Minimal Flow Anesthesia Research Articles

Comparative Evaluation of Minimal and Metabolic Flow Anaesthesia Using Desflurane

Objective: The aim of this study is the comparative evaluation of minimal and metabolic flow anaesthesia with regard to hemodynamic stability, trends of anaesthesia gases, problems during maintenance, time to recovery and the consumption of anaesthetic agent. Methods: A randomised controlled prospective study was conducted on 60 patients of ASA grades I and II between 20 and 60 years of age undergoing routine surgeries under general anaesthesia using the Dräger Primus workstation. Patients were randomly allocated to Group 1 (minimal flow) and Group 2 (metabolic flow). Anaesthesia consumption was calculated manually using Dion’s method and the Dräger Primus machine also using the Dräger algorithm. Results: The two groups were found comparable with regard to the above-mentioned objectives. No statistically significant difference was observed between the two groups. Conclusion: Metabolic flow anaesthesia is safe and feasible on a day-to-day basis with the judicious use of advanced anaesthesia workstations and newer lower solubility halogenated agents.

Comparison of automated and manual control methods in minimal flow anesthesia.

New-generation anesthesia machines administer inhalation anesthetics and automatically control the fresh gas flow (FGF) rate. This study compared the administration of minimal flow anesthesia (MFA) using the automatically controlled anesthesia (ACA) module of the Mindray A9 (Shenzhen, China) anesthesia machine versus manual control by an anesthesiologist. We randomly divided 76 patients undergoing gynecological surgery into an ACA group (Group ACA) and a manually controlled anesthesia group (Group MCA). In Group MCA, induction was performed with a mixture of 40-60% O2 and air with a 4L/min FGF until the minimum alveolar concentration (MAC) reached 1. Next, MFA was initiated with 0.5L/min FGF. The target fraction of inspired oxygen (FiO2) value was 35-40%. In Group ACA, the MAC was defined as 1, and the FiO2 was adjusted to 35%. Depth of anesthesia, anesthetic agent (AA) consumption, time to achieve target end-tidal AA concentration, awakening times, and number of ventilator adjustments were analyzed. The two groups showed no statistically significant differences in depth of anesthesia or AA consumption (Group ACA: 19.1 ± 4.9ml; Group MCA: 17.2 ± 4.5; p-value = 0.076). The ACA mode achieved the MAC target of 1 significantly faster (Group ACA: 218 ± 51s; Group MCA: 314 ± 169s). The number of vaporizer adjustments was 15 in the ACA group and 217 in the MCA group. The ACA mode was more advantageous than the MCA mode, reaching target AA concentrations faster and requiring fewer adjustments to achieve a constant depth of anesthesia.

Minimal fixed flow anesthesia for off-pump coronary artery bypass surgery: A parallel randomized trail

ObjectivesThe aim of the present study was to test a safety of a fixed minimal (0.5 l/min) fresh gas flow (FGF) anesthesia as a method ensuring adequate oxygenation during off-pump coronary artery bypass grafting operations. DesignA randomized, prospective study. SettingSingle-center clinical hospital affiliated with a university. Participants208 patients underwent off-pump coronary artery bypass surgery. InterventionsAll patients received endotracheal inhalational anesthesia with fixed minimal FGF. Half of them were anesthetized by sevoflurane and another half by isoflurane. The fresh (carrier) gas was pure oxygen in the control groups and a mixture of medical air and oxygen (FiO2 0.8) in the trial groups. Measurements and main resultsIn the control groups inhaled oxygen concentration changed minimally during the operation. In the trial groups in 28.8 % of cases inhaled oxygen concentration dropped below preliminary margin (0.4). Body surface area (BSA) (B = 38.7; p = 0.002) and patient's age (B = −0.47; p = 0.004) were retained into final logistic regression model as independent predictors. We divided BSA into subcategories and analyzed data by survival cox regression with Forward LR method. Patients with BSA>2.3 (Exp.B = 183) and BSA [2.2–2.3] (Exp.B = 59) had high chance to get less than 0.4 of inhaled oxygen concentration compared to the patients with BSA <2.0 (p < 0.001).Exp(B) or OR for the patients’ age as independent predictor tested in multiple logistic regression was 0.628 In other words, for every year less the patient had 1/0.628 = 1.6 times more chance to reach the preliminary low margin (0.4) of oxygenation. ConclusionsFixed minimal FGF 0.5 l/min with FiO2 0.8 may not be sufficient for the younger patients with BSA >2.0 to maintain inhaled oxygen concentration above 0.4. Using pure oxygen as a carrier gas during fixed minimal flow long term anesthesia is much safer and more reliable.

High, Low, and Minimal Flow Anaesthesia Management: Effects on Oxygen Reserve Index and Arterial Partial Oxygen Pressure.

To determine the oxygen reserve index (ORI) as a supporting parameter to the arterial partial oxygen pressure (PaO2) in blood gases in hypoxia and hyperoxia monitoring with different fresh gas flows (FGF) in patients undergoing abdominal surgery. Randomised controlled trial. Place and Duration of the Study: Department of Anaesthesiology and Reanimation, Samsun Education and Research Hospital, Turkey, from January to September 2020. The study population of ninety patients was divided into three groups. After the high-flow period, the inspired oxygen fraction (FiO2) and flow-guided ventilation (FGF) were set to be 4 L/m and 40% in Group H (high-flow), 1 L/m and 50% in Group L (low-flow), and 0.5 L/m and 68% in Group M (minimal-flow), respectively. There was a very high statistically positive correlation between PaO2 and ORI in H, L, and M groups. When using a cut-off value of 0.005 for ORI for the detection of PaO2 >100 mmHg, the area under the curve (AUC) was 0.97 (p<0.001) with a sensitivity of 94.4% and specificity of 95.3%. The AUC was detected to be 0.95 in receiver operating characteristic (ROC) analysis when the hyperoxia cut-off value of ORI was used to determine PaO2 >150 mmHg in the estimation of hyperoxia. ORI can be used to complement SpO2 in low-flow anaesthesia in patients undergoing abdominal surgeries, provide guidance for PaO2, give information about tissue oxygen delivery, and contribute to the individualisation of oxygen therapy, and will therefore be included in the standard monitoring in the future. Anaesthesia, Index, Inhalation, Oxygen, Pressure, Surgery.

Comparison of manual and target controlled methods for minimal-flow anesthesia with a laryngeal mask

Comparison of manual and target controlled methods for minimal-flow anesthesia with a laryngeal mask

The Effect of Anaesthesia Management with Different Fresh Gas Flows on Cognitive Functions of Geriatric Patients: A Randomized Double-blind Study.

The present study aimed to compare the effects of two different fresh gas flows (FGFs) (0.5 L min-1 and 2 L min-1) applied during maintenance of anaesthesia on recovery from anaesthesia and early cognitive functions in geriatric patients. In this prospective, randomised, double-blind study, sixty patients were divided into two groups according to the amount of FGF. Minimal-flow anaesthesia (0.5 L min-1 FGF) was applied to group I and medium-flow anaesthesia (2 L min-1 FGF) was applied to group II during maintenance of anaesthesia. Following the termination of inhalation anaesthesia, recovery times were recorded. The evaluation of cognitive functions was performed using the Addenbrooke's Cognitive Examination (ACE-R). There was no significant difference between the two groups in terms of demographic characteristics and recovery (P > 0.05). There was no significant difference between the two groups in terms of the preoperative day, the first postoperative day, and the third postoperative day; ACE-R scores (P > 0.05). In group II, on the third postoperative day ACE-R scores were found to be significantly lower than the preoperative ACE-R scores (P=0.04). In group II, third postoperative day ACE-R memory sub-scores (14.53 ± 3.34) were found to be significantly lower than preoperative ACE-R memory sub-scores (15.03 ± 3.57) (P=0.04). In geriatric patients, minimal-flow anaesthesia was not superior to medium-flow anaesthesia in terms of recovery properties and cognitive functions. Keeping in mind that hypoxaemia and changes in anaesthesia levels may occur with the reduction of FGF, both minimal- and medium-flow anaesthesia can be applied with appropriate monitoring without adverse effects on recovery and cognitive functions.

The effect of minimal and high flow anesthesia on optic nerve sheath diameter in laparotomic gynecological surgery

Background/Aim: Optic nerve sheath diameter (ONSD) is a surrogate parameter for intracranial pressure. This study evaluated the effect of anesthetics on ONSD in women undergoing surgery. We aimed to measure the effect of minimal and high flow anesthesia techniques on expiratory/inspiratory oxygen and carbon dioxide fraction values, hemodynamic parameters, and the optic nerve sheath diameter by ultrasonography in open gynecological surgeries.&#x0D; Methods: In the present prospective cohort study, 80 patients who planned laparotomic gynecological surgery were divided into two groups: a high flow of 2 L/min and a minimum flow of 0.5 L/min. Anesthesia was maintained with 50% oxygen-50% air at 2 L/min and desflurane at 1.1 MAC in Group 1 (n=40) and 50% oxygen-50% air at 0.5 L/min and desflurane at 1.1 MAC in Group 2 (n=40). After 10–15 min, group 2 was administered minimal flow with 50–60% oxygen and 40–50% air at 0.5 L/min desflurane, and 10 min before the end of the surgery, the patients were switched to high flow with 50% oxygen-50% air at 2 L/min.&#x0D; Results: Decreasing heart rates were higher in Group 2 (T0 P=0.001, T2 P=0.007, T3 P=0.035). There was a significant positive correlation between EtCO2 at the 60th min and optic nerve sheath diameter measurements in the minimal flow group (left ONSD r=0.440, P=0.004, right ONSD r=0.473, P=0.002). Although inspiratory oxygen values in Group 2 did not fall below 32%, it was lower than Group 1 except for the last measurement time.&#x0D; Conclusion: Minimal flow anesthesia is as safe as high flow in terms of effects on optic nerve sheath diameter and oxygenation parameters in laparotomic gynecological surgery.

THE EFFECTS OF MINIMAL, LOW AND HIGH FLOW ANESTHESIA ON BODY TEMPERATURE AND TISSUE OXYGENATION IN NASAL SURGERIES

OBJECTIVE: Intraoperative high fresh gas flow may cause Inadvertent perioperative hypothermia (IPH). For this reason, low and minimal flow anesthesia methods that improve the anesthesia climate are applied. We aimed to investigate the effects of minimal, low and high flow anesthesia on body temperature and tissue oxygenation in patients undergoing elective nasal surgery.MATERIAL AND METHODS: Prospective randomized controlled study included 92 patients aged 18-60 years, ASA1-2 operation time 1-4 hours, scheduled for elective nasal surgery under hypotensive anesthesia. The patients were divided into Group 1 (0.5Lmin-1), Group 2 (1Lmin-1) and Group 3 (2 Lmin-1). Demographic and operative data of the patients, preoperative waiting room temperature, intraoperative operating room temperature, intraoperative body temperature, anesthesia breathing circuit humidity and temperature, tissue oxygen saturation, 0th, 15th, 30th, 60th, 90th, 120th, 150thmin and postoperative shivering, Aldrete score, room temperature and body temperatures in the recovery unit were recorded.RESULTS: Perioperative hypothermia developed in all patients (p=0.001). Tympanic temperatures were similar in all three groups (p&amp;gt;0.05). In the subgroup comparison, it was found that the tissue oxygen saturation (StO2) 60 th min value of Group1 was higher than Group 2 (p=0.046). It was found statistically significant that the StO2 90 th min value of Group1 was higher than that of Group 2 and 3 (p=0.013, p=0.013). It was statistically significant that the StO2 120th min value of Group1 was higher than Group 3 (p=0.008).In Group1, postoperativeAldrete score was found to be significantly higher than the other two groups(p=0.002, p=0.002). A correlation was found between operating room temperature, postoperative recovery room temperature, and body temperature(r=.446, p&amp;lt;0.05;r=.531, p&amp;lt;0.01).CONCLUSIONS: Inadvertent perioperative hypothermia developed in all patients who underwent elective nasal surgery with hypotensive anesthesia in minimal, low and high flow anesthesia applications. It was observed that body temperatures, humidity and the temperature of the anesthesia period were similar in all groups. Tissue oxygen saturation was higher in the minimal flow anesthesia group and Aldrete score was higher in the postoperative recovery unit. Minimal flow anesthesia applications can be a good alternative to prevent IPH. However, we think that more studies are needed for the effects of low-flow anesthesia techniques at the tissue level.

Environmental sustainability in the operating room

BACKGROUND The healthcare industry carbon footprint is 5.2% of total CO2 equivalent emissions worldwide. The operating rooms are the most resource demanding areas in hospital care and the higher energy demands, lack of effective waste management, and inhaled anaesthetic use, lead to a high carbon footprint. There is wide variation in the carbon footprint of inhaled gases, with desflurane ranking 40 times higher than sevoflurane. Other inhaled agents, including N2O and isoflurane, have additional ozone-depleting properties. OBJECTIVE To describe what factors influence the implementation of sustainable anaesthetic strategies. DESIGN An international survey. SETTING Anaesthesia clinicians worldwide between April 2021 and April 2022. PARTICIPANTS One thousand two hundred and thirty-seven anaesthesia clinicians from 75 countries. MAIN OUTCOME MEASURES The primary outcome was a determination of the most used anaesthetic plans among anaesthesia practitioners. Secondary outcomes included an assessment of the influence of various socioeconomic variables on anaesthetic decision-making, and on the level of the practitioners’ awareness of peri-operative environmental sustainability. RESULTS Sixty-four percent of respondents use inhaled anaesthetics on a daily basis, with 83% preferring sevoflurane, and only 5% using N2O regularly. Forty-five percent do not know which halogen gas has the highest carbon footprint. Fifty-one percent do not use low flow anaesthesia regimes (&lt;1.0 l min-1) due to concerns about CO2 rebreathing (30%), hypoxia (25%), compound A related renal failure (12%) or CO generation (10%). Only 15% use minimal flow anaesthesia (&lt;0.5 l min-1). There is a correlation between higher income countries and implementation of more sustainable strategies, probably due to better access to updated technology and sustainability education programmes. Desflurane is used in 6 to 12% of the cases regardless of the GDP index. CONCLUSIONS Halogen gases are the most frequently used anaesthetic drugs worldwide. The majority of respondents are unaware of their global warming impact, or are not influenced in their anaesthetic choices by environmental concerns. More sustainable alternatives of anaesthesia are under-implemented, and vary significantly among countries depending on their GDP index. Further education and training in sustainability is needed.

MINIMAL FLOW ANESTHESIA, ITS PLACE IN PERIOPERATIVE MANAGEMENT IN PATIENTS WITH HIATAL HERNIA

Is relevant to study the perioperative use of minimal gas flow (minimal flow) during inhalation anesthesia in patients undergoing laparoscopic surgical interventions, in particular with hiatal hernia (HH).&#x0D; The aim of the study. To study the possibility of using minimal flow anesthesia with sevoflurane and evaluate its place in the perioperative management of patients with HH.&#x0D; Material and methods. The study was prospective, not randomized: 128 patients with HH, who underwent laparoscopic cruroraphy with Nissen fundoplication under general anesthesia with sevoflurane with low and minimal gas flow. Age 33-78 years, ASA II-III. (m.-67, w-61). ). In group I (n=66) Fresh Gas Flow (FGF) = 1,0 l/min, in group II (n=62) – FGF ≤0,5 l/min. All patients underwent personalized perioperative energy monitoring using indirect calorimetry.&#x0D; The results. The baseline metabolic parameters were without disturbance and significantly exceeded the basal metabolism. Anesthesia in Group I with a gas flow of 1 L/min was more stable, manageable and predictable. In group II with gas flow ≤ 0,5 l/min, at the stage of crurorrhaphy and fundoplication, there was a decrease in the FiO2–FeO2 gradient to 4,4% and a metabolic disorder of 27,2%, which in 14 (22,6%) patients needed a transition for low flow ventilation mode with gas flow 1l/min.&#x0D; Conclusions. Personalized perioperative energy monitoring makes it safer to perform inhalation anesthesia with gas flow ≤0,5 l/min. in patients with HH.

Feasibility, safety, and economic consequences of using minimal flow anaesthesia by Maquet FLOW-i equipped with automated gas control

Low fresh gas flow rates are recommended because of their benefits, however, its use is limited due to associated risks. The main purpose of this study was to investigate whether 300 mL of fresh gas flow that practised with automated gas control mode is applicable and safe. The second aim is to show that automated mode can provide economic benefits. Sixty hepatectomy cases who suitable criterias were included to cohort study in three groups as prospective, sequential, observational. An operating room were allocated only for this study. 300 mL fresh gas flow with automated mode (groupA3), 600 mL fresh gas flow with automated mode (groupA6) and, 600 mL fresh gas flow with manually (groupM6) was applied. Patients’ respiratory, hemodynamic parameters (safety), number of setting changes, O2 concentration in the flowmeter that maintained FiO2:0.4 during the low flow anaesthesia (feasibility) and comsumption data of anaesthetic agent and CO2 absorber (economical) were collected and compared. p < 0.05 was accepted as statistical significance level. No significant differences were detected between the groups in terms of demographic data and duration of operation. Safety datas (hemodynamic, respiratory, and tissue perfusion parameters) were within normal limits in all patients. O2 concentration in the flowmeter that maintained FiO2:0.4 was statistically higher in groupA3 (92%) than other groups (p < 0.001) but it was still within applicable limits (below the 100%). Number of setting changes was statistically higher in groupM6 than other groups (p < 0.001). The anaesthetic agent consumption was statistically less in groupA3 (p = 0.018). We performed fresh gas flow of 300 mL by automated mode without deviating from the safety limits and reduced the consumption of anaesthetic agent. We were able to maintain FiO2:0.4 in hepatectomies without much setting changes, and we think that the automated mode is better in terms of ease of practise.

The effect of minimal-flow and high-flow hypotensive anesthesia on oxidative stress

Objective: The main objective of this study was to compare the effects of minimal and high gas flow-controlled hypotension applications on IMA and thiol/disulfide balance, which are indicators of oxidative stress.Methods: Patients undergoing elective tympanoplasty were randomized to two groups as minimal-flow and high-flow anesthesia groups. Minimal flow anesthesia was performed with 5L/min fresh gas flow reduced to 0.4 L/min. High flow was administered as 2 L/min fresh gas. Preoperative and intraoperative SpO2, StO2, EtCO2, mean arterial pressure and heart rate values were recorded. Preoperative and intraoperative IMA, total thiol, native thiol, disulfide, disulfide/native thiol and disulfide/total thiol values were recorded and compared between the two groups. Results: The mean intraoperative arterial pressure was statistically notably higher in the high flow group (p=0.048). The mean intraoperative SPO2 value was remarkably higher in the minimal flow group (p=0.032). The mean EtCO2 value was notably lower in the minimal flow group at 5 minutes and 15 minutes of the operation (p=0.029; p=0.048). The mean preoperative and intraoperative IMA values were statistically notably higher in the minimal flow group compared to the high flow group (for both, p=0.001). There was no remarkable difference between the groups in terms of the other monitored parameters (for all, p&amp;gt;0.05).Conclusion: IMA value was found to be significantly higher with minimal-flow anesthesia. However, no notable difference was found in terms of thiol/disulfide homeostasis, indicating the need for further comprehensive studies in order to draw a definitive conclusion

Non-invasive control of oxygen consumption during inhalation anesthesia of antireflux laparoscopic interventions by the method of Minimal flow

Aim: to study the features of the general anesthesia of antireflux laparoscopic interventions in abdominal surgery using sevoflurane by the method of Low flow, Minimal flow from the standpoint of the ERAS protocol.Materials and methods. The study was conducted at State Institution of Science “Research and Practical Centre of Preventive and Clinical Medicine” of State Administrative Department, it was prospective and not randomized. Forty patients with esophageal hernia of the diaphragm, who underwent laparoscopic crurorraphy and Nissen fundoplication were examined. The age of patients ranged from 21 to 76 years. There were 10 men (25 %) and 30 women (75 %). Patients enrolled in the study had informed consent to be examined, tested, and processed. All patients underwent combined low-flow inhalation anesthesia with sevoflurane in combination with perioperative multimodal analgesia during surgery. Patients were divided into 2 groups. The first group – Low flow anesthesia (n = 20) included patients who underwent combined inhalation anesthesia with sevoflurane with a flow of fresh gas mixture (FGF) 1.0 l/min, the second group – Minimal flow anesthesia (n = 20 ) included patients who underwent combined inhalation anesthesia with sevoflurane with a fresh gas mixture (FGF) flow of 0.5 l/min. In the study, we analyzed monitoring indicators, which included registration of non-invasive blood pressure, heart rate, 5-lead electrocardiography, registration of peripheral oxygen saturation (SrO2) + plethysmogram, depth of anesthesia according to BIS, working pressure in the operating space. Gas exchange indicators – capnography, oxygen and sevoflurane concentration in the mixture during inhalation and exhalation, ventilation parameters were constantly monitored. The monitoring is supplemented by our developed and patented method of intraoperative non-invasive control of oxygen consumption by the patient during inhalation anesthesia in the operating room.Formation, storage, analysis of electronic database, statistical data processing and visualization of research results were performed in license packages: MedStat v. 4. and Microsoft Office.Results. In the study of oxygen consumption by patients of the first and second groups, it was found that at stages 3 and 4 of surgery VO2 was higher compared to stages 1, 2, 5, 6. Statistically significant differences in VO2 in the study periods in the first and second groups were not detected. In both subgroups, there was no significant statistical difference between the indicators of BIS at the stages of surgery during 2–6 stages of the study, which were at the level of the surgical stage of anesthesia.Conclusions. Monitoring of oxygen consumption by the patient is one of the criteria of intraoperative safety of the patient and adequacy of anesthesia. Oxygen consumption by the patient at all the stages of surgery makes it possible to claim that use of the method of Minimal flow anesthesia is safe for the patient.

I-gel supraglottic airway use is efficient and safe during minimal flow anesthesia with volume controlled ventilation - a randomized controlled trial

Background: A fear of potential gas leak limits the wide spread use of minimal flow anesthesia with supraglottic airway devices. Second generation supraglottic airway devices have been claimed to be come with good airway seal. I-gel is one of these and it has been extensively evaluated for spontaneous as well as assisted ventilation. We conducted this study to evaluate its use with low flow anesthesia and volume controlled ventilation.&#x0D; Methodology: In a prospective randomized controlled trial, 50 patients undergoing laparoscopic surgeries for less than 2 h duration were administered general anesthesia, with controlled ventilation, using either endotracheal tube or an I-gel for airway control. The total fresh gas flow was gradually reduced until it was 400 mL/min. Patients were monitored for evidence of loss of respiratory gas volume in the breathing circuit and other parameters for ventilation failure.&#x0D; Results: Ventilation could be maintained at a fresh gas flow of 400 mL/min, without clinical or volumetric evidence of gas leak in all patients in the two groups. Two patients in the I-gel group had intraoperative gas leak leading to ventilator failure alarm but the same was corrected by repositioning of the head. The vital signs, peak airway pressure, end-tidal carbon dioxide, set tidal volume and expired tidal volumes were statistically similar in the two groups.&#x0D; Conclusion: I-gel supraglottic airway can be safely and efficiently used for laparoscopic surgery using minimal flow anesthesia and volume controlled ventilation.&#x0D; Citation: Khan A, Kapoor MC, Garg S, Puri A, Sinha A. I-gel supraglottic airway use is efficient and safe during minimal flow anesthesia with volume controlled ventilation - a randomized controlled trial. Anaesth pain intensive care 2020;24(1):__&#x0D; Abbreviations: Supraglottic airway device – SAD; Volume controlled ventilation – VCV; Pressure controlled ventilation – PCV; Endotracheal tube – ETT; Laryngeal Mask Airway - LMA&#x0D; &#x0D; DOI: https://doi.org/10.35975/apic.v24i1.&#x0D; Received – 11 June 2019;&#x0D; Reviewed – 20, 23 October 2019;&#x0D; Revised – 31 January 2020;&#x0D; Second Review – 2, 7 January 2020;&#x0D; Accepted – 02 February 2020;

FEATURES OF PERIOPERATIVE MANAGEMENT OF PATIENTS AT LAPAROSCOPIC ANTIREFLUX INTERVENTIONS

Aim. The analyzing current available literature on the problem of anesthesiology of antireflux interventions in patients with hernias of the esophageal aperture.&#x0D; Materials and methods. Biblosemantic, comparative and systems analysis. The suggested recommendations are based on the data of contemporary literature analysis, the results of randomized trials and meta-analyzes, devoted to the study of the problem of anesthesiology of antireflux surgery.&#x0D; Results and discussion. The analyzing the problems of anesthesia and analgesia in patients with hernias of the esophageal aperture, it is necessary following next concepts: general inhalation anesthesia in laparoscopic surgery, should be taking into account the technical features of surgery, as well as, the injection and diffusion of CO2 in tissue in time of carboperitoneum, in the same time, besides that to guarantee rapid awakening of the patient without residual sedation. The possibility of developing specific late complications, as well as, ruptures of the esophagus and stomach, pneumothorax makes adjustments in the tactics of the introduction in this category of patients in the perioperative period.The choice of anesthesia method is greatly determined the length of the post-anesthetic rehabilitation period, the stay of the patient with artificial ventilation of the lungs, the need and the length of stay in the intensive care unit.&#x0D; Conclusions. Ourday the question is still remain, which of the methods of inhalation anesthesia Low flow anesthesia or Minimal flow anesthesia is better, in the case of the requirements of comfort, patient’ safety and pharmacoeconomic feasibility.The principles of accelerated rehabilitation are possible not only if the surgical invasion is reduced, but also with the use of managed general anesthesia with adequate perioperative anesthesia.The operation of the patient in time is the best method of prevention of many early and delayed complications of the postoperative period. This provision has been validated by numerous clinical trials and is rarely take into account at present.The ideology of inhaled anesthesia involves not only sufficient control over the depth of anesthesia, but also predictability at the stage of anesthesia.

Hysteresis Loop Can be an Adjunct Monitoring for Neuromuscular Blockade while on Controlled Ventilation During Low- and Minimal-Flow Anaesthesia.

Hysteresis Loop Can be an Adjunct Monitoring for Neuromuscular Blockade while on Controlled Ventilation During Low- and Minimal-Flow Anaesthesia.

The Effect of Minimal, Low and Medium Flow Anesthesia on Intraoperative Neuromuscular Blocker Consumption: Prospective Cohort Study

The Effect of Minimal, Low and Medium Flow Anesthesia on Intraoperative Neuromuscular Blocker Consumption: Prospective Cohort Study

Perioperative challenges in a primary hyperparathyroid patient with osteitis fibrosa cystic and borderline QTc: a case-based review and practice analysis

&lt;b&gt;Introduction:&lt;/b&gt; Perioperative care of primary hyperparathyroidism patients is a significant challenge. The challenge increases when the preoperative optimization of the patient is suboptimal due to any reason. Concomitant complications like osteitis fibrosa cystic, renal involvement, and multiple electrolyte abnormalities predispose these patients towards multiple morbidities and even mortality during the perioperative period. It is known that the hypercalcemia causes shortened QT, and the inhalational and intravenous anesthesia drug-induced QT prolongation is likely to be buffered. On the other hand, prolonged QTc in primary hyperparathyroid patients in the presence of hypercalcemia is more uncommon, but an extremely challenging situation for anesthesiologists as these patients are more prone to torsadogenesity. &lt;br&gt;&lt;b&gt;Materials and methods:&lt;/b&gt; A case-based review is presented in this paper. To review the current practice and opinions, we searched PubMed and Google Scholar using the advanced search engine with the combination index words of primary hyper-parathyroidism, anesthesia, anaesthesia, anesthesia management, and anaesthesia management with a time frame of January 1, 2000, to August 30, 2018. &lt;br&gt;&lt;b&gt;Results:&lt;/b&gt; The results are enumerated in the text. Although anesthetic management of primary hyperparathyroid patients is available in the literature, anesthetic management of primary hyperparathyroid patients with prolonged or borderline QTc is not well described. In this paper, we present a case that was successfully managed using Desflurane based minimal flow anesthesia, which is probably also the first of such. &lt;br&gt;&lt;b&gt;Conclusion:&lt;/b&gt; Balanced anesthesia with Propofol induction and modern inhalational agents for maintenance and non-depolarizing neuromuscular blockade appears to be safe method of anesthesia.

Comparison of the Effects of Minimal and High-Flow Anaesthesia on Cerebral Perfusion During Septorhinoplasty.

The aim of this study was to analyse the effects of minimal-and high-flow anaesthesia on cerebral oxygenation during septorhinoplasty with controlled hypotension using near-infrared spectroscopy. Eighty patients scheduled for septorhinoplasty under general anaesthesia with controlled hypotension were randomised into two groups: minimal-flow (MF) or high-flow (HF). Both groups received desflurane anaesthesia to maintain bispectral index values at 40%-50% and 0.25-0.5 μg kg-1 min-1 i.v. remifentanyl infusion to maintain mean arterial blood pressure between 55 and 65 mmHg. The MF group received 5 L min-1 of fresh gas flow for the first 10 mins then the gas flow was reduced 0.4 L min-1. The HF group received 2 L min-1 of fresh gas flow throughout. Haemodynamic parameters and cerebral oxygen saturation were measured. There were no statistical differences in demographic variables, duration of anaesthesia and surgery, time to extubation and proceeding to an Aldrete score of 9. There were no statistical differences in haemodynamic parameters, end-tidal CO2 and cerebral oxygen saturation. The amount of desflurane used in the MF group was significantly lower than that used in the HF group (30.5±9.8 mL vs. 48.5±12.1 mL; p<0.05). MF and HF anaesthesia did not lead to any difference in cerebral oxygen saturation in patients undergoing septorhinoplasty with controlled hypotension. MF anaesthesia may thus be used as safely as HF anaesthesia is.

Minimal flow anesthesia can be initiated early with the use of higher fresh gas flow to facilitate desflurane "Wash-in".

Background and Aims:More than 80% of delivered anesthetic gases get wasted at high fresh gas flows as they are vented out unused. Use of minimal flow anesthesia is associated with less waste anesthetic gas emission and environmental pollution. There is no approved or validated technique to initiate minimal flow anesthesia and simultaneously achieve denitrogenation of the breathing circuit. We studied the wash-in characteristics of desflurane, when delivered with 50% nitrous oxide, to reach a target end-tidal concentration at two different gas flow rates.Material and Methods:Patients were allocated randomly to two groups of 25 adults each. In Group A, with the vaporizer dial fixed at 4 vol %, after an initial fresh gas flow of 4 L/min was administered to wash-in of desflurane using the closed-circuit, with 50% N2O in O2, and in group B, 6 L/min was used. Minimal flow anesthesia, with 0.5 L/min, was initiated in both groups on attaining a target end-tidal desflurane concentration of 3.5 vol %. After initiation of desflurane delivery, the inspired/expired gas concentrations were noted every minute for 15 min.Results:In Group A, the target desflurane end-tidal concentration was reached in 499.2 ± 68.6 s±, and in the Group B (P < 0.001), it was reached significantly faster in 314.4 ± 69.89 s. Denitrogenation of the circuit was adequate in both groups.Conclusion:Minimal flow anesthesia can be initiated, without any gas-volume deficit, in about 5 min with an initial fresh gas flow rate of 6 L/min and the vaporizer set at 4 vol%.