Abstract
We compared the performance of three newly developed anesthetic agent (AA) monitors: the Bruel & Kjaer Anesthetic Agent Monitor 1304 (BK 1304), the Datex Capnomac Ultima (ULTIMA), and the Nellcor N-2500 (N-2500). The following were investigated: the linearity and accuracy in measuring AAs, oxygen, carbon dioxide, and nitrous oxide; the linearity and accuracy during warm-up time; the effect of increasing respiratory rate on the accuracy; the consequences of a difference between monitored and delivered AA and of delivering a mixture of AAs; and, finally, the effect of water vapor and alcohol. For all three monitors we found that the accuracy in determining the respiratory and anesthetic gases was sufficient for clinical use (the N-2500 does not measure oxygen). Because of the calibration mixture supplied with the device, however, the ULTIMA recorded values that were 10 to 12% (relative) less than the AA that was present. The BK 1304 had greater accuracy at higher respiratory rates than did the other two monitors, probably favoring its use in pediatric anesthesia. The N-2500 will detect which agent (isoflurane, enflurane, or halothane) is being used, alone or in a mixture. With the two other monitors the user must define which agent is given. In some situations a difference between this and the one actually delivered can theoretically lead to an overdose of AA, with the ULTIMA up to a 14.9 minimal alveolar concentration (MAC) overdose. No interference from alcohol or water vapor in the expired air was found. When the units millimeters of mercury (mm Hg) and kilopascal (kPa) were chosen, the ULTIMA displayed the values in standard temperature pressure dry (STPD) instead of body temperature pressure saturated (BTPS) conditions. Following power-up, some time lapsed before the monitors accurately displayed all variables, shortest with the BK 1304 and ULTIMA (15 min) and longest with the N-2500 (40 min).
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References
Elliot SE. A modified oxygen gauge for the rapid measurement of oxygen fraction in respiratory gases. J Appl Physiol 1966;21:1672–1674
Collier CR, Affeldt JE, Farr AF, Hondo BA. Continuous rapid infrared carbon dioxide analysis. J Clin Med 1955;45:526–539
Burchardi H, Teichmann J. The use of mass spectrometry in anesthesia and intensive care. Pneumologie 1974;151:288–290
Ozanne GM, Young WG, Mazzei WJ, Severinghaus JW. Multipatient anesthetic mass spectrometry: rapid analysis of data stored in long catheters. Anesthesiology 1981;55:62–70
Gravenstein JS, Gravenstein N, van der Aa JJ, Paulus DA. Pitfalls with mass spectrometry in clinical anesthesia. Int J Clin Monit Comp 1984;1:27–34
Kay B, Cohen AT, Wheeler MF. A laboratory investigation of a multigas monitor for anaesthesia (EMMA). Anaesthesia 1982;37:446–450
Luff NP, White DC. Evaluation of the Datex Normac Anaesthetic agent monitor. Anaesthesia 1985;40:555–559
Ilsley AH, Plummer JL, Runcimann WB, Cousins MJ. An evaluation of three volatile anaesthetic agent monitors. Anaesth Intensive Care 1986;14:437–442
McPeek H, Palayiwa E, Madgwick R, Sykes MK. Evaluation of a multigas anaesthetic monitor: the Datex Capnomac. Anaesthesia 1988;43:1035–1041
Guyton DG, Gravenstein N. Infrared analysis of volatile anesthetics: impact of monitor agent setting, volatile mixtures, and alcohol. J Clin Monit 1990;6:203–206
Christensen PL, Nielsen J, Kann T. Methods to produce calibration mixtures for anesthetic gas monitors and volumetric calculations on anesthetic gases. J Clin Monit 1992;8:279–284
Dubowski KM. The blood/breath ratio of ethanol. Clin Chem 1979;25:1144
Badgwell JM, McLeod ME, Lerman J, Creighton RE. End-tidal PCO2 measurements sampled at the distal and proximal ends of the endotracheal tube in infants and children. Anesth Analg 1987;66:959–964
de Jong RH, Eger EI II: MAC expanded. AD50 and AD95 values of common inhalation anesthetics in man. Anesthesiology 1975;42:384–389
Bruce DL, Linde HW. Vaporization of mixed anesthetic liquids. Anesthesiology 1984;60:342–346
Clarke RF, Daniels S, Harrison CB, Jordan MJ, Paton WDM, Smith EB, Smith RA. Potency of mixtures of general anaesthetic agents. Br J Anaesth 1978;50:979–983
Cullen SC, Eger EI II, Cullen BF, Gregory P. Observations on the anesthetic effect of the combination of xenon and halothane. Anesthesiology 1969;31:305–309
Cooper JB, Newbower RS, Kitz RJ. An analysis of major errors and equipment failures in anesthesia management: considerations for prevention and detection. Anesthesiology 1984;60:34–42
Severinghaus JW: Water vapor calibration errors in some capnometers: respiratory conventions misunderstood by some manufacturers? Anesthesiology 1989;70:996–998
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Presented in part at the Annual Meeting of the American Society of Anesthesiologists, Las Vegas, NV, 1990.
The authors thank professor and chairman S. H. Johansen and J. Qvist M.D. (Herlev Hospital, University of Copenhagen, Denmark) for their helpful discussion of the manuscript. We are grateful to Bruel & Kjaer (Naerum, Denmark), Datex Instrumentarium Corp. (Helsinki, Finland), and Nellcor Corp (Hayward, CA) for providing the gas monitors for the study.
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Nielsen, J., Kann, T. & Moller, J.T. Evaluation of three transportable multigas anesthetic monitors: The Bruel & Kjaer Anesthetic Gas Monitor 1304, the Datex Capnomac Ultima, and the Nellcor N-2500. J Clin Monitor Comput 9, 91–98 (1993). https://doi.org/10.1007/BF01616920
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DOI: https://doi.org/10.1007/BF01616920