Journal of Clinical Monitoring and Computing

, Volume 33, Issue 1, pp 115–121 | Cite as

Low-flow anaesthesia with a fixed fresh gas flow rate

  • Seyma Bahar
  • Mahmut ArslanEmail author
  • Aykut Urfalioglu
  • Gokce Gisi
  • Gozen Oksuz
  • Bora Bilal
  • Hafize Oksuz
  • Adem Doganer
Original Research


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.


Low 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.

Ethical approval

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).


  1. 1.
    Brattwall M, Warrén-Stomberg M, Hesselvik F, Jakobsson J. Brief review: theory and practice of minimal fresh gas flow anesthesia. Can J Anaesth. 2012;59(8):785–97.CrossRefGoogle Scholar
  2. 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
  3. 3.
    Mapleson WW. The theoretical ideal fresh-gas flow sequence at the start of low-flow anaesthesia. Anaesthesia 1998;53(3):264–72.CrossRefGoogle Scholar
  4. 4.
    Hendrickx JF, Dewulf BB, De Mey N, Carette R, et al. Development and performance of a two-step desflurane-O2/N2O fresh gas flow sequence. J Clin Anesth. 2008;20(7):501–7.CrossRefGoogle Scholar
  5. 5.
    Sathitkarnmanee T, Tribuddharat S, Suttinarakorn C, et al. 1-1-12 one-step wash-in scheme for desflurane-nitrous oxide low-flow anesthesia: rapid and predictable induction. Biomed Res Int. 2014. Scholar
  6. 6.
    Hendrickx JF, Lemmens H, De Cooman S, et al. Mathematical method to build an empirical model for inhaled anesthetic agent wash-in. BMC Anesthesiol. 2011;11:13.CrossRefGoogle Scholar
  7. 7.
    Mashour GA, Shanks A, Tremper KK, et al. Prevention of intraoperative awareness with explicit recall in an unselected surgical population: a randomized comparative effectiveness trial. Anesthesiology 2012;117(4):717–25.CrossRefGoogle Scholar
  8. 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
  9. 9.
    Ip-Yam PC, Goh MH, Chan YH, Kong CF. Clinical evaluation of the Mapleson theoretical ideal fresh gas flow sequence at the start of low-flow anaesthesia with isoflurane, sevoflurane and desflurane. Anaesthesia 2001;56:160–4.CrossRefGoogle Scholar
  10. 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
  11. 11.
    Gan TJ, Glass PS, Windsor A, et al. Bispectral index monitoring allows faster emergence and improved recovery from propofol, alfentanil, and nitrous oxide anesthesia. BIS Utility Study Group. Anesthesiology 1997;87(4):808–15.CrossRefGoogle Scholar
  12. 12.
    Ekman A, Lindholm ML, Lennmarken C, Sandin R. Reduction in the incidence of awareness using BIS monitoring. Acta Anaesthesiol Scand. 2004;48(1):20–6.CrossRefGoogle Scholar
  13. 13.
    Myles PS, Leslie K, McNeil J, Forbes A, Chan MT. Bispectral index monitoring to prevent awareness during anaesthesia: the B-Aware randomised controlled trial. Lancet. 2004;363(9423):1757–63.CrossRefGoogle Scholar
  14. 14.
    McKay RE. Inhaled anesthetics. In: Strales LM, Miller RD. Miller’s anesthesia review. 2nd ed. Philadelphia: Saunders; 2013. p. 45.Google Scholar
  15. 15.
    Ebert TJ, Muzi M. Sympathetic hyperactivity during desflurane anesthesia in healthy volunteers: a comparison with isoflurane. Anesthesiology 1993;79(3):444–53.CrossRefGoogle Scholar
  16. 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
  17. 17.
    Lucangelo U, Garufi G, Marras E, Ferluga M, Turchet F, Bernabè F, Comuzzi L, Berlot G, Zin WA. End-tidal versus manually-controlled low flow anaesthesia. J Clin Monit Comput. 2014;28(2):117–21. Scholar
  18. 18.
    Baum JA. Low-flow anesthesia: theory, practice, technical preconditions, advantages, and foreign gas accumulation. J Anesth. 1999;13:166–74.CrossRefGoogle Scholar

Copyright information

© Springer Science+Business Media B.V., part of Springer Nature 2018

Authors and Affiliations

  • Seyma Bahar
    • 1
  • Mahmut Arslan
    • 1
    Email author
  • Aykut Urfalioglu
    • 1
  • Gokce Gisi
    • 1
  • Gozen Oksuz
    • 1
  • Bora Bilal
    • 1
  • Hafize Oksuz
    • 1
  • Adem Doganer
    • 2
  1. 1.Department of Anesthesiology and Reanimation, School of MedicineKahramanmaras Sutcu Imam UniversityKahramanmarasTurkey
  2. 2.Department of Biostatistics and Medical Informatics, School of MedicineKahramanmaras Sutcu Imam UniversityKahramanmarasTurkey

Personalised recommendations