cpd for circle use in GA?

RE: cpd for circle use in GA?

Rob Loxley — Fri, 10 Aug 2018 08:45:53 GMT

[quote user="Anthony Todd"]

Just use a Stephens or the modern equivalent that Evelyn uses, Humphrey I think

[quote user="robloxley"]The HumphreyADE is an out-of-circle vaporiser system.[/quote]

According to this:

https://www.anaequip.com/ade/

it can be both

[/quote]

No, the vapouriser is definitely out of the circuit (however it can be run in both rebreathing and non-rebreathing modes with/without soda lime), unlike the stephens/komesaroff where it is in-circuit. Different beasts.

RE: cpd for circle use in GA?

Jill Butterworth — Thu, 09 Aug 2018 21:39:53 GMT

If you are still feeling in need of CPD after all this advice, I think you will find, if you ask, that Anaesthetic Diploma holders will do a day or half a day of freelance work to improve the system, advise you what to buy, and and give in-house CPD for your staff. If you are using a really inefficient system it should pay for itself and save the environment.

RE: cpd for circle use in GA?

Martin Atkinson — Thu, 09 Aug 2018 14:19:10 GMT

[quote user="Michael Woodhouse"]We make our own O2 (why wouldn't you?)[/quote]Erm...because the circle adsorber is so efficient on oxygen use I only use 1 size F cylinder a month and that includes some oxygen therapy via a mask or flow-by. OK I'm single handed but how much does an oxygen generator cost?!

[quote user="Clive Ansell"]Should we all be considering the possible effect on the environment? [/quote]Wot he says.

RE: cpd for circle use in GA?

Clive Ansell — Thu, 09 Aug 2018 11:51:41 GMT

[quote user="Michael Woodhouse"]with iso cheap I don't want to use re-breathing circuits. If we were operating solid 6 hours a day then maybe.[/quote]

Should we all be considering the possible effect on the environment?

Used volatile anaesthetics are halogenated hydrocarbons, chemically similar to CFCs, giving them the potential to impact the environment negatively via both ozone depletion and global warming. This is especially true in the light of these gases being exhaled with minimal metabolism, and that scavenging systems which (while keeping theatre concentrations low) transfer gases unchanged into atmosphere.

RE: cpd for circle use in GA?

Michael Woodhouse — Wed, 08 Aug 2018 23:59:23 GMT

[quote user="David Mills"]

Bloody hell, using lacks for everything? If you're not producing your own o2 the expense must be astronomical??

Switch to t pieces and circles ASAP (very easy to use, loads in nursing manuals and bsava manuals about it)

[/quote]

T-pieces make me very sad!

We make our own O2 (why wouldn't you?) and with iso cheap I don't want to use re-breathing circuits. If we were operating solid 6 hours a day then maybe. Lack and mini-lack nice and easy and low O2 flow. 2 liters and 2% works surprisingly well for most things, and adjust based on signs/co2.

RE: cpd for circle use in GA?

Anthony Todd — Wed, 08 Aug 2018 23:51:21 GMT

[quote user="robloxley"]The HumphreyADE is an out-of-circle vaporiser system.[/quote]

According to this:

https://www.anaequip.com/ade/

it can be both [site worth a read though]

And it looks as if the Komesaroff is as well from this:

The Mini-Kom with two in circuit vaporisers (AN-7570) enables the choice of 2 of the 4 most commonly used volatile anaesthetic agents (Isoflurane, Enflurane, Sevoflurane or Halothane).

Interesting to discuss the merits of various agents, probably dangerous to have a choice I would have thought?

Hopefully Evelyn will put us all straight, as we've been here before and his knowledge and experience is always worth listening to.

RE: cpd for circle use in GA?

David Mills — Wed, 08 Aug 2018 22:19:48 GMT

Bloody hell, using lacks for everything? If you're not producing your own o2 the expense must be astronomical??

Switch to t pieces and circles ASAP (very easy to use, loads in nursing manuals and bsava manuals about it)

RE: cpd for circle use in GA?

Rob Loxley — Wed, 08 Aug 2018 19:40:10 GMT

[quote user="Anthony Todd"]Just use a Stephens or the modern equivalent[/quote]

This would require a lot of money spend, how much is a Komesaroff? The HumphreyADE is an out-of-circle vaporiser system.

RE: cpd for circle use in GA?

Anthony Todd — Wed, 08 Aug 2018 15:17:21 GMT

[quote user="Aisling McGrath"]start using circle![/quote]

Just use a Stephens or the modern equivalent that Evelyn uses, Humphrey I think, which has some advantages and some disadvantages....[query about plastic CO2 absorber and tracking of gases but not a problem in practice.

O2 use is actually patient metabolic plus the bag [which is hard to beat] and anaesthetic agent minimal.

We always thought the small 500 ml bag affected the circuit resistance [which is 2cms of water] which therefore increased necessary respiratory effort, but I'm not sure this is significant in practice.

As you can do a rat or smaller in a closed circuit I suppose it might be?

Easy to use, easy to teach, totally fool proof, and cheap to run; can't be beat, except by dogma ignorance or prejudice.

RE: cpd for circle use in GA?

Rob Loxley — Wed, 08 Aug 2018 13:50:53 GMT

We generally start at 3l/min oxygen until settled under anaesthesia then reduce down to 1l/min (for simplicity, can reduce further and monitor the capnograph for rebreathing); calculate whether you need 500ml, 1l or 2l bag as using a larger bag just takes longer for adjustments in gas concentration to equilabrate, likewise if you need to get the animal deeper/lighter quickly during the op then empty the rebreathing bag into the scavenge & increase the fresh gas flow rate; take into account what minimum flow rate your vapouriser is accurate down to (often 200-500ml/min) and how much gas a sidestream sampling capnograph takes; using nitrous oxide takes a little more thought. I suspect most aren't running their circles as fully closed systems, but more as 'semi-rebreathing' with the exhaust valve not fully closed (some have slightly more complicated exhaust valves to avoid any closing needed to keep the bag filled). Worth bunging the circle closed when not in use else the soda lime will revert to its 'unused colour'. Remember most circles are designed as semi-disposable items - or have replaceable valves (ADE system).

RE: cpd for circle use in GA?

Clive Ansell — Wed, 08 Aug 2018 13:19:31 GMT

Most veterinary nursing textbooks, such as Jones's animal nursing, have a good overview of breathing vs rebreathing systems, along with recommended flow rates etc. Unsure what is in the BSAVA manual, and don't have my copy to hand.

Have you got oximetry or capnography for monitoring?

[quote user="Aisling McGrath"]Before I worked here, I worked somewhere with NO gas at all[/quote]

Seriously? when?

I once did a locum in a practice where they had no inhalation anaesthesia, bottled oxygen or ET tubes - and it was in this century! 2003 I think. Unbelievable really. No autoclave either; instruments were boiled in a saucepan every day, and all ops done with the same kit.

RE: cpd for circle use in GA?

Martin Atkinson — Wed, 08 Aug 2018 13:15:47 GMT

Not sure why you need CPD. Just connect the patient up and monitor it as normal adjusting the oxygen flow and Iso concentration to suit. I'd say its a lot simpler to manage than what you're currently using and you'll save a fortune in O2 and Iso.