Yonsei Med J.  2011 Jul;52(4):668-672. 10.3349/ymj.2011.52.4.668.

Effect of Charcoal Filter on the Emergence from Sevoflurane Anesthesia in a Semi-Closed Rebreathing Circuit

Affiliations
  • 1Department of Anesthesiology and Pain Medicine, Hallym University Sacred Health Hospital, Anyang, Korea.
  • 2Department of Anesthesiology and Pain Medicine, and Anesthesia and Pain Research Institute, Yonsei University College of Medicine, Seoul, Korea. ktmin501@yuhs.ac
  • 3Department of Anesthesiology and Pain Medicine, Yonsei University College of Medicine, Seoul, Korea.

Abstract

PURPOSE
A charcoal filter attached within the anesthetic circuit has been shown to efficiently adsorb halothane or isoflurane, thus hastening anesthetic recovery in low or minimal flow system. This study was intended to demonstrate whether the charcoal filter enhances the recovery time from sevoflurane anesthesia using a semi-closed circuit system.
MATERIALS AND METHODS
Thirty healthy patients scheduled for elective surgery under sevoflurane anesthesia were randomly assigned to the charcoal filter or control group. Upon completion of surgery, the end-tidal concentration of sevoflurane was maintained at 2.0 vol%. A charcoal filter was attached to the expiratory limb of the breathing circuit of charcoal filter group subjects. After sevoflurane was discontinued, ventilation was controlled with the same minute volume as the intra-operative period at a fresh gas flow rate of 5 L.min(-1) with 100% O2. The elimination kinetics of sevoflurane from end-tidal concentration, Bispectral index and times of eye opening and extubation were obtained.
RESULTS
The exponential time constant (tau) of alveolar sevoflurane concentration in the charcoal filter group was significantly shorter than that in the control group (1.7+/-0.5 vs. 2.5+/-1.1 min, p=0.008). The charcoal filter hastened rapid eye opening (11.1+/-3.8 vs. 14.8+/-3.0 min, p=0.007) and extubation (11.9+/-3.9 vs. 15.3+/-3.2 min, p=0.014), compared to the control group.
CONCLUSION
A charcoal filter enhances the recovery from sevoflurane anesthesia with a semi-closed rebreathing circuit.

Keyword

Anesthetic emergence; BIS; charcoal filter; semi-closed circuit; sevoflurane

MeSH Terms

Adult
Anesthesia/methods
*Anesthesia Recovery Period
Anesthesiology/instrumentation
Anesthetics, Inhalation/chemistry/*pharmacology
Charcoal/*chemistry
Filtration/*methods
Humans
Methyl Ethers/chemistry/*pharmacology
Middle Aged
Time Factors

Figure

  • Fig. 1 A hand-made charcoal filter [approximate dimension of the canister; volume of 100 mL, length of 17 cm, and diameter of 3 cm, filled with pallet typed charcoal granules, 4×(5-8) mm] attached into anesthetic circuit.

  • Fig. 2 Effect of charcoal filter on end-tidal sevoflurane concentration (ET-sevo) for in vitro pretest. Artificial lung (5 L) was connected to a semi-closed breathing circuit and mechanically ventilated with 100% O2 at a fresh gas flow of 5 L·min-1 and a minute volume of 6 L·min-1. Sevoflurane was administered at a vaporizer dial setting of 1 vol% for three minutes. Dial setting was then raised to 2 vol% and 4 vol% every three minutes. Arrows indicate the beginning of each concentration of sevoflurane. ET-sevoflurane concentrations with the charcoal filter reached 80.0%, 76.4%, and 78.1% of those without the charcoal filter after 3 minute administration of 1, 2 and 4 vol% of sevoflurane, respectively.

  • Fig. 3 FA·FA0-1 declined exponentially after sevoflurane anesthesia. A plot equation for exponential decay was derived using the least-squares fit for data from FA·FA0-1 (r2: control=0.885; charcoal filter=0.933). The exponential time constant (τ) of sevoflurane for the charcoal filter group was significantly shorter than that for the control group (1.7±0.5 vs. 2.5±1.1 min, P=0.008). FA·FA0-1, the decay rate of alveolar concentration (FA) during elimination of sevoflurane relative to the last alveolar concentration during administration of sevoflurane (FA0); exp, exponent.


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Time course of end-tidal desflurane concentration during delivery and elimination according to the type and location of filters in a semi-closed circuit system
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