doktorska disertacija
Igor Karnjuš (Avtor), Miljenko Križmarić (Mentor), Pavel Skok (Član komisije za zagovor), Dušan Mekiš (Komentor)

Povzetek

Uvod: Pri uporabi sistema za inhalacijsko sedacijo AnaConDaTM (ACD, Sedana Medical, Uppsala, Švedska) lahko tehnološki dejavniki vplivajo na njegovo delovanje. Med sedacijo bolnika z uporabo tekočega hlapnega anestetika lahko v brizgalki nastane plinski mehurček in zaradi njega pojav autopumpinga. Namen raziskave je bil preučiti, kako izpostavljenost tekočega anestetika viru toplote, način shranjevanja hlapnega anestetika, prisotnost plinskega mehurčka v ACD-brizgalki in gravitacija vplivajo na pojav autopumpinga. Dodatno smo želeli ugotoviti, kako dihalni minutni volumni (MV), predvsem enkratni dihalni volumen (Vt), in hitrost pretoka tekočega anestetika vplivajo na izgube hlapnega anestetika iz dihalnega sistema pri uporabi ACD. Metode: Pojav autopumpinga z uporabo ACD-sistema smo testirali in vitro na štirih različnih skupinah brizgalk z dvema hlapnima anestetikoma (izofluran in sevofluran): hlapni anestetik, shranjen na sobni temperaturi ali temperaturi hladilnika, z ali brez prisotnosti plinskega mehurčka v brizgalki. Tekoči hlapni anestetik smo v ACD-sistem dovajali s pomočjo infuzijske črpalke s konstantno hitrostjo pretoka in ga ogrevali postopoma, dokler na površini brizgalke nismo dosegli temperature 50 °C. Vpliv gravitacije smo testirali ločeno, pri višinah infuzijske črpalke ± 30 cm in ± 60 cm glede na višino ACD-sistema. Med eksperimentom smo opazovali spremembe v koncentracijah hlapnega anestetika v izdihanem zraku (Fet, v vol %). Za ugotavljanje izgub hlapnega anestetika skozi filter ACD-sistema smo dodatni analizator dihalne zmesi umestili na ekspiratorno cev dihalnega sistema takoj za Y-konektom. Rezultati: Do autopumpinga je prišlo le v skupinah z začetnim plinskim mehurčkom, pri obeh hlapnih anestetikih. V teh primerih so se vrednosti Fet povečevale z naraščanjem velikosti plinskega mehurčka (ΔFet pri izofluranu = +2,5–4,2 vol %; pri sevofluranu = +0,9–2,3 vol %). V skupinah brez začetnega plinskega mehurčka so pri obeh hlapnih anestetikih vrednosti Fet ostale stabilne med celotnim eksperimentom (ΔFet = +0,1–0,3 vol %). S spremembo višine infuzijske črpalke so se vrednosti Fet le prehodno spreminjale za ± 0,1 vol %. Izgube hlapnega anestetika iz dihalnega sistema so bile pri vrednostih Fet 0,9 vol % minimalne (< 0,1 vol %), pri vrednostih Fet > 0,9 vol %, pa so izgube naraščale v odvisnosti od hitrosti pretoka tekočega anestetika in Vt. Zaključki: Na pojav autopumpinga vplivata predvsem izpostavljenost tekočega anestetika viru toplote in prisotnost plinskega mehurčka v ACD-brizgalki. Zatorej je potrebno pred pričetkom sedacije z ACD-sistemom iz brizgalke odstraniti vse vidne plinske mehurčke in odstraniti vire toplote. Na izgube hlapnega anestetika iz dihalnega sistema vplivajo zlasti vrednosti Fet in MV oz. Vt.

Ključne besede

AnaConDa;hlapni anestetiki;inhalacijska sedacija;varnost pacienta;enota intenzivne terapije;

Podatki

Jezik: Slovenski jezik
Leto izida:
Tipologija: 2.08 - Doktorska disertacija
Organizacija: UM MF - Medicinska fakulteta
Založnik: I. Karnjuš]
UDK: 616-089.5:615.211/.214+615.458/.473(043.3)
COBISS: 6163519 Povezava se bo odprla v novem oknu
Št. ogledov: 1222
Št. prenosov: 238
Ocena: 0 (0 glasov)
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Ostali podatki

Sekundarni jezik: Angleški jezik
Sekundarni naslov: Analysis of technological factors that influence the performance of inhalation sedation system »AnaConDa«
Sekundarni povzetek: Introduction: During inhalational sedation with the AnaConDaTM (ACD, Sedana Medical, Uppsala, Sweden) system, certain technological factors can affect its performance. When liquid volatile anaesthetic is used to sedate patients, a gas bubble may arise in the syringe, which in turn may lead to the occurrence of auto-pumping. The aim of the study was to examine how exposure of the liquid anaesthetic to the heat source, its storage mode, the presence of a gas bubble in the ACD syringe and gravity affect the occurrence of auto-pumping. In addition, we wanted to determine how breathing minute volumes (MV), especially the tidal volume (Vt), and the infusion rate of the liquid anaesthetic agent, affect the loss of volatile anaesthetics from the breathing circuit when using ACD. Methods: The occurrence of auto-pumping when using ACD was tested in four different syringe groups in vitro, with two volatile anaesthetics (isoflurane and sevoflurane): with the liquid agent either at room temperature or precooled, and with or without the presence of gas bubbles in the syringe. The liquid agent was infused into the ACD via a syringe pump at a fixed rate and heated gradually until the temperature of the syringe surface reached 50°C. The influence of gravity was tested separately, with the syringe pump placed at ±30 cm and ±60 cm according to the level of the ACD system. During the experiment, we observed changes of the expired fraction of volatile anaesthetic (Fet, in vol%). In order to determine the losses of volatile anaesthetic through the ACD filter, an additional gas analyser was inserted in the expiratory hose of the breathing circuit, right after the Y piece. Results: Auto-pumping occurred only in syringe groups in which a gas bubble was initially present, for both volatile anaesthetics. In these groups, the Fet values increased with expansion of the gas bubble in the syringe (ΔFet for isoflurane was +2.5 – 4.2 vol%; for sevoflurane +0.9 – 2.3 vol%). In the groups without the presence of an initial gas bubble in the syringe, Fet values remained relatively stable in both volatile anaesthetics during the entire experiment (ΔFet = +0.1 – 0.3 vol%). Only a small transitory change in Fet values of ±0.1 vol% was noted with positioning the syringe pump above or below the level of the ACD. Losses of volatile anaesthetic from the breathing circuit were minimal with Fet values <0.9 vol% (<0.1 vol%), with Fet values >0.9 vol% losses increased in dependence with the infusion rate of liquid anaesthetic and Vt. Conclusions: The occurrence of auto-pumping is mainly affected by exposure of the liquid anaesthetic to the heat source, and the presence of a gas bubble in the ACD syringe. Before staring sedation with the ACD system, therefore, care must be taken to expel all visible gas bubbles from the syringe and to remove any heat sources from the vicinity of the syringe pump. The loss of volatile anaesthetic from the breathing circuit is mainly affected by the Fet value and MV, especially Vt.
Sekundarne ključne besede: AnaConDa;volatile anaesthetics;inhalational sedation;patient safety;intensive care unit;
URN: URN:SI:UM:
Vrsta dela (COBISS): Doktorska disertacija
Komentar na gradivo: Univ. v Mariboru, Medicinska fak.
Strani: XI f., 138 str.
ID: 10834727