What are the minimum elements required to get started with inhaled sedation?+
In addition to an anaesthetic agent such as Sedaconda (isoflurane), the following elements are required to get started with inhaled sedation: Sedaconda ACD, FlurAbsorb, Sedaconda Syringe, Respiratory Gas Monitoring Line, Nafion Dryer Tubing, gas monitor such as the AMG-06, syringe pump, ventilator.
Which anaesthetic agents can be used with the Sedaconda ACD? +
Sedaconda ACD is only approved for use with isoflurane and sevoflurane. It cannot be used with desflurane and it has not been tested with NO.
How long can the Sedaconda ACD be used for?+
Sedaconda ACD is intended for single use only and needs to be replaced every 24 hours, or earlier if needed. After 24 hours of use, there is an increased risk of occlusion of the bacterial/viral filter in the device. In case of signs of occlusion, the Sedaconda ACD needs to be changed earlier. For example, copious secretions may affect the efficiency of the Sedaconda ACD, leading to shorter replacement intervals.
What is the difference between the Sedaconda ACD-S and Sedaconda ACD-L?+
The Sedaconda ACD-S has a dead space of 50 ml and can be used in patients with tidal volumes 200-800 ml. The Sedaconda ACD-L has a dead space of 100 ml and can be used in patients with tidal volumes 350-1200 ml. In patients with tidal volumes of 30-200 ml or dead space problems, the Sedaconda ACD-S can be connected to the inspiratory port of the ventilator (i.e. ventilator/alternative placement) with the advantage that no dead space is added to the breathing circuit.
What type of syringe pumps should be used with the Sedaconda ACD?+
The syringe pump should be CE marked, be programmable for delivery of pharmaceutical drugs and have settings for Sherwood Monoject or Becton Dickinson Plastipak 50/60 ml syringes.
What kind of ventilators can be used with the Sedaconda ACD?+
The Sedaconda ACD should only be used with CE‑approved ventilators that comply with applicable requirements (including standard ISO 80601‑2‑12) and have an accessible exhaust. The Sedaconda ACD can be used with all conventional ventilator modes except oscillator mode for intubated patients. The ventilator circuits used should be compatible with anaesthetic agents.
Can pressure support ventilation be used with the Sedaconda ACD?+
Yes; however, changes in concentration may occur. Normal fluctuations during pressure support ventilation do not significantly affect the gas concentration.
Can a nebulizer be used with Sedaconda ACD?+
Yes, the Sedaconda ACD can be used together with a nebulizer, which should be connected between the patient and the Sedaconda ACD. Synchronised nebulisation is preferred and it is possible to use jet, ultrasound and mesh nebulizers. Ultrasonic and mesh nebulisers are preferable as they do not add extra airflow and therefore do not affect volatile anaesthetic concentrations. If a jet nebuliser is used, it may be necessary to increase the syringe pump rate to compensate for the extra airflow from the nebuliser. Note: Repeated nebulisations may increase the flow resistance of the Sedaconda ACD. Pay attention to signs of occlusions. Sticky nebulised drugs (e.g. acetylcysteine, colistin and amphotericin B) may increase the resistance of the filter and require early replacement of the Sedaconda ACD. Always consider the increased dead space when connecting extra items. Do not use devices or components made from polycarbonate or polystyrene on the patient side when using the Sedaconda ACD. Always follow the manufacturer’s instructions or ask the relevant manufacturer about the suitability of their product for use with volatile anaesthetics.
Can the Sedaconda ACD be used with active humidification?+
Active humidification must not be used when the Sedaconda ACD is put in the standard/patient placement (between the ET tube and Y-piece). This is because the moisture passing through the Sedaconda ACD will flood the charcoal filter, preventing it from absorbing the gases and causing the device to stop working. Sedaconda ACD has 5mg/l moisture loss at average tidal volumes. This is according to ISO 9360-1 moisture loss test. Sedaconda ACD is also tested according 23328-2 regarding breathing filters. Often, this is sufficient to keep the patient’s airways moist.
If additional humidification is deemed necessary, the Sedaconda ACD must be put in the alternative/ventilator placement (connected to the inspiratory port of the ventilator), with the active humidification placed downstream, closer to the patient. In this set-up, moisture will not pass through the device and cause occlusion. However, the alternative/ventilator placement also uses higher doses of the volatile anaesthetic since reflection of the drug is not possible.
Can other syringes be used with the Sedaconda ACD?+
No, only the Sedaconda Syringe has been tested and validated for use with Isoflurane or Sevoflurane. The connector on the syringe is unique, and can only be connected to the filling adapters provided by Sedana Medical and the Sedaconda ACD agent line.
How should increased/high CO2 concentrations be managed?+
If the Sedaconda ACD-L (100 ml dead space) is used, changing to the smaller Sedaconda ACD-S (50 ml dead space) may be an appropriate measure. Consider adjusting the ventilator settings if the Sedaconda ACD–S is used and no other devices adding dead space in the circuit can be removed. In cases where the above is not sufficient, ventilator/alternative placement of the Sedaconda ACD can be considered.
Can Sedaconda ACD be used in COVID-19 patients?+
Yes, the Sedaconda ACD can be used in COVID-19 patients. The Sedaconda ACD has a viral filtration capacity of 99.76% and a bacterial filtration capacity of 99.87%. It contains a spun bound bacterial/viral filter that captures microorganisms via their electrostatic charge, as opposed to mechanical HEPA filters that work like net filters. The viral filter size is 27nm (SARS-CoV-2 virus is 80-160nm). Note: When using side stream gas monitoring, exhaled air is sampled from the patient side to the gas analyser and is thus not filtered through the Sedaconda ACD. However, a water trap is usually used for side stream gas monitoring and most modern water traps contain a bacterial/viral filter, which is highly efficient. An additional filter would need to be added to the waste pipe connecting to the FlurAbsorb to ensure that all waste gases are filtered.
What is scavenging used for and how does it work?+
Sedana Medical provides the passive gas scavenging filter FlurAbsorb/FlurAbsorb-S. Studies demonstrate that with the correct use of passive gas scavenging system, mean exposure levels of inhaled anaesthetics for staff remain well below the recommended exposure limits. The FlurAbsorb collects the exhaled gases as well as the waste gas from the gas monitor. It contains activated carbon and is connected to the exhaust port of the ventilator. A FlurAbsorb accessory kit is available to facilitate the connection between the ventilator, the gas monitor and the FlurAbsorb. The FlurAbsorb is available in two sizes with different capacities; the small FlurAbsorb-S has a capacity of 3 syringes of 50 ml (total 150 ml) and the large FlurAbsorb has a capacity of up to 10 syringes of 50 ml (total 500 ml). Add link to FlurAbsorb.
Is it possible to temporary stop the treatment?+
Yes, the syringe pump needs to be stopped and the gas sampling line disconnected. Disconnect the Sedaconda ACD from the Y-piece first and then from the ET-tube. It is extremely important that the gas monitor is stopped or disconnected, since it draws 50-200 ml/min of gas. To reconnect the patient to the Sedaconda ACD, please follow the Instructions for Use.
Where can I find training and education resources?+
See Training materials for User Guides and a set-up video, and E-Learning for an introduction and resource guide on the practical aspects of using the Sedaconda ACD.
What is the gas monitor used for and which type should be used with the Sedaconda ACD?+
A gas monitor enables continuous non-invasive sidestream monitoring of CO2 and anaesthetics concentration in inspired and expired gases. The Sedaconda ACD can be used together with any CE-marked gas monitor that complies with ISO 80601 2 55. The gas monitor must be able to measure concentrations of anaesthetic gases in FET (end expiratory) concentration, which represents the alveolar concentration. Sedana Medical offers the AMG-o6 gas monitor. Add link to gas monitor.
What is a MAC and Fet% value?+
The minimal alveolar concentration (MAC) is the alveolar concentration of an inhaled anaesthetic at one atmosphere that prevents skeletal muscle movement in response to a noxious stimulus in 50% of patients. MAC represents a relative measure of the level of anaesthesia. It is a useful index of anaesthetic potency and can be used to compare inhaled anaesthetics. MAC corresponds to FET%, which is the end expiratory concentration of anaesthetic gases.
Why is the Fet value higher than the Fi value?+
The highest gas concentration occurs at the start of the inspiration cycle when the recycled gas is mixed with the fresh gas from the Sedaconda ACD. However, this represents a short peak and the concentration decreases rapidly to its lowest point at the end of inspiration. Most monitors show a Fi value which is measured at the end of inspiration, thus showing a low value when using the Sedaconda ACD. The expiratory values are measured at the end of expiration, which gives the value of alveolar concentration.
What type of gas sampling line can be used?+
Always refer to the gas analyser manual regarding which sampling line to use. Connecting the incorrect type or length of line may cause incorrect Fet/MAC readings from the gas analyser.