Volumetric and reflective device dead space of anaesthetic reflectors under different conditions

J Clin Monit Comput. 2018 Dec;32(6):1073-1080. doi: 10.1007/s10877-018-0105-8. Epub 2018 Jan 27.


Inhalation sedation is increasingly performed in intensive care units. For this purpose, two anaesthetic reflectors, AnaConDa™ and Mirus™ are commercially available. However, their internal volume (100 ml) and possible carbon dioxide reflection raised concerns. Therefore, we compared carbon dioxide elimination of both with a heat moisture exchanger (HME, 35 ml) in a test lung model. A constant flow of carbon dioxide was insufflated into the test lung, ventilated with 500 ml, 10 breaths per minute. HME, MIRUS and AnaConDa were connected successively. Inspired (insp-CO2) and end-tidal carbon dioxide concentrations (et-CO2) were measured under four conditions: ambient temperature pressure (ATP), body temperature pressure saturated (BTPS), BTPS with 0.4 Vol% (ISO-0.4), and 1.2 Vol% isoflurane (ISO-1.2). Tidal volume increase to maintain normocapnia was also determined. Insp-CO2 was higher with AnaConDa compared to MIRUS and higher under ATP compared to BTPS. Isoflurane further decreased insp-CO2 and abolished the difference between AnaConDa and MIRUS. Et-CO2 showed similar effects. In addition to volumetric dead space, reflective dead space was determined as 198 ± 6/58 ± 6/35 ± 0/25 ± 0 ml under ATP/BTPS/ISO-0.4/ISO-1.2 conditions for AnaConDa, and 92 ± 6/25 ± 0/25 ± 0/25 ± 0 ml under the same conditions for MIRUS, respectively. Under BTPS conditions and with the use of moderate inhaled agent concentrations, reflective dead space is small and similar between the two devices.

Keywords: Anaesthetic reflector; Carbon dioxide reflection; Dead space.

Publication types

  • Comparative Study
  • Evaluation Study

MeSH terms

  • Anesthesia, Inhalation / instrumentation*
  • Anesthesia, Inhalation / statistics & numerical data
  • Anesthetics, Inhalation / administration & dosage
  • Carbon Dioxide / metabolism
  • Humans
  • Intensive Care Units
  • Isoflurane / administration & dosage
  • Lung / metabolism
  • Models, Biological
  • Monitoring, Physiologic / statistics & numerical data
  • Respiration, Artificial / instrumentation
  • Respiration, Artificial / statistics & numerical data
  • Respiratory Dead Space / physiology*
  • Tidal Volume


  • Anesthetics, Inhalation
  • Carbon Dioxide
  • Isoflurane