• Robert M Brustowicz and Koichi Yuki.
• Department of Anesthesiology, Critical Care and Pain Medicine, Boston Children's Hospital, Boston, MA, USA.
• Paediatr Anaesth. 2020 Nov 1; 30 (11): 1269-1274.

BackgroundDuring the coronavirus pandemic, preventing contamination of the anesthesia machine, critical to avoid cross-contamination between patients, has proven challenging when treating premature infants and neonates. While attaching a HEPA filter to the endotracheal tube will protect the anesthesia machine and the gas sampling line from contamination, this contribution to the dead space makes ventilation of these small patients challenging. Direct filtration of the gas sampling line eliminates this problem; however, appropriate filters are not readily available.AimsIdentify a small filter capable of filtering out particles of a size similar to the SARS-CoV-2 virus for the gas sampling line.MethodsWe used fluorescence microspheres suspended in a solution for a challenge test to determine the filtration efficiency of various filters. The microspheres varied in diameter (0.02 µm, 0.042 µm, 0.109 µm, and 0.989 µm). A fluorescence plate reader was used to evaluate the degree of fluorescence intensity in the flow-through from various filters and referenced to the fluorescence intensity of the input.ResultsAHEPA filter, as recommended as an anti-viral filter, effectively filtered all the particles tested. The B. Braun PERIFIX Flat Epidural Filter was the second most effective filter, filtering particles larger than 0.042 µm. Other filters tested did not filter fluorescence microspheres equivalent in size to a single coronavirus particle (0.07 µm).ConclusionsAlthough the Food and Drug Administration (FDA) has not approved the Flat Epidural Filter for use as an anesthesia machine gas filter, our simple challenge test suggests that it could be used to effectively filter the anesthesia gas sampling line.© 2020 John Wiley & Sons Ltd.

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