Scavenging

Scavenging will be perceived as important as continuing anxiety remains that trace concentrations of inhalational agents may be carcinogenic or fetotoxic. In a review of many large studies in several countries, no clear evidence was obtained for an adverse effect on health produced by the working environment. However, there are now strict regulations about the amount of vapor or gas allowed in the air breathed by hospital staff. Most ICUs do not have piped scavenging, and the most convenient means of scavenging the isoflurane is with an Aldasorber. This contains activated charcoal which adsorbs the anesthetic agent. At the low concentrations of isoflurane used, this does not require changing more than once in 24 h. Used canisters should be sealed in polythene bags until incineration to avoid re-release of the vapor.

Exposure of ICU personnel to isoflurane has been significantly reduced by the development of closed suction systems which do not require disconnection of the patient from the ventilator for tracheal suction.

The cost of isoflurane is about $120 (ยง80) per day which is comparable with alternative short-acting Ragents such as propofol. Chapter References

Howie, A.F., Spencer, E.M., and Beckett, G.J. (1992). Aspartate aminotransferase, alanine aminotransferase and glutathione transferase in plasma during and after sedation by low-dose isoflurane and midazolam. Clinical Chemistry, 38, 476-9.

Slogoff, S., et al. (1991). Steal-prone coronary anatomy and myocardial ischemia associated with four primary anesthetic agents in humans. Anesthesia and Analgesia, 72, 22-7. Spencer, E.M. and Willatts, S.M. (1992). Isoflurane for prolonged sedation in the intensive care unit: efficacy and safety. Intensive Care Medicine, 18, 415-21.

Spencer, E.M., Willatts, S.M., and Prys-Roberts, C. (1991). Plasma inorganic fluoride concentrations during and after prolonged isoflurane sedation: effect on renal function. Anesthesia and Analgesia, 73, 731-7.

Willatts, S.M. and Spencer, E.M. (1994). Sedation for ventilation in the critically ill. A role for isoflurane? Anaesthesia, 49, 422-8.

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