Bispectral index and cerebral oximetry in low-flow and high-flow rate anaesthesia during laparoscopic cholecystectomy - a randomized controlled trial.

Abstract

IntroductionThe need to reduce pollution emissions in the operating room and to reduce treatment costs motivates more frequent use of general anaesthesia with a small or minimal fresh gas flow rate. Nevertheless, the reduction of the delivery of fresh gases should not influence the quality and safety of the anaesthesia.Material and methodsA total of 105 elective laparoscopic cholecystectomy patients were included in the study. There were 72 female (68.6%) and 33 male (31.4%) patients. Patients were randomized by a ‘closed envelope’ method into two groups. Group I included patients with low-flow anaesthesia and group II included patients with high-flow anaesthesia. In all patients the cerebral oximetry was measured separately for each cerebral hemisphere; the bispectral index (BIS), heart rate, blood pressure, end-tidal carbon dioxide concentration and haemoglobin oxygen saturation were monitored.ResultsHeart rate, blood pressure, end-tidal carbon dioxide concentration and saturation were similar in both groups and the differences between them were statistically insignificant. The BIS values were similar in both groups and indicated that patients who underwent low-flow anaesthesia were not exposed to a higher risk of awakening during the procedure than the high-flow anaesthesia patients. The changes in brain oximetry values were similar in both low-flow and high-flow anaesthesia.ConclusionsUse of both low-flow and high-flow rate general anaesthesia provided patients undergoing laparoscopic cholecystectomy proper oxygenation of the central nervous system, adequate sleep depth and haemodynamic stability.

Influence of intra-abdominal pressure on the amplitude of fluctuations of cerebral hemoglobin concentration in the respiratory band

“…We did not observe any significant changes in the tissue oxygen saturation while increase in the IAP. This observation is in a good agreement with reports of other authors [23][24][25][26][27][28][29][30][31] where only small changes (increase or decrease) in the saturation were noted. In 3 out of 8 studies no significant changes in StO2 were reported.…”

Comparison of effects of low-flow and normal-flow anesthesia on cerebral oxygenation and bispectral index in morbidly obese patients undergoing laparoscopic sleeve gastrectomy: a prospective, randomized clinical trial.

“…We did not observe significant differences between low-flow and normal-flow groups with respect to HR and SpO 2 . Similarly, Kupisiak et al reported no significant differences between patients who received low-flow and high-flow anesthesia during laparoscopic cholecystectomy with respect to HR, MAP, EtCO 2 , and SpO 2 ; patients also did not have a high risk of awakening from anesthesia [9]. Although we found that the MAPs of the low-flow group were significantly higher than the normal-flow group at T 2 , T 3 , and T 4 , the higher MAPs were considered clinically negligible because the MAPs did not increase by 20% above baseline during surgery.…”

“…On the other hand, BIS is the most effective method for assessing depth of anesthesia and sedation. BIS monitoring reduces the number of intraoperative wake-ups in patients [9].…”

Effects of Low-Flow Sevoflurane Anesthesia on Pulmonary Functions in Patients Undergoing Laparoscopic Abdominal Surgery

“…A few groups have studied the effects of low-flow anesthesia on hemodynamic and pulmonary functions and in these studies isoflurane and desflurane were used as volatile anesthetic agents [ 18 , 23 ]. Bilgi et al [ 1 ] compared FVC and FEV1 levels after low-flow and high-flow anesthesia with desflurane as the inhalation anesthetic agent and observed a decrease in FVC and FEV1 levels in both groups on the postoperative first day, but, in the low-flow anesthesia group, the decrease was much greater than in the high-flow anesthesia group.…”