Abstract
The single lever Humphrey A.D.E. anaesthetic system, in both coaxial and parallel (non-coaxial) forms, has recently been introduced. In principle the system offers efficient“universal” function by combining the advantages of Mapleson A, D and E systems. A within-patient comparison of its function in the Mapleson A mode (lever up) in spontaneously-breathing anaesthetized subjects was made to that of the original two lever A.D.E., the Magill (Mapleson A) and the Bain (Mapleson D) systems. The coaxial and parallel single lever A.D.E. systems functioned identically to each other and to the original two lever A.D.E. system, a mean fresh gas flow (FGF) of 51 ml.kg-1.min-1 causing minimal rebreathing. Under identical conditions, the mean FGF required to just cause rebreathing increased to a mean of 71 ml.kg-1.min-1 and 150 ml.kg-1.min-1 with the Magill and the Bain systems respectively. With the single lever system, the switch to its Mapleson E mode for controlled ventilation involves the selection of the only alternative lever position (lever down) without further adjustment. The function and practical advantages in this E mode are presented in Part II.
Résumé
Le système de Humphrey A.D.E, à levier unique pour des circuits anesthésiques tant dans les formes coaxiales que les formes parallèles (non coaxiales) a été récemment introduit. En principe le système offre un fonctionnement universel efficace en combinant les avantages du système Mapleson A. Det E. Une comparaison de sonfonctionnemenl en mode E chez des patients aneslhésiés en respiration spontanée a été faite avec celle du circuit Magill (Mapleson A) et du circuit de Bain (Mapleson B). Le système coaxial est parallèle à levier unique A.D.E. lorsqu’ employé avec des flots de gaz frais moyens de 51 ml.kg-1.min-1 n’a provoqué qu’une réinspiration minime. Sous des conditions indentiques, le flot de gaz frais moyen requis pour provoquer la réinspiration était de 71 ml. kg-1.min-1 pour le circuit Magill et de 150 ml.kg-1.min-1 pour le système de Bain. En pratique, le contrôle de la pollution dans les salles d’opération était facilité avec le système A.D.E. par une réduction simultanée des flots de gaz fraiset la facilité d’attache du système anti pollution à la machine. Le fonctionnement et les avantages pratiques de ce circuit sont présentés.
Abbreviations
- A.D.E.:
-
Humphrey A.D.E. anaesthetic breathing system
- A.D.E.:
-
A.D.E. set in A mode
- A.D.E.:
-
A.D.E. set in D mode
- A.D.E.:
-
A.D.E. set in E mode
- FGF:
-
Fresh gas flow
- PiCO2 :
-
Minimum inspired carbon dioxide tension
- PéCO2 :
-
End-expired (or end-tidal) carbon dioxide tension
References
Nunn JF. Applied Respiratory Physiology. Ed 2, Butterworths; London, 1977, p 233.
Dixon J, Chakrabarti MK, Morgan M. An assessment of the Humphrey A.D.E. anaesthetic system in the Mapleson A mode during spontaneous ventilation. Anaesthesia 1984; 39: 593–6.
Shulman JS, Brodsky JB. The A.D.E. system — a new anesthetic breathing system. Anesth Analg 1984; 63: 273.
Humphrey D. A new anaesthetic breathing system combining Mapleson A, D and E principles: a simple apparatus for low flow universal use without carbon dioxide absorption. Anaesthesia 1983; 38: 361–72.
Dennison PH. Co-axial tubing for conventional anaesthetic systems. Anaesthesia 1984; 39: 841.
Humphrey D. The A.D.E. anaesthetic breathing system. Anaesthesia 1984; 39: 715–7.
Humphrey D, Brock-Utne JG, Downing JW. Single lever Humphrey A.D.E. low flow universal breathing system. Part II: Comparison with the Bain system in anaesthetized adults during controlled ventilation. Can Anaesth Soc J. 1986; 33: 710–8.
Gravenstein N, Lampotang S, Beneken JEW. Factors influencing capnography in the Bain system. J Clin Monitoring 1985; 1: 6–10.
Lack JA. Theatre pollution control. Anaesthesia 1976; 31: 259–62.
Humphrey D. The Lack, Magill and Bain anaesthetic breathing systems: a direct comparison in spontaneously breathing anaesthetized adults. J Roy Soc Med 1982; 75: 513–24.
Bain JA.Spoerel WE. A streamlined anaesthetic system. Can Anaesth Soc J 1972; 19: 426–35.
Goodwin K. Bain circuit. Can Anaesth Soc J 1976; 23: 675.
Mansell WH. Spontaneous breathing with the Bain circuit at low flow rates: a case report. Can Anaesth Soc J 1976; 23: 432–4.
Rose DK, Byrick RJ, Froese AB. Carbon dioxide elimination during spontaneous ventilation with a modified Mapleson D system: studies in a lung model. Can Anaesth Soc J 1978; 25: 353–65.
Nott MR, Norman J. The Bain and Lack breathing systems. Anaesthesia 1981; 36: 635.
Conway CM, Barnes PK. The Bain breathing system. Anaesthesia 1982; 37: 100–1.
Nott MR, Norman J. Rebreathing and the Bain circuit. Anesthesiology 1983; 58: 392–3.
Dean SE, Keenan RL. Rebreathing and the Bain circuit. Anesthesiology 1983; 58: 393–4.
Humphrey D. Rebreathing and the Bain circuit. Anesthesiology 1984; 60: 80–1.
Alexander JP. Clinical comparisons of the Bain and Magill anaesthetic systems during spontaneous respiration. Br J Anaesth 1982; 54: 1031–6.
Conway CM, Seeley HF, Barnes PK. Spontaneous ventilation with the Bain anaesthetic system. Br J Anaesth 1977; 49: 1245–9.
lingerer MJ. A comparison between the Bain and Magill anaesthetic systems during spontaneous breathing. Can Anaesth Soc J 1978; 25: 122–4.
Byrick RJ. Respiratory compensation during spontaneous ventilation with the Bain circuit. Can Anaesth Soc J 1980; 27: 96–105.
Nott MR, Walters FJM, Norman J. The Lack and Bain systems in spontaneous respiration. Anaesth Intensive Care 1982; 10: 333–9.
Flynn PJ, Morris LE. Humidity in anaesthetic systems. Br J Anaesth 1981; 53: 1096.
Taylor MB. A suggestion. Anaesthesia 1983; 38: 906.
Newton N, Cundy JM. The ultimate goal? Anaesthesia 1983; 38: 906–7.
Burchett KR, Bennett JA. A new co-axial breathing system; a combination of the benefits of Mapleson A, D and E systems. Anaesthesia 1985; 40: 181–7.
Ramaya GP. Multi-mode switchable breathing systems. Anaesthesia 1985; 40: 706–7.
Manicom AW, Schoonbee CG. The Johannesburg A-D circuit switch; a valve device for converting a co-axial Mapleson D into a co-axial Mapleson A system. Br J Anaesth 1979; 51: 1185–7.
Humphrey D. A new coaxial breathing system. Anaesthesia 1985; 40: 1136–7.
Kain ML, Nunn JF. Fresh gas economics of the Magill system. Anesthesiology 1968; 29: 964–74.
Norman J, Adams AP, Sykes MK. Rebreathing with the Magill attachment. Anesthesia 1968; 23: 75–81.
Conway CM, Davis FM, Knight HJ, Leigh JM, Preston TD, Tennant R. An experimental study of gaseous homeostasis and the Magill circuit using low fresh gas flows. Br J Anaesth 1976; 48; 447–55.
Conway CM. Alveolar gas relationships during the use of semi-closed rebreathing anaesthetic systems. Br J Anaesth 1976; 48: 865–9.
Barnes PK, Conway CM. The Lack system — a further reply. Anaesthesia 1983; 38: 603.
Conway CM. Anaesthetic breathing systems. Br J Anaesth 1985; 57: 649–57.
Humphrey D. Rebreathing and the Bain circuit. Can Anaesth Soc J 1984; 31, 343–4. 39 Nunn JF. Applied Respiratory Physiology. Ed 2, Butterworths; London, 1977, p 186.
Bain JA, Spoerel WE. Carbon dioxide output and elimination in children under anaesthesia. Can Anaesth Soc J 1977; 24: 533–9.
Nunn JF. Applied Respiratory Physiology. Ed 2, Butterworths; London, 1977, p 354.
Kain ML, Panday J, NunnJ F. The effect of intubation on the deadspace during halothane anaesthesia. Br J Anaesth 1969; 41: 94–102.
Spoerel WE, Aitken RR, Bain JA. Spontaneous respiration with the Bain breathing circuit. Can Anaesth Soc J 1978; 25: 30–5.
White DC, Halsey MJ. Anaesthetic apparatus. In: Gray TC, Utting JE, Nunn JF, eds. General Anaesthesia. Ed 4, London: Butterworths, 1980: 967–91.
Nunn JF. Potential economics of using closed circuit anesthesia. In: Aldrete JA, Lowe HJ, Virtue RW, eds. Low Flow and Closed System Anesthesia. New York: Grune & Stratton, 1979: 109–12.
Author information
Authors and Affiliations
Rights and permissions
About this article
Cite this article
Humphrey, D., Brock-Utne, J.G. & Downing, J.W. Single lever Humphrey A.D.E. low flow universal anaesthetic breathing system. Can Anaesth Soc J 33, 698–709 (1986). https://doi.org/10.1007/BF03027118
Issue Date:
DOI: https://doi.org/10.1007/BF03027118
Key words
- equipment: anaesthetic breathing systems: Bain
- Humphrey A.D.E.
- Magill
- Mapleson
- ventilation: spontaneous