A Clinical Determination of Optimal Fresh Gas Flow in a Baby EAR Circuit
Sunchai Theerapongpakdee MD*, Thanyathorn Phanpanusit MD*, Duenpen Horatanaruang MD*, Piyaporn Bunsangjaroen MD*, Prapapan Limpkulwathanaporn BSc (Nursing)*, Maneerut Thananun BSc (Nursing)*, Duangthida Nonlhaopol BSc (Nursing)*
Affiliation : * Department of Anesthesiology, Faculty of Medicine, Khon Kaen University, Khon Kaen, Thailand
Objective : Baby EAR circuit is a new modified enclosed afferent reservoir anesthetic breathing system for
pediatric patients. By following His Majesty the King of Thailand’s self-sufficiency philosophy, the circuit is
simple and made of low-cost and easy-to-find materials found in the operating room. This present study was to
investigate clinical use of the circuit and to find the optimal fresh gas flow in clinical setting.
Material and Method: A prospective descriptive study was conducted in pediatric patients, weighed 5-20 kg,
anesthetized for surgery. The Baby EAR breathing circuit was used for general anesthesia with endotracheal
tube and control ventilation. Different fresh gas flow of 3,2.5,2 and 1.5 liter per minute (LPM) was used
consecutively. The authors recorded end-tidal carbon dioxide (EtCO2) and mean inspiratory carbon dioxide
(ImCO2 ) while using fresh gas flow at 3, 2.5, 2, and 1.5 LPM. EtCO2 of 35-45 mmHg and ImCO2 of < 6 mmHg
were considered clinically acceptable.
Results : Fifty patients were enrolled. Mean value (95% CI) of EtCO2 at fresh gas flow rate of 1.5, 2, 2.5, and 3
LPM were 39.6 (39.2, 40.9), 36.7 (35.5, 37.8), 35.4 (34.3, 36.4), and 35.4 (34.3, 36.4) mmHg respectively.
Mean value (95% CI) of ImCO2 at fresh gas flow rate of 1.5, 2, 2.5, and 3 LPM were 4.0 (3.0, 4.9), 2.4 (1.7, 3.0),
1.8 (0.9, 2.6), and 1.3 (0.9, 1.7) mmHg respectively. Percentage of patients (95% CI) who had clinically
acceptable EtCO2 and ImCO2 at fresh gas flow rate of 1.5, 2, 2.5, and 3 LPM were 70% (56.2, 80.9), 92% (81.2,
96.8), 98% (89.5, 99.6), and 100% (92.9, 100) respectively. No patients had serious complications.
Conclusion : Baby EAR circuit can be made economically and used safely for general anesthesia with control
ventilation in pediatric patients weighing 5 to 20 kg at optimal fresh gas flow of 3 LPM.
Keywords : Anesthesia, EAR circuit, Pediatrics, Respiration, Ventilators, Mechanical
