A new anaesthetic breathing system combining Mapleson A, D and E principles

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Abstract
A new simple anaesthetic breathing system is described which has been designed to incorporate into a single system advantages of Mapleson A, D and E type systems. Coaxial and non-coaxial versions are available. The system can be used for adults, children or neonates and allows both spontaneous or controlled ventilation with low fresh gas flows at all times. As a Mapleson A system for spontaneous respiration a considerable saving of anaesthetic gases and vapours is achieved since, for adults, the new system requires a lower fresh gas flow even than that for the Magill. For children breathing spontaneously the system requires only one third of the fresh gas flow necessary for the Jackson Rees modification of Ayre's T-piece. For controlled ventilation the system behaves as a modified Mapleson D/E (Bain type) system with the advantage of predictable CO2 tensions and good humidification. The system is safe, simple in design and operation, and is easily sterilized. Further it offers low resistance to expiration and facilitates scavenging at all times which, with low anaesthetic gas flows, permits complete theatre pollution control. Its potential application in academic and rural environments and major advantages over the circle absorber system are discussed.