Decreasing Environmental Impact and Costs of Using Inhalational Anesthetic With a Carbon Dioxide Membrane Filter System

Anesthesia Clinical Trial

Official title:

Decreasing Environmental Impact and Costs of Using Inhalational Anesthetics by Replacing Chemical Absorbers With an Innovative Carbon Dioxide Membrane Filter System - a Prospective, Randomized, Clinical Trial

Clinical Trial Details — Status: Recruiting

Administrative data

• NCT number: NCT04210570
• Other study ID #: 114511
• Status: Recruiting
• Phase: N/A
• Start date: March 1, 2021
• Est. completion date: December 31, 2023

Study information

• Verified date: February 2021
• Source: Western University, Canada
• Contact: Ruediger Noppens, MD, PhD, FRCPC
• Phone: 519) 685-8500
• Email: ruediger.noppens[@]lhsc.on.ca
• Is FDA regulated: No
• Study type: Interventional

Clinical Trial Summary

Efficient inhalational anesthetic delivery requires the use of low-flow air and oxygen to reduce drug waste and minimize workspace contamination and environmental pollution. Currently, excess anesthetic gas is scavenged and removed from the operating room via the hospital ventilation system, where it is released into the atmosphere. CO2 is removed from the anesthesia circuit by the use of CO2 removal systems to prevent re-breathing and potential hypercarbia.

Carbon dioxide is currently removed using chemical granulate absorbers (CGAs), which trap CO2 in the granules that are later disposed of when absorption capacity is reached. They require replacement approximately every other day when used in moderate to high volume surgical centres, placing a costly burden on the healthcare system and environment (landfill).

One of the more concerning downfalls of using CGAs is the potential for the inhalational anesthetics to react with the granules and potentially produce toxic byproducts known as compounds A-E that are nephrotoxic and neurotoxic and require excess amounts of anesthetic gas to dilute.

This excess use of anesthetics gases places a financial burden on the healthcare system and has a detrimental impact on the environment. The vast majority of the gases used are eventually released into the environment with little to no degradation where they accumulate in the troposphere and act as greenhouse gases.

DMF Medical has created Memsorb, a new CO2 filtration membrane. Memsorb can remove CO2 from the anesthesia circuit without the use of CGAs, thereby eliminating the potential for toxic byproducts and allowing for significantly lower air and oxygen flow to be used, resulting in less use of inhalational anesthetics. Memsorb uses a polymeric membrane (similar to the ones used in oxygenators for cardiac surgery) that selectively allows CO2 to leave the rebreathing system, while maintaining the inhalational anesthetic in the circuit.

The lifespan of Memsorb is at least 12 months, resulting in less particulate waste and a decreased cost to the healthcare system.

We wish to evaluate the ability and efficacy of Memsorb in removing CO2 from the anesthesia circuit while maintaining physiologic minute volume ventilation, as compared to the traditional CGAs in a variety of surgical procedures, patient populations, and anesthesia gas flows.

Recruitment information / eligibility

• Status: Recruiting
• Enrollment: 510
• Est. completion date: December 31, 2023
• Est. primary completion date: July 1, 2023
• Accepts healthy volunteers: No
• Gender: All
• Age group: 18 Years and older

Eligibility

Inclusion Criteria:

• ASA I - III

• Elective surgical procedure

• Laparoscopic surgery for study aim III

Exclusion Criteria:

• ASA > IV

• Emergency surgery

• Severe respiratory disease (eg Asthma)

• Raised intracranial pressure

• Regional anesthesia

• Absence of arterial line for study aim III

• Self-reported pregnancy

Related Conditions & MeSH terms

• Anesthesia
• Inhalation; Vapor
• Respiratory Aspiration

Intervention

Device:
• Memsorb
Memsorb uses a polymeric membrane (similar to the ones used in oxygenators for cardiac surgery) that selectively allows CO2 to leave the rebreathing system while maintaining the inhalational anesthetic in the anesthesia circuit

Drug:
• Chemical granulate absorber
Chemical granulate absorber trap CO2 chemically in granules that are later disposed of when absorption capacity is reached

Locations

Country	Name	City	State
Canada	LHSC	London	Ontario

Sponsors (1)

Lead Sponsor	Collaborator
Western University, Canada

Country where clinical trial is conducted

Canada, 

Outcome

Type	Measure	Description	Time frame	Safety issue
Primary	Effectiveness of Memsorb compared to CGA to eliminate CO2	etCO2 (mmHg) and tidal volumes (ml) will be measured with the two systems in GE / Dates Ohmeda anesthesia machines	Duration of general anesthesia (up to 12 hours)
Primary	Impact of Memsorb, using minimal flow anesthesia (= 0.50 L/min), on the amount of inhalational anesthetic (ml) used, compared to standard practice	Usage of Desflurane in ml will be measured during minimal flow (= 0.5 L/min) anesthesia, compared to traditional higher gas flow (> 2 L/min).	Duration of general anesthesia (up to 12 hours)
Primary	Effectiveness of using Memsorb during ventilation for removal of CO2 in laparoscopic surgeries resulting in high CO2 exposure, compared to CGAs	etCO2 (mmHg), paCO2 (mmHg) and tidal volumes (ml) needed remove CO2 during laparoscopic surgery, resulting in higher CO2 exposure.	Duration of general anesthesia (up to 12 hours)
Secondary	Amount of inhaled anesthetics used	Usage on inhaled anesthetics in ml for the surgery.	Duration of general anesthesia (up to 12 hours)
Secondary	Duration of anesthesia	Durantion measured in minutes	Duration of general anesthesia (up to 12 hours)
Secondary	Water build up in anesthesia circuit	Likert scale to measure water build up (1- no water, 3 - large amount of water)	Duration of general anesthesia (up to 12 hours)
Secondary	Freshgas flow during general anesthesia	Measured in ml/min	Duration of general anesthesia (up to 12 hours)
Secondary	Number of CGAs used during the study period	absolute number of canisters used	Duration of general anesthesia (up to 12 hours)
Secondary	Minute volume ventilation	tidal volume (ml) x respiratory rate (/min)	Duration of general anesthesia (up to 12 hours)