Efficiency of CONTRAfluran™ in reducing sevoflurane pollution from maintenance anaesthesia in minimal flow end-tidal control mode for laparoscopic surgery

Harold Mulier; Michel M R F Struys; Hugo Vereecke; Steffen Rex; An Teunkens; Alain F Kalmar

doi:10.1111/anae.16289

Efficiency of CONTRAfluran™ in reducing sevoflurane pollution from maintenance anaesthesia in minimal flow end-tidal control mode for laparoscopic surgery

Anaesthesia. 2024 Apr 12. doi: 10.1111/anae.16289. Online ahead of print.

Authors

Harold Mulier^{1

2}, Michel M R F Struys^{3

4}, Hugo Vereecke^{2

3}, Steffen Rex^{1

5}, An Teunkens^{1

5}, Alain F Kalmar^{2

6}

Affiliations

¹ Department of Anaesthesiology, University Hospitals Leuven, Leuven, Belgium.
² Department of Anaesthesia and Critical Care, AZ Sint-Jan Brugge, Bruges, Belgium.
³ Department of Anaesthesiology, University Medical Center Groningen and University of Groningen, Groningen, The Netherlands.
⁴ Department of Basic and Applied Medical Sciences, Ghent University, Gent, Belgium.
⁵ Department of Cardiovascular Sciences, KU Leuven - University of Leuven, Leuven, Belgium.
⁶ Department of Electronics and Information Systems, IBiTech, Ghent University, Gent, Belgium.

PMID: 38606765
DOI: 10.1111/anae.16289

Abstract

Background: Recommendations exist that aim to mitigate the substantial ecological impact of anaesthesia. One option is to use anaesthetic gas capturing technology at anaesthesia workstation exhausts to harvest and recycle volatile agents. However, the efficiency of such technology is mainly unverified in vivo.

Methods: The efficiency of CONTRAfluran™ in capturing sevoflurane from an anaesthesia workstation exhaust (when set to minimal flow and end-tidal control mode) was evaluated in 70 adult patients scheduled for general or bariatric laparoscopic surgery. The weight of the sevoflurane vaporiser and CONTRAfluran canister was measured before and after each case, to calculate total sevoflurane consumption and retention. Retention was measured after the minimal flow maintenance phase and after the high flow washout phase. The total retention efficiency was the fraction of all consumed sevoflurane captured by the CONTRAfluran canister. The primary objective was to examine the retention efficiency of CONTRAfluran in a clinical surgical setting, where all feasible strategies to minimise sevoflurane consumption and optimise the efficacy of CONTRAfluran were utilised. The secondary objective was to analyse the correlation between mass transfer and the duration of the case.

Results: Mean (SD) volume of sevoflurane captured using CONTRAfluran was 4.82 (1.41) ml, representing 45% (95%CI 42-48%) of all sevoflurane administered. The highest amount of retention was found during the washout phase. Retention efficiency did not correlate with the duration of the case.

Conclusions: Over half of the sevoflurane administered was not captured by the CONTRAfluran canister when minimal flow techniques were used, likely due to residual accumulation of sevoflurane in the patient after tracheal extubation or, to a lesser extent, due to ventilation system leakage. However, as every prevented emission is commendable, CONTRAfluran may be a potentially valuable tool for reducing the environmental footprint of sevoflurane-based anaesthesia.

Keywords: CONTRAfluran™; environment; greenhouse gas; sevoflurane; volatile capture technology.