Comparison of Minimal Fresh Gas Requirements of Baby Enclosed Afferent Reservoir and Jackson Rees Anesthetic Circuit for General Anesthesia in Spontaneously Breathing Children

Sunchai Theerapongpakdee MD*, Thepakorn Sathitkarnmanee MD*, Sirirat Tribuddharat MD, PhD*, Nonthida Rojanapithayakorn MD*, Kanchana Uppan BN*, Cattleya Thongrong MD*, Piyaporn Bunsangcharoen MD*

Affiliation : * Department of Anesthesiology, Faculty of Medicine, Khon Kaen University, Khon Kaen, Thailand

Objective : The authors compared the baby enclosed afferent reservoir (Baby EAR) with the Jackson-Rees (JR) anesthesia circuit for the minimal fresh gas flow (FGF) requirement with no and clinically acceptable rebreathing in spontaneous breathing anesthesia among pediatric patients. Material and Method: The present study was a randomized crossover study. Twenty patients, weighing 5 to 20 kg with ASA physical status I-II were enrolled. They were allocated to group 1 (EAR-JR) starting with Baby EAR then switching to JR or group 2 (JR-EAR), reversed pattern. After induction and intubation, anesthesia was maintained with a N2O/O2 combination with sevoflurane 1 to 3% and fentanyl. Starting with the first circuit, all patients were spontaneously ventilated with FGF 500 mL/kg/min for 10 minutes, and then gradually decreased by 50 mL/kg/min every five minutes. End-tidal CO2 (ETCO2) and inspired minimum CO2 (imCO2) were recorded until rebreathing (imCO2 >2 mmHg) occurred and continued until rebreathing was not clinically acceptable (imCO2 >6 mmHg). The anesthesia breathing circuit was switched and the procedure repeated.
Results : The minimal FGF at no rebreathing of Baby EAR and JR were 192.576.6 and 347.5108.2 mL/kg/min; p<0.001. At acceptable rebreathing, the values were 117.546.7 and 227.690.6 mL/kg/min; p<0.001.
Conclusion : Baby EAR can be used safely, effectively, and requires less FGF than JR in pediatric anesthesia in patients weighing 5 to 20 kg.

Keywords : Enclosed afferent reservoir (EAR), Jackson Rees system (JR), Anesthesia breathing circuit, Spontaneous breathing, Pediatric anesthesia

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