Veterinary Anaesthesia and Analgesia, 2014, 41, 54–63
12087
RESEARCH PAPER
Delivery of sevoflurane to dogs using a Stephens
anaesthetic machine
Andrew J Ferguson*, Lucio J Filippich* & Helen L Keates*
*School of Veterinary Science, University of Queensland, Gatton, QLD, Australia
Correspondence: Andrew J Ferguson, School of Veterinary Science, The University of Queensland, Gatton Campus, Gatton, QLD 4343
Australia. E-mail: a.ferguson@uq.edu.au
Abstract
Objective To investigate the sevoflurane concentra-
tions produced within the Stephens anaesthetic
machine circuit (vaporizer in-circle system) at differ-
ent fresh gas flow rates (FGFRs), temperatures,
vaporizer settings and vaporizer sleeve positions
when used to anaesthetize dogs of different body sizes.
Study design Experimental non-blinded studies.
Animals Eighteen mixed breed dogs, weights 4–
39 kg.
Methods Anaesthetic induction with propofol was
followed by maintenance with sevoflurane in oxygen
via the Stephens anaesthetic machine. In study 1,
the vaporizer setting, temperature and circuit FGFRs
were altered with the vaporizer sleeve down (n = 3),
or in separate experiments, up (n = 3). Delivered
(FI′SEVO) and expired sevoflurane concentrations
were recorded. Study 2 determined the vaporizer
settings (sleeve up) required to achieve predeter-
mined multiples of minimal alveolar concentration
(MAC) of FI′SEVO when sevoflurane was delivered to
dogs (n = 12) of different bodyweights and at
different FGFRs.
Results Delivered concentrations of sevoflurane
were sufficient to maintain anaesthesia in all dogs,
regardless of bodyweight, FGFR, vaporizer tempera-
ture and sleeve position. FI′SEVO increased with
increasing temperature, when the vaporizer sleeve
was down, when vaporizer setting was increased
54
doi:10.1111/vaa.
and when FGFR was decreased. As the FGFR
increased or the dog’s bodyweight decreased, higher
vaporizer settings were required to produce the same
FI′SEVO. The median Stephens vaporizer settings to
achieve an FI′SEVO of 1.3 MAC ranged from 4.3 to
5.0 for a small dog (1–10 kg), 2.5 to 5.6 for a
medium dog (15–25 kg) and 2.5 to 3.5 for a large
dog (30–40 kg), depending on the FGFR.
Conclusion and clinical relevance The Stephens
anaesthetic machine can deliver to dogs, weighing
4 kg and above, concentrations of sevoflurane
sufficient or in excess of that required to maintain
anaesthesia, at temperatures from 10 to 35 °C,
FGFRs of 1 to 5 times the patient’s estimated
metabolic oxygen requirement and at any vaporizer
sleeve position.
Keywords anaesthesia, respiratory minute volume,
sevoflurane, Stephens anaesthetic machine, vapor-
izer in-circle.
Introduction
The delivery of volatile anaesthetic agents using a
vaporizer-in-circuit (VIC) system has some major
advantages. It enables the use of low fresh gas flow
rates (FGFRs) and in consequence, minimizes the
quantity of agent required, the cost and also atmo-
spheric pollution (Komesaroff 1973; Cust 1975).
Although VIC can be performed using any suitable
low-resistance vaporizer included within any circle
anaesthetic breathing system, two systems, the
Stephens and the Komesaroff machines are designed
 Sevoflurane delivery in a Stephens anaesthetic machine AJ Ferguson et al.

for the purpose. A survey of Australian veterinary

practices conducted in 2001 found that 49% of
practices used only VIC systems; 24% stating they
used the Stephens and 15% the Komesaroff. Another
12% of practices used both VIC and vaporizer out-of-
circle (VOC) systems; the remaining 39% used only
VOC systems (Nicholson & Watson 2001).
Any vaporizer used for VIC has to have a very low
resistance as the flow of gas through is generated by
the animal’s respiration. Therefore most are simple,
and are not compensated for temperature or for flow.
The Stephens vaporizer consists of a glass bottle in
which the flow through, or bypassing is controlled
by a central control which is graded in settings
labelled 0–8; at setting 0 all gas bypasses the
vaporizer; at setting 8 all passes through it. The
vaporizer also has an adjustable metal sleeve which
can be altered to change the proximity of gas
entering the vaporizer chamber to the surface of
the liquid anaesthetic (Fig. 1). The Stephens vapor-
izer has been used successfully with halothane and
isoflurane for dogs, cats and rabbits (Bednarski &
Muir 1991; Wagner & Bednarski 1992; Karas et al.
1996; Henke et al. 1997; Pablo et al. 2001). Figure 1 The Stephens vaporizer with the adjustable metal
sleeve in a downward position.
Depending on the size of the animal and the FGFR
(semi-closed or closed circuit) the first or second
vaporizer setting, with the sleeve fully up, has been the gas flow characteristics of the Stephens vaporizer
recommended for anaesthetic maintenance with (adjustable chamber sleeve and larger liquid anaes-
either halothane or isoflurane (Bednarski & Muir thetic agent surface area) are such that it might be
1991; Wagner & Bednarski 1992). expected that higher concentrations of sevoflurane
Sevoflurane has a lower saturated vapour pres- could be achieved than with the Komesaroff system.
sure (at sea level, 20.9 kPa [157 mmHg] at 20 °C) The studies presented here were designed to test
than have isoflurane and halothane (at sea level, the hypothesis that it would be possible to deliver
31.7 kPa [238 mmHg] and 32.4 kPa [243 mmHg] concentrations of sevoflurane suitable for mainte-
at 20 °C, respectively). Thus for any specified nance of anaesthesia in dogs under a variety of
temperature and flow rate, the concentration of conditions of temperature, FGFRs and patient weight
sevoflurane obtained will be less than that of the using a Stephens circle absorber system. The study
other two agents (Patel & Goa 1996). In addition, also determined the volume of sevoflurane con-
the potency of sevoflurane (minimum alveolar sumed. Specifically, the objective of study 1 was to
concentration [MAC] 2.36%) in dogs is less than determine the concentration of sevoflurane delivered
that of isoflurane (MAC = 1.28%) and halothane using the Stephens circle absorber with variations in
(MAC = 0.87%; Steffey 1996). Theoretically the FGFR, vaporizer sleeve position, vaporizer tempera-
lower saturated vapour pressure and required higher ture and vaporizer setting. The objective of study 2
agent concentration, could be limiting factors in the was to determine the vaporizer setting required to
use of sevoflurane in some VIC systems. Muir & achieve a predetermined delivered concentration of
Gadawski (1998), successfully anaesthetized dogs sevoflurane in experimental dogs of various weights.
with sevoflurane delivered through a VIC system
using a Ohio No. 8 vaporizer. Laredo et al. (2001),
Materials and methods
using a Komesaroff system, found it difficult to
obtain adequate concentrations of the agent, whilst Ethical approval for these studies was obtained from
in contrast Straker et al. (2004) used the Komesaroff The University of Queensland Animal Ethics Com-
system effectively for clinical anaesthesia. However mittee, which operates under the Australian Code of

© 2013 Association of Veterinary Anaesthetists and the American College of Veterinary Anesthesia and Analgesia, 41, 54–63 55
Sevoflurane delivery in a Stephens anaesthetic machine AJ Ferguson et al.
Practice for the Care and Use of Animals for Scientific
Purposes.
Animals
A total of 18 healthy mixed breed dogs (American
Society of Anesthesiologists Physical Status I) were
used in these studies. The dogs were anaesthetized
specifically for these experiments- no surgery was
performed. The dogs were fed dry dog food, had ad
libitum access to water and were exercised daily.
They were weighed on the day of each experiment.
Anaesthesia
Premedication with acepromazine maleate
(0.05 mg kg 1; Delvet Pty Ltd., NSW, Australia)
and atropine sulfate (0.04 mg kg 1; Apex Labora-
tories Pty Ltd., NSW, Australia) was administrated
via subcutaneous injection. Thirty minutes later
anaesthesia was induced with intravenous (IV)
propofol (mean 4.2  SD 0.2 mg kg 1; Schering
Plough Animal Health, NSW, Australia) to enable
tracheal intubation with a cuffed orotracheal tube of
the appropriate size. Anaesthesia was maintained
with sevoflurane (Abbott Australasia, NSW, Austra-
lia) delivered in oxygen via the Stephens anaesthetic
machine (Series II; Cenvet Pty Ltd., QLD, Australia)
operated as a semi-closed rebreathing system. The
carbon dioxide absorbent (Medisorb Datex-
OhmedaAB, Sweden) was renewed prior to each
anaesthesia. The same volume (50 mL) of sevoflu-
rane was placed in the vaporizer for each anaesthetic
in both studies. Once anaesthetized, the dogs were
placed in lateral recumbency on an electrical heat-
ing mat (HP-200 Breville Heat Pad with SCD-1
switched control device; NSW, Australia) and cov-
ered with a heat reflective blanket.
For all experiments, metabolic oxygen require-
ment rate was estimated by the following formula: in
mL minute 1 = bodyweight (kg)0.75 9 10 (Aldrete
et al. 1979; Wagner & Bednarski 1992).
Study 1
Six mixed breed dogs, weighing 14–25 kg, were
allocated to two groups. In one group (n = 3),
anaesthesia was maintained with the Stephens
vaporizer sleeve down (defined as the end of the
sleeve touching the anaesthetic agent with the upper
archers of the sleeve open to the vaporizer chamber;
Fig. 1) and in the other group (n = 3) with the
56 © 2013 Association of Veterinary Anaesthetists and the American College of Veterinary Anesthesia and Analgesia, 41, 54–63
vaporizer sleeve fully up. In all six dogs during
anaesthesia, the vaporizer setting, FGFR and vapor-
izer temperature were varied and circuit gases
delivered to the dog were sampled from the inspira-
tory and expiratory limb for determination of sevo-
flurane concentration. The only difference between
the protocols used in the two groups of dogs was the
vaporizer sleeve position. The following variations
were employed.
● The FGFR was set at either two or five times the
estimated metabolic oxygen requirement.
● The temperature of the vaporizer was controlled
by placing the vaporizer into an insulated beaker
filled with water at the required temperatures of 10,
20 and 35 °C. An analogue thermometer measured
water temperature continuously. Sevoflurane con-
centration in the inspiratory and expiratory limb of
the patient circuit was recorded at vaporizer tem-
peratures of 10, 20 and 35 °C.
● The vaporizer settings were varied randomly
through all 8 ‘on’ settings using a Balanced Latin
square design (Portney & Watkins 1993).
For any change of the three variables investigated
(fresh gas flow, temperature, vaporizer setting) the
new setting was maintained for 3–5 minutes after
end tidal sevoflurane concentrations (FE′SEVO) had
stabilized. At this time the delivered sevoflurane
concentration (FI′SEVO) and FE′SEVO were mea-
sured, and recorded. When respiratory depression
prevented stable concentrations being achieved, the
maximum recorded values were taken.
Study 2
Twelve healthy, mixed breed dogs were allocated into
three groups of four animals, according to body size.
The groups were designated as small, medium and
large dogs, and were 1–10, 15–25 and 30–40 kg
bodyweight respectively. For this experiment the
Stephens vaporizer was maintained at room temper-
ature (20–22 °C) with the vaporizer sleeve up. The
vaporizer setting was altered to deliver predetermined
inhaled percentages of sevoflurane, these represent-
ing concentrations of 1.0, 1.3, 1.5, 2.0 and 2.3 times
the ‘population’ MAC (taken as of 2.36% in mongrel
dogs; Kazama & Ikeda 1988). Predetermined con-
centrations were taken to one decimal point to match
the accuracy of the monitor. The position of the
vaporizer setting between the manufacturer’s marks
was determined by even segregation with a ruler to
provide continuous measure. The study was repeated
at FGFRs of one, two or five times the estimated
 Sevoflurane delivery in a Stephens anaesthetic machine AJ Ferguson et al.
metabolic oxygen requirement rate for each MAC
multiple. Each dog in study 2, within one anaesthetic,
was exposed to all five MAC multiples (1.0, 1.3, 1.5,
2.0 and 2.3 times MAC) and each corresponding
FGFR (1, 2 and 5 times estimated metabolic oxygen
requirements). The predetermined vaporizer output
concentrations were measured sequentially in
ascending order at each FGFR starting at one times
metabolic oxygen requirement, before moving in
ascending order to the next prescribed flow rate. The
peak inspired sevoflurane concentration was allowed
to stabilise, which required approximately 3–5 min-
utes. Once the concentration of sevoflurane was
stable the measurement was recorded. The vaporizer
setting required to achieve each of the predetermined
circuit concentrations of sevoflurane was recorded
for each FGFR.
Monitoring
The patient breathing system gas was sampled by
the anaesthetic agent monitor (model: AM-1; Aco-
ma Medical Industry Co Ltd., Japan) for the peak FI′
SEVO at the beginning of the inspiratory limb after
the vaporizer, and for FE′SEVO at the end of the
expiratory limb before the carbon dioxide (CO2)
absorbent canisters. The anaesthetic agent monitor
was calibrated at the start of each experiment using
the manufacturer’s protocols and a gas standard
(Scott Medical Products, PA, USA). The sampled
circuit gas from the anaesthetic agent monitor was
returned to the inspiratory limb at the patient
Y-piece. The capnograph (Datex Normocap; Datex
Instrumentarium, Finland) sampled circuit gas from
the junction of the tracheal tube and the patient
Y-piece, and then returned it at the end of the
expiratory limb. Systolic arterial blood pressure
(SAP) was measured from the palmar artery with
an ultrasonic doppler flow detector in conjunction
with a sphygmomanometer (model 811-B; Parks
Medical Electronics Inc., OR, USA). Circuit gas
temperature was measured using an analogue
thermometer placed in the anaesthetic circuit
through an airtight connection immediately after
the vaporizer.
The following variables were measured during
anaesthesia at each vaporizer or MAC setting: peak
FI′SEVO and FE′SEVO concentrations, vaporizer
settings, FGFR, end tidal CO2 (PE′CO2) concentra-
tion, respiratory rate (fR), heart rate, rectal temper-
ature, SAP, arterial haemoglobin oxygen
saturation, and anaesthetic circuit gas temperature.
© 2013 Association of Veterinary Anaesthetists and the American College of Veterinary Anesthesia and Analgesia, 41, 54–63
Results were expressed as median (range) for all
dogs at each vaporizer setting. The volume of
sevoflurane consumed was measured using a glass
syringe to draw up the sevoflurane before and after
anaesthesia.
Analysis
Data calculation and statistical analysis were con-
ducted using Prism 5 (GraphPad Software, CA, USA)
and Excel XP (Microsoft, CA, USA). The data were
reported as median (range) and, where appropriate,
data were analysed using Mann–Whitney test.
Results were reported as significant if p < 0.05.
Results
Study 1 results
The median (range) bodyweight of dogs in the
‘vaporizer sleeve down’ group was 17 (16.0–22.3)
kg and ‘sleeve up’ groups was 20 (14.0–25.0) kg;
these were not significantly different. Anaesthesia
could be maintained at a depth to prevent sponta-
neous movement (henceforth termed ‘maintained’)
in all dogs with sevoflurane delivered via the
Stephens anaesthetic machine regardless of the
sleeve position, FGFR and vaporizer temperature.
The sevoflurane output, with the vaporizer sleeve in
either position, increased as the vaporizer setting or
the vaporizer temperature increased but decreased
with increased FGFR (Tables 1 and 2). The con-
centration of sevoflurane in the inspired limb of the
patient circuit was significantly (p < 0.03) higher
with the vaporizer sleeve down than up. The peak
FI′SEVO was greater than the FE′SEVO, except for a
few dogs which recorded an equal to or higher
concentration in the expiratory limb at the lowest
(1/8) vaporizer setting. These exceptions were in
dogs that had experienced a higher vaporiser
setting immediately prior to that recording, accord-
ing to the Latin square design. However, in accor-
dance with the protocol, the inspired concentration
was stable when measurement was recorded. The
inspired anaesthetic levels were measured continu-
ously after a vaporizer setting change until the
concentration became steady. The time for this to
occur was dependent on the depth of anaesthesia.
At high anaesthetic concentrations respiratory
depression (as demonstrated by the increase in
PE′CO2) occurred, and was associated with reduced
FI′SEVO.
57
Sevoflurane delivery in a Stephens anaesthetic machine AJ Ferguson et al.

Table 1 Median (range) values for peak inspired (FI′SEVO) and expired (FE′SEVO) in three dogs, bodyweight 17 (16.0–22.3)
kg, anaesthetized with sevoflurane delivered via a Stephens anaesthetic machine with its vaporizer sleeve down, with the
vaporizer maintained at various temperatures and with different fresh gas flow rates

Sevoflurane
concentration (%)*

FI′SEVO FE′SEVO

Vaporizer Vaporizer 2 3 Metabolic 5 3 Metabolic 2 3 Metabolic

temperature setting (x/8) O2 flow O2 flow O2 flow 5 3 Metabolic O2 flow

10  1 °C 1/8 1.5 (0.9–2.0) 1.3 (1.3–2.1) 1.8 (1.0–2.0) 1.5 (1.4–2.4)

2/8 2.5 (1.7–2.8) 1.8 (1.8–2.4) 2.3 (1.6–2.6) 2.1 (2.1–2.5)
3/8 4.1 (3.5–4.5) 3.3 (3.1–3.5) 3.8 (2.9–4.0) 2.8 (2.8–2.8)
4/8 5.3 (4.5–6.0) 4.4 (4.0–4.6) 4.5 (3.1–5.3) 3.7 (3.6–3.9)
5/8 6.7 (6.6–7.0) 5.6 (4.7–5.8) 5.8 (5.5–6.0) 4.6 (4.3–4.9)
6/8 7.8 (7.8–8.2) 6.7 (6.0–7.0) 6.8 (6.3–7.0) 5.6 (5.5–5.9)
7/8 8.7 (8.4–9.0) 6.9 (6.2–7.2) 7.5 (7.4–7.9) 6.0 (5.8–6.1)
8/8 9.1 (8.4–9.3) 7.1 (6.7–7.8) 8.1 (7.4–8.2) 6.3 (5.8–6.8)
20  1 °C 1/8 1.4 (1.4–2.0) 1.4 (0.9–1.6) 1.5 (1.3–1.7) 1.3 (1.0–1.8)
2/8 2.4 (1.8–2.5) 2.0 (1.4–2.1) 2.2 (1.7–2.3) 1.8 (1.3–2.2)
3/8 3.9 (3.9–4.7) 3.2 (2.9–3.8) 3.6 (2.9–3.8) 2.8 (2.1–2.9)
4/8 5.9 (5.3–6.4) 4.5 (4.5–4.6) 5.3 (4.0–5.8) 3.8 (3.6–4.0)
5/8 7.0 (7.0–7.7) 5.5 (5.1–6.3) 6.2 (5.6–6.4) 4.5 (4.3–5.6)
6/8 8.3 (8.3–8.9) 6.3 (6.2–6.8) 6.9 (6.7–7.5) 5.8 (5.2–5.8)
7/8 9.2 (8.6–9.4) 7.5 (6.9–8.7) 7.7 (7.4–8.4) 6.8 (6.2–7.1)
8/8 9.4 (8.7–9.7) 8.5 (7.1–9.0) 8.2 (7.5–8.6) 7.2 (6.3–7.4)
35  2 °C 1/8 2.3 (1.0–3.1) 1.8 (1.0–1.8) 2.3 (1.0–3.0) 1.5 (1.2–2.0)
2/8 3.3 (2.4–3.8) 2.4 (1.6–3.2) 3.1 (2.4–3.6) 2.1 (1.5–2.5)
3/8 5.6 (5.4–6.9) 5.1 (5.1–5.2) 4.8 (4.4–5.6) 3.9 (3.2–4.6)
4/8 9.0 (8.3 to >10.0) 7.8 (6.9–9.1) 6.7 (6.1–7.4) 5.9 (5.8–8.5)
5/8 >10.0 (9.2 to >10.0) 9.3 (8.1 to >10.0) 9.0 (8.3–10.0) 8.6 (6.9–9.0)
6/8 >10.0 (>10.0) >10.0 (9.2 to >10.0) 9.9 (9.1 to >10.0) 9.0 (8.6–10.0)
7/8 >10.0 (>10.0) >10.0 (>10.0) 9.9 (9.1 to >10.0) >10.0 (>10.0)
8/8 >10.0 (>10.0) >10.0 (>10.0) >10.0 (9.4 to >10.0) >10.0 (>10.0)

*Values greater than the maximum reading of the Acoma anaesthetic monitor were recorded as >10.0%.

concentration (Table 3). The Stephens vaporizer

Study 2 results
The median (range) bodyweight for the small,
medium and large dog groups were 4 (4.0–4.5),
19 (17.5–21.0) and 35 (31.0–39.0) kg respectively
(p < 0.03). Anaesthesia was maintained with sevo-
flurane delivered via the Stephens anaesthetic
machine (sleeve up), for all dogs used in the study.
As the FGFR increased, a higher vaporizer setting
was required to produce the same sevoflurane
concentration output (Table 3). There was a signif-
icant (p < 0.02) difference in the vaporizer settings
between 1 and 5 times metabolic oxygen require-
ment in the medium and large dogs. Compared with
the larger dogs, the smaller dogs required a signif-
icantly (p < 0.03) higher vaporizer setting to pro-
duce the same peak inspired sevoflurane
settings to achieve 1.0 to 2.0 MAC ranged from
3.4 to 6.6 for a small dog (1–10 kg), 1.9 to 5.6 for a
medium dog (15–25 kg) and 1.9 to 4.6 for a large
dog (30–40 kg), depending on the FGFR and
required sevoflurane concentration.
In the small dog group median fR significantly
(p < 0.03) decreased from 13 (12–17) to 10 (7–10)
breaths minute 1 when the anaesthetic concentra-
tion increased from 1.0 to 2.3 MAC. The fR in both
the medium and large dogs remained stable as the
anaesthetic concentration increased from 1.0 to 2.3
MAC (Table 4). In all three groups (n = 12), the
median PE′CO2 values remained above 4.7 kPa
(35 mmHg) for all concentrations of sevoflurane,
with a median maximum of 9.3 kPa (70 mmHg).
As the FI′SEVO increased from 1.0 to 2.3 MAC, the

58 © 2013 Association of Veterinary Anaesthetists and the American College of Veterinary Anesthesia and Analgesia, 41, 54–63
 Sevoflurane delivery in a Stephens anaesthetic machine AJ Ferguson et al.

Table 2 Median (range) values for peak FI′SEVO and FE′SEVO using a Stephens anaesthetic machine with its vaporizer sleeve
up and at various vaporizer temperatures in three dogs with a bodyweight of 20 (14.0–25.0) kg

Sevoflurane
concentration (%)*

FI′SEVO FE′SEVO

Vaporizer Vaporizer 2 3 Metabolic 5 3 Metabolic 5 3 Metabolic

temperature setting (x/8) O2 flow O2 flow 2 3 Metabolic O2 flow O2 flow

10  1 °C 1/8 0.9 (0.6–1.2) 0.8 (0.5–1.3) 1.0 (0.8–1.3) 0.9 (0.7–1.4)

2/8 1.5 (0.9–1.7) 1.2 (0.8–1.7) 1.4 (1.2–1.6) 1.0 (0.9–1.6)
3/8 2.6 (2.5–3.8) 2.0 (1.7–3.2) 2.2 (2.1–2.8) 1.6 (1.5–2.3)
4/8 3.9 (3.1–4.4) 2.8 (2.5–3.6) 3.1 (2.8–3.5) 2.2 (2.1–2.5)
5/8 4.9 (3.8–5.5) 3.7 (3.1–3.8) 4.0 (3.5–4.3) 2.9 (2.8–3.1)
6/8 5.9 (4.5–6.0) 4.0 (3.8–4.4) 4.5 (4.0–4.6) 3.6 (2.9–3.7)
7/8 6.1 (5.1–6.4) 4.6 (3.9–5.8) 4.7 (4.4–5.1) 4.1 (3.0–4.3)
8/8 6.1 (5.3–6.6) 4.7 (4.4–5.9) 4.7 (4.7–5.3) 4.3 (3.5–4.5)
20  1 °C 1/8 1.3 (0.8–1.4) 0.8 (0.6–1.0) 1.3 (0.8–1.3) 1.0 (0.7–1.0)
2/8 1.8 (1.3–2.2) 1.3 (0.9–1.7) 1.6 (1.3–1.8) 1.2 (0.9–1.5)
3/8 2.9 (2.9–4.5) 2.4 (2.3–3.3) 2.4 (2.1–3.2) 1.7 (1.7–2.2)
4/8 4.0 (3.9–5.5) 3.3 (3.0–4.5) 3.2 (2.9–3.8) 2.6 (2.3–3.0)
5/8 5.1 (4.3–5.9) 4.4 (3.5–4.9) 4.0 (3.5–4.1) 3.5 (3.0–3.6)
6/8 6.2 (4.8–6.2) 5.1 (4.1–5.2) 4.5 (4.0–4.9) 3.8 (3.7–3.9)
7/8 6.6 (5.8–6.7) 5.5 (5.1–6.0) 5.3 (4.8–5.3) 4.8 (4.4–5.1)
8/8 6.7 (5.9–6.9) 5.9 (5.8–6.0) 5.3 (4.7–5.9) 4.8 (4.7–5.2)
35  2 °C 1/8 1.3 (1.2–1.4) 0.9 (0.8–1.2) 1.4 (1.3–1.4) 1.0 (0.9–1.2)
2/8 2.3 (2.0–3.5) 1.8 (1.3–2.3) 2.1 (2.1–2.9) 1.6 (1.5–1.8)
3/8 5.4 (2.8–6.0) 3.7 (3.5–4.9) 3.7 (2.5–4.1) 2.6 (2.5–2.8)
4/8 7.9 (6.1–8.3) 4.9 (4.9–7.5) 5.4 (4.7–6.3) 3.7 (3.5–5.5)
5/8 8.3 (7.5 to >10.0) 6.0 (5.2–9.0) 6.7 (5.9–7.7) 4.4 (4.1–5.4)
6/8 >10.0 (8.9 to >10.0) 8.5 (5.9–9.9) 7.2 (7.0–8.2) 6.9 (5.3–7.2)
7/8 >10.0 (9.4 to >10.0) >10.0 (6.4 to >10.0) 8.7 (8.2–9.1) 7.9 (5.8–9.4)
8/8 >10.0 (9.7 to >10.0) >10.0 (7.0 to >10.0) 9.3 (8.1–9.3) 8.7 (6.1–9.7)

*Values greater than the maximum reading of the Acoma anaesthetic monitor were recorded as >10.0%.

PE′CO2 increased in the small, medium and large
dog groups (Table 4), but this was not analysed
statistically. The FI′CO2 remained at zero for the
entire trial.
The heart rate did not change significantly in any
of the three groups when the anaesthetic concen-
tration increased from 1.0 to 2.3 MAC (Table 4).
There was a non-significant decrease in the SAP in
the medium and large dog groups as the sevoflurane
increased from 1.0 to 2.3 MAC (Table 4). Blood
pressure data for the small dog group was incom-
plete due to practical difficulties so was not analysed.
Arterial haemoglobin oxygen saturation in all three
groups of dogs remained above 95% during anaes-
thesia. There was a significant (p < 0.02) increase in
the amount of sevoflurane consumed as the body
size of the dogs increased; there was no significant
difference in the duration each animal spent at each
MAC multiple. The median volume of sevoflurane
used per hour for the small, medium and large dog
groups were 2.3 (2.2–2.3), 4.3 (3.6–5.7) and 6.5
(5.0–6.6) mL hour 1, respectively.
Discussion
Study 1 demonstrated that anaesthesia could be
maintained in dogs with sevoflurane delivered via
the Stephens anaesthetic machine with FGFRs of
two and five times the estimated oxygen require-
ments of the patient and at vaporizer temperatures
from 10 to 35 °C, irrespective of vaporizer sleeve
position. As expected the vaporizer produced a
higher delivered sevoflurane concentration with
the sleeve down compared with the sleeve fully up
under equivalent conditions, as the anaesthetic
vapour concentration in a VIC system will be highest

© 2013 Association of Veterinary Anaesthetists and the American College of Veterinary Anesthesia and Analgesia, 41, 54–63 59
Sevoflurane delivery in a Stephens anaesthetic machine AJ Ferguson et al.

Table 3 Median (range) values of

Stephens vaporizer the Stephens anaesthetic machine
(sleeve up) settings (x/8) vaporizer settings (sleeve up), used
to achieve a designated sevoflurane
FI′SEVO 53 concentration for small (4 [4.0–
(MAC 1 3 Metabolic 2 3 Metabolic Metabolic 4.5] kg bodyweight), medium (19
Dog size multiple)* oxygen flow† oxygen flow oxygen flow† [17.5–21.0] kg bodyweight) and
large (35 [31.0–39.0] kg body-
Small (n = 4) 2.4% (1.0 MAC) 3.3 (2.5–4.5) 3.5 (3.0–4.5) 4.5 (3.5–5.0) weight) dogs at different fresh gas
3.1% (1.3 MAC) 4.3 (3.0–5.0) 4.9 (3.8–5.0) 5.0 (3.8–5.5) flow rates
3.5% (1.5 MAC) 5.0 (3.5–5.2) 5.3 (4.0–5.5) 5.5 (4.0–5.8)
4.7% (2.0 MAC) 5.5 (4.0–5.7) 5.7 (4.2–6.0) 6.2 (4.5–6.5)
5.4% (2.3 MAC) 6.0 (4.5–6.0) 6.1 (4.5–6.5) 6.9 (5.0–7.5)
Medium (n = 4) 2.4% (1.0 MAC) 2.0 (1.5–2.0) 2.1 (2.0–2.5) 2.4 (2.3–2.5)
3.1% (1.3 MAC) 2.5 (2.0–2.5) 2.8 (2.5–3.0) 3.2 (3.0–3.5)
3.5% (1.5 MAC) 3.0 (2.5–3.0) 3.3 (3.0–3.5) 4.3 (3.5–4.5)
4.7% (2.0 MAC) 3.9 (3.5–4.5) 4.5 (3.8–5.0) 5.0 (4.3–5.7)
5.4% (2.3 MAC) 4.5 (4.0–5.0) 5.0 (4.3–5.5) 5.5 (4.5–7.0)
Large (n = 4) 2.4% (1.0 MAC) 2.0 (1.8–2.0) 2.0 (2.0–2.3) 2.8 (2.5–3.0)
3.1% (1.3 MAC) 2.5 (2.5–2.8) 3.0 (2.8–3.5) 3.5 (3.0–3.5)
3.5% (1.5 MAC) 2.9 (2.8–3.2) 3.4 (3.0–3.8) 3.8 (3.2–3.8)
4.7% (2.0 MAC) 3.4 (3.2–3.7) 4.0 (3.5–4.2) 4.3 (3.5–4.7)
5.4% (2.3 MAC) 3.8 (3.5–4.0) 4.3 (3.8–4.5) 4.8 (3.8–5.2)

*Based on one minimum alveolar concentration (MAC) for sevoflurane = 2.36% (Kazama
& Ikeda 1988) but using only one decimal point. †Significant (p < 0.02) difference in the
vaporizer settings between 1 and 5 times metabolic oxygen requirement in the medium
and large dogs.

nearest to the surface of the liquid anaesthetic
(Smith 1996; Young et al. 2000).
The increases in fresh gas flow resulted in a
reduction in the concentration of sevoflurane deliv-
ered was again, as anticipated. The proportion of
expired gas that is re-breathed is determined by the
FGFR in relation to the patient’s respiratory minute
volume, with increasing FGFRs in VIC systems
diluting the anaesthetic circuit concentration (Cust
1975; Wagner & Bednarski 1992; White & Royston
1998; Wright et al. 1998). The delivered concen-
tration of sevoflurane increased as the vaporizer
temperature increased, again as expected for vapor-
izers that are not temperature compensated (Patel &
Goa 1996; Smith 1996; Young et al. 2000). This
may be of clinical importance in extremes of the
ambient temperature. That the difference in sevo-
flurane output between 20 and 10 °C was smaller
than between 20 and 35 °C may have been due to
the expired air of the dogs’ lungs warming the circuit
gases at the lower temperature. The temperature
inside the anaesthetic circuit was maintained at 19
to 23 °C, as recorded by a thermometer in the
breathing circuit.
In study 2 a delivered concentration of sevoflura-
ne sufficient to maintain anaesthesia was achieved
in all dogs of different bodyweights and with all
FGFRs, used in this study. Differences in vaporizer
output due to dog size are seen with non-flow
compensated in-circle vaporizers where the gas flow
is generated by the dogs’ respiration. Thus, their
respiratory minute volume affects the concentration
of anaesthetic agent in the breathing system (Cust
1975; Jordan & Bushman 1981; Brosnan et al.
1998; Laredo et al. 1998). This is supported by the
results of the current study as the small dogs
required a higher vaporizer setting to maintain a
designated concentration of anaesthetic agent.
The use of lower FGFRs resulted in lower
consumption of sevoflurane during the procedure
and, therefore, reduced costs of the anaesthesia.
When the vaporizer is used out-of circuit, higher
FGFRs have been shown to be associated with lower
concentrations of the toxic breakdown products
within the circuit, in particular for sevoflurane of
compound A (Bito & Ikeda 1994; Fang & Eger
1995; Fang et al. 1996; Eger et al. 1997). Low
fresh gas flow may be expected to increase the
accumulation of toxic products also in VIC circuits.
Low flows also result in increased usage and
exhaustion of the absorbent with a resultant
increase in absorbent temperature (Straker et al.
2004). Thus it has been advised to use more than
minimal FGFRs until further studies are conducted

60 © 2013 Association of Veterinary Anaesthetists and the American College of Veterinary Anesthesia and Analgesia, 41, 54–63
 Sevoflurane delivery in a Stephens anaesthetic machine AJ Ferguson et al.

Table 4 Median (range) values of physiological variables for small (4 [4.0–4.5] kg [n = 4]), medium (19 [17.5–21.0] kg
[n = 4]) and large (35 [31.0–39.0] kg [n = 4]) bodyweight dogs at different MAC multiples of sevoflurane delivered by the
Stephens anaesthetic machine vaporizer (sleeve up)

Sevoflurane concentration (MAC multiple)*

1.0 MAC 1.3 MAC 1.5 MAC 2.0 MAC 2.3 MAC

Respiration rate
(breaths
minute 1)
Small dog 13 (12–17) 13 (11–16) 12 (11–14) 10 (10–13) 10 (7–10)
Medium dog 15 (13–33) 14 (13–33) 15 (12–31) 14 (11–23) 11 (10–20)
Large dog 15 (6–25) 15 (6–29) 14 (6–27) 13 (6–27) 12 (6–25)
Heart rate
(beats
minute 1)
Small dog 113 (76–122) 116 (77–120) 112 (77–116) 109 (78–117) 107 (78–119)
Medium dog 96 (69–107) 97 (67–107) 103 (71–110) 111 (77–119) 114 (83–128)
Large dog 86 (67–121) 90 (71–125) 97 (77–126) 103 (82–125) 108 (88–125)
PE′CO2
Small dog
kPa 7.9 (5.2–9.8) 8.4 (5.4–9.8) 8.6 (5.6–10.1) 8.9 (5.8–10.1) 9.3 (5.8–10.1)
mmHg 59 (38.7–73.4) 63 (40.7–73.4) 65 (42.0–76.0) 67 (43.4–76.0) 70 (43.4–76.0)
Medium dog
kPa 6.2 (5.8–7.2) 6.2 (5.9–7.3) 6.4 (6.0–7.6) 6.6 (6.5–7.7) 7.0 (6.8–8.4)
mmHg 47 (43.4–54.0) 47 (44.0–54.7) 48 (45.0–56.7) 50 (48.7–60.0) 53 (50.7–62.7)
Large dog
kPa 4.7 (3.7–6.3) 4.8 (3.7–6.5) 5.0 (4.0–6.7) 5.4 (4.0–7.1) 5.7 (4.2–7.1)
mmHg 35 (28.0–47.3 36 (28.0–48.7) 38 (30.0–50.0) 41 (30.0–53.3) 43 (31.4–53.3)
SAP (mmHg)
Medium dog 128 (122.7–140.0) 127 (120.7–140.0) 122 (113.3–136.7) 116 (106.7–133.3) 110 (100.0–129.3)
Large dog 147 (109.0–160.0) 144 (103.3–156.7) 137 (99.0–156.7) 133 (97.3–151.7) 133 (97.3–148.3)

PE′CO2, partial pressure of end tidal carbon dioxide; SAP, systolic arterial blood pressure. *Based on one minimum alveolar
concentration (MAC) for sevoflurane = 2.36% (Kazama & Ikeda 1988).

(Gonsowski et al. 1994; Fang & Eger 1995; Fang
et al. 1996). The type of CO2 absorbent affects the
breakdown of inhalation anaesthetics (Bito & Ikeda
1994; Neumann et al. 1999). In this current study
the absorbent used contained 3% sodium hydroxide
and >75% calcium hydroxide with approximately
15% moisture content (Datex Ohmeda 1999). The
problem of anaesthetic breakdown may be over-
come by the use of absorbents without a strong base
(Yamakage et al. 2009).
The physiological data from study 2 are presented
both to demonstrate the relative degrees of respira-
tory depression that occurred, and also that mea-
sured circulatory variables remained in an
acceptable range, despite the high inspired sevoflu-
rane concentrations that were achieved at times.
The PE′CO2 increased as the anaesthetic concentra-
tion increased in all three groups, being highest in
the small dogs and tending to decrease as the size of
the dog increased. These increased end tidal CO2
levels could be due to the reduced fR but it is probable
that there was a decreased respiratory tidal volume,
caused by sevoflurane respiratory depression (Doi &
Ikeda 1987; Ide et al. 1991, 1992; Kubota 1992),
although this was not measured in the current
study. As the sevoflurane concentration increased
there was a non-significant trend of an increase in
the heart rate and a decrease in SAP in the
medium and large dog groups, but surprisingly the
cardiovascular variables remained within clini-
cally acceptable limits, presumably due to cardio-
vascular stimulation from the elevated carbon
dioxide levels.
In conclusion, this study investigated the capac-
ity of the Stephens anaesthetic machine to deliver
sevoflurane to dogs under different conditions, such

© 2013 Association of Veterinary Anaesthetists and the American College of Veterinary Anesthesia and Analgesia, 41, 54–63 61
Sevoflurane delivery in a Stephens anaesthetic machine AJ Ferguson et al.
as vaporizer temperature, altered fresh gas flows
and respiratory minute volumes. Concentrations of
sevoflurane suitable for anaesthetic maintenance
were achieved with the Stephens vaporizer in dogs
with a bodyweight ranging from 4 to 39 kg, at
FGFRs of one, two and five times the estimated
oxygen requirement and with vaporizer tempera-
ture ranging from 10 to 35 °C regardless of
vaporizer sleeve position. At inspired sevoflurane
concentrations between 1.0 and 2.3 MAC there was
a reduction in the respiration rate and the PE′CO2
remained high throughout delivery of these MAC
multiples, but HR and SAP remained at acceptable
levels. The study demonstrates that under all
conditions investigated for patient weight, FGFRs,
vaporizer temperatures, and sleeve position, the
concentrations of sevoflurane delivered to the dogs
were sufficient to maintain anaesthesia. Thus the
Stephens machine provides a suitable cost–effective
method of delivery of sevoflurane anaesthesia to
dogs of 4 kg and above.
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Received 22 December 2011; accepted 28 August 2012.

© 2013 Association of Veterinary Anaesthetists and the American College of Veterinary Anesthesia and Analgesia, 41, 54–63 63