Low-Flow Desflurane Anesthesia Research Articles

The Effects of Low Flow and Normal Flow Desflurane Anesthesia on Liver and Renal Functions and Serum Cystatin C Levels in Geriatric Patients: A Prospective Randomized Controlled Study

Introduction: Aging is a physiological process and the elderly population is increasing. In parallel to the increasing of the elderly population, the number of geriatric patients who required an invasive procedure or surgical intervention under anesthesia are also increasing. The geriatric patients who are frailty and have a loss of functional reserve in all organ systems are more sensitive to anesthetic agents. The purpose of this research was to investigate whether low flow desflurane anesthesia also affects hepatic and kidney functions, in elderly patients. Methods: After approval from the local ethics committee, the patients were divided into two groups; as the low flow desflurane anesthesia group and the normal flow desflurane anesthesia group using the closed-envelope method. Calibration and leakage tests of the anesthesia device (Primus, Drager) were performed before anesthesia. Heamodynamics parametres, peripheral oxygen saturation, and bispectral index monitoring were performed to all patients in operating room. The blood samples were collected before anesthesia induction, after surgery, and at the postoperative 24th hour. The serum alanine aminotransferase and aspartate aminotransferase levels were measured to assess the liver damage. The serum creatinine, blood urea nitrogen, and cystatin C levels were measured to assess the kidney function. Results: The serum alanine aminotransferase, aspartate aminotransferase, blood urea nitrogen, creatinine and cystatin C levels and hemodynamic parameters, peripheral oxygen saturation and bispectral index values were similar in both groups. Conclusions: It was concluded that low-flow desflurane anesthesia does not adversely affect liver and kidney functions in geriatric patients and is as safe as normal-flow desflurane anesthesia. Keywords: Anesthesia; Cystatin C; Desflurane; Aged; Kidney; Liver.

Comparison of the Effects of Low-flow and Normal-flow Desflurane Anaesthesia on Inflammatory Parameters in Patients Undergoing Laparoscopic Cholecystectomy.

ObjectiveAccording to previous studies, anaesthesia type has an important effect on immune response. However, there are limited data determining the effect of low-flow and normal-flow desflurane anaesthesia on inflammatory parameters. This study aimed to investigate the effect of low-flow and normal-flow desflurane anaesthesia on inflammatory parameters in patients undergoing laparoscopic cholecystectomy.MethodsA total of 92 patients who underwent laparoscopic cholecystectomy were retrospectively included in this study. The patients were divided into the following 2 groups according to the type of anaesthesia they received: low-flow desflurane anaesthesia group (fresh gas flow rate: 0.5 L min−1) and normal-flow desflurane anaesthesia group (fresh gas flow rate: 2 L min−1). Neutrophil-to-lymphocyte ratio (NLR) and platelet-to-lymphocyte ratio (PLR) were obtained before the procedure and 6 hours after the end of the procedure for all patients.ResultsAlthough pre-procedural NLR and PLR were similar between the normal-flow and low-flow anaesthesia groups, post-procedural NLR (4.38±2.00 vs. 3.51±1.37, p=0.023) and PLR (144.38±71.04 vs. 120.58±35.35, p=0.037) were significantly higher in the normal-flow anaesthesia group. In addition, compared with pre-procedural values, post-procedural NLR (from 2.31±1.02 to 4.38±2.00, p<0.001) and PLR (from 125.60±50.97 to 144.38±71.04, p=0.017) were significantly increased in the normal-flow anaesthesia group, whereas post-procedural NLR (from 2.88±2.51 to 3.51±1.37, p=0.135) and PLR (from 121.86±42.78 to 120.58±35.35, p=0.847) did not change significantly in the low-flow anaesthesia group.ConclusionThe study results indicated that postoperative inflammatory response was significantly lower with low-flow desflurane anaesthesia than with normal-flow desflurane anaesthesia.

Effect of entropy-guided low-flow desflurane anaesthesia on laryngeal mask airway removal time in children undergoing elective ophthalmic surgery - A prospective, randomised, comparative study.

Background and Aims:In children, entropy-guided titration of isoflurane and sevoflurane leads to faster recovery after anaesthesia. However, role of entropy in recovery following desflurane anaesthesia is not known. Hence, we compared laryngeal mask airway (LMA) removal time and desflurane consumption with entropy and minimal alveolar concentration–guided titration in children given low-flow desflurane anaesthesia.Methods:After ethics committee approval and parental consent, 80 American Society of Anesthesiologists grade I–II children, age 2–14 years, undergoing elective ophthalmic surgery were randomised into entropy and minimal alveolar concentration–guided groups. After LMA insertion, anaesthesia was maintained using oxygen, air (FiO2 0.5) and desflurane using low fresh gas flow of 0.75 L/min. In the entropy-guided group, desflurane was titrated to maintain state entropy between 40 and 60. In the minimal alveolar concentration–guided group, desflurane was titrated to maintain a minimal alveolar concentration between 1 and 1.3. We recorded LMA removal time (from switching off desflurane at the end of surgery till removal of LMA), haemodynamic parameters, uptake and consumption of desflurane between the groups.Results:LMA removal time was significantly decreased in the entropy-guided group in comparison to the minimal alveolar concentration–guided group (4.34 ± 2.03 vs 8.8 ± 2.33 min) (P < 0.0001). Consumption of desflurane was significantly less in the entropy-guided group compared with the minimal alveolar concentration–guided group (18.7 ± 5.07 vs 25.3 ± 8.11 mL) (P < 0.0001).Conclusion:Entropy-guided low-flow desflurane anaesthesia is associated with faster LMA removal and reduced consumption of desflurane in children undergoing ophthalmic surgery.

Comparison of Effects of Low-Flow Sevoflurane and Low-Flow Desflurane Anaesthesia on Renal Functions Using Cystatin C.

Numerous studies have indicated nephrotoxic effects of sevoflurane because of its two bioproducts compound A and fluoride. Cystatin C (CyC) is a more sensitive biomarker than creatinine to show early and mild changes in kidney function. We designed this prospective randomised study to compare the effects of low-flow sevoflurane anaesthesia and low-flow desflurane anaesthesia on renal functions based on CyC levels. No studies have evaluated the effects of low-flow sevoflurane anaesthesia on renal functions based on CyC levels to date. Thirty American Society of Anesthesiologists (ASA) physical status I-II patients who were scheduled for urological procedures were enrolled in this study. The patients were randomly assigned to 2 groups: low-flow sevoflurane anaesthesia or low-flow desflurane anaesthesia. Serum urea, creatinine and CyC levels were measured before the operation, just before extubation and 24 h after the operation. Creatinine clearance was calculated in the first 24-h urine sample. There were no significant differences in serum urea, creatinine and CyC levels or 24 h creatinine clearance between the groups. Our study demonstrates with a more sensitive biomarker, CyC, that low-flow sevoflurane anaesthesia is safe in terms of the effects on renal function.

The Effect of Low-Flow Desflurane Anesthesia on Mucociliary Clearance

The Effect of Low-Flow Desflurane Anesthesia on Mucociliary Clearance

Effects of flow rate on hemodynamic parameters and agent consumption in low-flow desflurane anesthesia: An open-label, prospective study in 90 patients

Background: In surgical patients, decreasing the fresh gas flow rate in anesthesia may minimize costs, reduce environmental pollution, and preserve heat and humidity in the respiratory system. Objective: The aim of this study was to investigate the effects of 3 low-flowdesflurane rates on perioperative hemodynamic stability, end-tidal desflurane concentration, emergence and recovery characteristics, and agent consumption. Methods: This open-label, prospective study was conducted at the Departmentof Anesthesiology and Reanimation, University of Gaziantep, Gaziantep, Turkey. Nonpremedicated adult patients scheduled to undergo surgery (ureterolithotomy, cholecystectomy, pyelolithotomy, or thyroidectomy) were enrolled. Patients were anesthetized with propofol and fentanyl and intubated after neuromuscular blockade with vecuronium. Patients were randomly allocated to 1 of 3 groups according to the fresh gas flow rate: medium flow (2 L/min), low flow (1 L/min), and minimal flow (0.5 L/min). Intraoperative fentanyl volume was recorded. Heart rate, mean arterial pressure, and end-tidal desflurane concentration were recorded before (baseline) and after anesthesia induction; immediately before incision; and 5, 10, 15, 30, 45, and 60 minutes after incision. Emergence time and desflurane consumption after extubation were recorded. Aldrete scores were recorded at 5, 15, and 30 minutes after extubation. Results: Ninety patients (46 women, 44 men; mean [SD] age, 39.74 [13.73] years; 30 patients per treatment group) participated in the study. Means of hemodynamic parameters, intraoperative volume of fentanyl, end-tidal desflurane concentration, emergence time, and Aldrete score were statistically similar between the 3 groups. Mean (SD) desflurane consumption was significantly higher in the medium-flow group compared with the low- and minimal-flow groups (110.43 [28.18] g vs 98.40 [23.62] g and 79.80 [17.54] g, respectively; both, P < 0.01). Mean (SD) desflurane consumption was also significantly higher in the low-flow group compared with the minimal-flow group ( P < 0.01). Conclusion: The results of the present study in adult surgical patients suggestthat desflurane may be used in low-flow anesthesia, even with the minimal fresh gas flow rate.