a closed system with CO2 absorption. We 1st employed Lowe's square-root-of-time uptake model in 30 patients, using halothane or enflurane. We found that the model provided a good starting point for learning to use the closed system. However, anesthetic concentrations were not accurately predicted. Based on our experience with that model, we examined a simpler approach. We began each of 10 anesthetics using a semiclosed system, then closed the system. Only sufficient O2 for metabolic demand and halothane were added to the closed system. The rate of halothane administration was the same for each patient. This approach proved clinically satisfactory, and the measured halothane concentration remained relatively constant during 45 minutes using the closed system. Changing from a semiclosed to a closed system affords the advantages of the closed system 75 percent of the time, yet requires no extra tasks or equipment.