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Continuous measurement of gas uptake and elimination in anesthetized patients using an extractable marker gas

¹Deparment of Anesthesia & Pain Management, The Alfred Hospital, ²Department of Anesthesia, Austin Hospital, Heidelberg 3084 and ³Department of Allergy, Immunology, and Respiratory Medicine, The Alfred Hospital and Monash University, Melbourne, Australia 3181

Submitted 11 November 2003 ; accepted in final form 12 April 2004

Measurement of pulmonary gas uptake and elimination is often performed, using nitrogen as marker gas to measure gas flow, by applying the Haldane transformation. Because of the inability to measure nitrogen with conventional equipment, measurement is difficult during inhalational anesthesia. A new method is described, which is compatible with any inspired gas mixture, in which fresh gas and exhaust gas flows are measured using carbon dioxide as an extractable marker gas. A system was tested in eight patients undergoing colonic surgery for automated measurement of uptake of oxygen, nitrous oxide, isoflurane, and elimination of carbon dioxide with this method. Its accuracy and precision were compared with simultaneous measurements made with the Haldane transformation and corrected for predicted nitrogen excretion by the lungs. Good agreement was obtained for measurement of uptake or elimination of all gases studied. Mean bias was –0.003 l/min for both oxygen and nitrous oxide uptake, –0.0002 l/min for isoflurane uptake, and 0.003 l/min for carbon dioxide elimination. Limits of agreement lay within 30% of the mean uptake rate for nitrous oxide, within 15% for oxygen, within 10% for isoflurane, and within 5% for carbon dioxide. The extractable marker gas method allows accurate and continuous measurement of gas uptake and elimination in an anesthetic breathing system with any inspired gas mixture.

gas elimination; nitrogen balance; gas dilution

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