Safety and reliability of inhalational anesthesia for disaster medicine: the use of the Glostavent® Helix in Turkey in the aftermath of 2023 earthquake, a case-series

Abstract

Background: While it has already been demonstrated that anesthetic care can and should be used in disaster medicine, inhalational anesthesia can be a challenge, given its logistical footprint. After the 2023 earthquakes in Turkey, Belgium decided to send a field hospital with emergency surgical capacity (EMT type 2). The Health Federal Public Service provided the CE approved Glostavent® Helix for this mission. This open circuit anesthesia machine is able to work on battery or AC power, to operate on with oxygen cylinder or only with its integrated oxyconcentrator, to use different types of halogenated anesthetics vapors, in particular in “draw over” mode and to ventilate an adult or pediatric patient.

Objective: The aim of this article is to describe the reliability and safety of inhaled anesthesia via the Glostavent® Helix in a context of disaster medicine.

Methods: We conducted a retrospective case-series study. All patients who underwent general anesthesia at our field hospital during the period 16 February till 25 February 2023 were included. We did not establish any exclusion criteria. The primary endpoint was mechanical failure during the procedure. Secondary endpoints were perioperative desaturation (SpO2<94%), ventilation failure (ETCO2 > 45mmHg) and awareness.

Results: We performed 62 surgical procedures including 19 under general anesthesia. Maintenance of anesthesia has always been done with sevoflurane. The average operation time was 56 min (SD: 38,32), the cumulated time 1055 min. We performed 4 inhalation inductions in our pediatric population. All supplied fresh gases were generated by the oxyconcentrator. There were no critical failures of the Glostavent® Helix. No patient underwent desaturation. Only one patient was transiently inadequately ventilated. No patients reported any awareness.

Conclusions: Our Glostavent® Helix was fully operational in this setting. In comparison, our other CE approved medical machines (X-ray and sterilization unit) regularly broke down due to AC variations. It was also self- sufficient in terms of oxygen supply. We experienced only one transient failed ventilation due to a partial airway obstruction in a prone obese patient, noticed with delay due to lack of tidal volume alarm. Although it requires thorough knowledge of its operation and continuous clinical attention, the Glostavent® Helix offers a simple but elegant, reliable and safe solution.