Low-flow anaesthesia with a fixed fresh gas flow rate
- 163 Downloads
During the wash-in period in low flow anaesthesia (LFA), high fresh gas flow is used to achieve the desired agent concentration. In this study, we aimed to evaluate the safety of fixed 1 L/min fresh gas flow desflurane anaesthesia in both the wash-in and maintenance periods in patients including the obese ones. 104 patients undergoing surgery under general anaesthesia were included. After endotracheal intubation, fresh gas flow was reduced to 1 L/min and the desflurane vaporizer was set at 18%. The time from opening the vaporizer to end-tidal desflurane concentration reaching 0.7 MAC was recorded (MAC 0.7 time). Throughout the surgery, hemodynamic variables, FIO2, MAC and BIS values were observed. MAC 0.7 time, BIS and MAC values at the start of surgery, number of adjustments in vaporizer settings, desflurane consumption were recorded. The average MAC 0.7 time was 2.9 ± 0.5 min. MAC and BIS values at the start of the surgery were 0.7 (0.6–0.8) and 39 ± 8.5 respectively. No individual patient had a BIS value above 60 throughout the surgery. Hemodynamic variables were stable and FIO2 did not fall below 30% in any patient. The number of adjustments in vaporizer settings was 56. Average desflurane consumption was 0.33 ± 0.05 mL/min. We demonstrated that LFA without use of initial high fresh gas flow during the wash-in period is an effective, safe and economic method which is easy to perform.
KeywordsLow flow anaesthesia Desflurane Obese Wash-in BIS Fixed fresh gas flow rate
Compliance with ethical standards
Conflict of interest
The authors declare no conflict of interest.
All procedures performed in studies involving human participants were in accordance with the ethical standards of the institutional and/or national research committee and with the 1964 Helsinki declaration and its later amendments or comparable ethical standards. The study was approved by the Ethics Committee of the Healthcare Application and Research Hospital of Kahramanmaras Sutcu Imam University (no.154 dated 04.05.2016).
- 2.Bilgi M, Goksu S, Mizrak A, Cevik C, Gul R, Koruk S, et al. Comparison of the effects of low-flow and high flow inhalational anaesthesia with nitrous oxide and desflurane on mucociliary activity and pulmonary function tests. Eur J Anaesthesiol. 2011;28(4):279–83.Google Scholar
- 8.Avidan MS, Jacobsohn E, Glick D, Burnside BA, Zhang L, Villafranca A, Karl L, Kamal S, Torres B, O’Connor M, Evers AS, Gradwohl S, Lin N, Palanca BJ, Mashour GA. BAG-RECALL Research Group: prevention of intraoperative awareness in a high-risk surgical population. N Engl J Med. 2011;365(7):591–600.CrossRefGoogle Scholar
- 10.Horwitz M, Jakobsson JG. Desflurane and sevoflurane use during low- and minimal-flow anesthesia at fixed vaporizer settings. Minerva Anestesiol. 2016;82:180–5.Google Scholar
- 14.McKay RE. Inhaled anesthetics. In: Strales LM, Miller RD. Miller’s anesthesia review. 2nd ed. Philadelphia: Saunders; 2013. p. 45.Google Scholar
- 16.Weiskopf RB, Cahalan MK, Eger El 2nd, Yasuda N, et al. Cardiovascular actions of desflurane in normocarbic volunteers. Anesth Analg. 1991;73(2):143–56.Google Scholar