End-tidal Control is a gas delivery software option for the GE Healthcare Aisys Carestation and Aisys CS2 anaesthesia delivery systems.

  • Five studies compared End-tidal Control with manual gas control: 1 randomised trial (n=200), 2 observational studies (n=3675, n=80), 1 service evaluation (n=489) and 1 audit (population size not described). Three of these 5 studies reported effectiveness outcomes.

  • The randomised trial reported that using End‑tidal Control resulted in a significant reduction in anaesthetic consumption compared with manual gas control.

  • The randomised trial also reported that target anaesthetic concentration was reached faster using End‑tidal Control than with manual gas control. One observational study reported that it took longer to reach target anaesthetic concentration with End‑tidal Control, but was quicker to maintain steady concentrations.

  • The service evaluation reported that the average fresh gas flow using End-tidal Control decreased significantly with increased duration of anaesthesia, resulting in reduced anaesthetic use.

Adverse events and safety

  • One observational study (n=80) reported that there were no complications associated with End‑tidal Control. Four studies did not report on adverse events or safety.

Of the 5 reviewed studies, only the randomised trial recorded depth of anaesthesia. However, this was used as an exclusion criterion and not as an outcome measure.

  • The audit study survey reported some issues for concern, including difficulty in changing the anaesthetic agent during surgery (not usually done during anaesthesia) and poor performance with circuit leaks.

Cost and resource use

  • The End-tidal Control software is an optional addition which is compatible only with Aisys anaesthesia systems, and costs £5000–5500 depending on whether it is added to an existing system or purchased with a new system. If a new system is purchased, the initial capital cost is approximately £40,000 (list price) per system. There are no additional consumable costs for using End-tidal Control.

  • Four of the reviewed studies reported cost and resource use when using End-tidal Control.

  • One service evaluation, conducted in the UK, reported that when using End-tidal Control for 20−40 minutes, the average cost of sevoflurane reduced by £7.94 per hour (53%), and desflurane by £4.83 per hour (41%).

  • One randomised trial conducted in India reported a mean reduction in oxygen, nitrous oxide and sevoflurane consumption using End‑tidal Control, equivalent to a £0.64 saving per hour. One observational study conducted in Australia reported that using End‑tidal Control led to a mean reduction in the use of anaesthetic (desflurane, sevoflurane, isoflurane) equivalent to a saving of £3.32 per hour. No change in fresh gas (oxygen, nitrous oxide, air) costs was identified.

  • One observational study fixed fresh gas flow rates between End-tidal Control and manual gas control groups and found no difference in the consumption of sevoflurane, oxygen or air, and no difference in costs when using End‑tidal Control.

Technical factors

  • End-tidal Control is designed for use with the anaesthetics desflurane, isoflurane and sevoflurane.

  • Three of the reviewed studies reported an overall reduction in key presses, adjustments and anaesthetist interventions when using End-tidal Control.

  • One audit study reported the survey results of 18 trainee and 50 specialist anaesthetists who described some advantages of End‑tidal Control. These included better control of end‑tidal anaesthetic agent concentrations, allowing attention to be directed to other aspects of care.

  • One observational study reported a significant reduction in greenhouse gas emissions when using End‑tidal Control.