The Science Journal of the American Association for Respiratory Care

2009 OPEN FORUM Abstracts

USE OF AN ANESTHESIA MACHINE FOR ISOFLURANE DELIVERY IN A PEDIATRIC INTENSIVE CARE UNIT

Shawn Colborn, Michael Duff, Angela Hedgman, Patricia Achuff, Ann Marie Wallack, Susan Ferry, Richard Lin; Respiratory Care, The Children’s Hospital of Philadelphia, Philadelphia, PA

Background: The use of isoflurane in the Pediatric Intensive Care Unit (PICU) is not a common practice. Cost of the drug, need for specialized equipment and training contribute to its infrequent use. Indications for isoflurane therapy outside of the operating room (OR) can include status asthmaticus, status epilepticus, and inability to maintain sedation with intravenous medications. Anesthetic delivery outside the OR requires the Respiratory Care Practioner (RCP) to operate under the auspices of an anesthesiologist. Currently, there are no critical care ventilators that have the ability to add a vaporizer to deliver volatile anesthetics. Now that older technology is outdated, anesthesia machines have become the only viable option. Incorporating a semi-closed circle breathing system into the practice of the PICU staff requires education and vigilance by a trained practioner. This presents new challenges for practioners who are not familiar with a circle breathing system. Methods: RCPs were trained on the use and functionality of the anesthesia system. The primary role of the RCP is to monitor the patient, adjust ventilator parameters and maintain the vaporizer according to orders from physicians in the Department of Anesthesia and Critical Care Medicine. Education sessions where held for staff who provide care for patients in the PICU. A 2 person check needs to be performed when any dose adjustments are made to the isoflurane settings. Results: There have been two patient incidents to date. One patient had fresh gas flowrates increased due to increasing oxygen requirements and the vaporizer emptied faster than expected. The anesthetic gas monitor alarmed appropriately and there was no harm to the patient. The second incident involved higher than desired nitric oxide concentrations. The desired dose was 10 ppm and the analyzed dose was 18 ppm. The situation was resolved by increasing the fresh gas flow. There have been no issues with CO2 rebreathing to date. Conclusions: RCPs can be trained to safely deliver isoflurane therapy under the direction of an Anesthesiologist. Introduction of a circle breathing system creates new challenges in critical care for the multi-disciplinary team. Sponsored Research - None

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