case_images: PMC4823227_01
case_images: a Mirus  device. b Setup of the Mirus  system: the interface ("Mirus  Exchanger") is inserted between the Y-piece (1) and the endotracheal tube (2). The interface is connected with the control unit by a multi-lumen cable (blue line). An active anaesthesia gas scavenging system (black arrow) connected to the vacuum system is provided by the manufacturer. c Setup of the AnaConDa : the AnaConDa  is inserted between the Y-piece (1) and the endotracheal tube (2). Liquid isoflurane or sevoflurane is administered by a syringe pump into a hollow rod ("Evaporator"). An external gas monitor must be used. Active and passive scavenging systems are available and should be connected to the gas outlet of the ventilator (black arrow). Sample gas should also be scavenged. d Wash-out kinetics of desflurane (blue) and isoflurane (purple) over 20 min in the same patient after 24-h application. The end-tidal desflurane concentration decreases down to 20 % of the initial concentration (C0; 3.8 vol%) after 1 min; the isoflurane concentration only decreases to 50 % of C0 (0.8 vol%) during the whole observation period. The patient first responded after 5.08 min at 0.7 vol% desflurane and after 17 min at 0.44 vol% isoflurane
case_images: 40064_2016_2065_Fig1_HTML.jpg
case_images: PMC4823227_01_40064_2016_2065_Fig1_HTML.jpg
case_images: Fig1
case_images: Saarlandes; reference 199/09) and informed consent by the legal representative, later confirmed by the patient herself, sedation was switched on day four from midazolam/sufentanil to desflurane, 3.3-3.8 vol%, administered with the Mirus  for 24 h (Fig. 1a). Sufentanil was decreased from 0.95 to 0.38 microg kg-1 h-1. A desflurane specific version of the Mirus  was connected to an Evita 4 ICU ventilator as prescribed by the manufacturer (Fig. 1b). Setup was according to the manufacturer's instructions (Fig. 1c). With the Mirus , we observed the patient's first response 5.08 min after stopping desflurane at an end-tidal concentration of 0.7 vol% as opposed to 17 min after stopping isoflurane at a concentration of 0.4 vol% using the AnaConDa  system (Fig. 1d).