Low-flow anaesthesia with desflurane: kinetics during clinical procedures

Johansson, Anders; Lundberg, Dag; Luttropp, H. H.

doi:10.1046/j.1365-2346.2001.00872.x

Cited by 12 publications

(16 citation statements)

References 22 publications

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“…As per Johansson et al, 4 with a vaporizer setting of 5%, the InsDes and EtDes concentrations in the 1.0 L/ min group after 120 min were 4.54% vs. 4.37%. In the 2.0 L/min group, the InsDes and EtDes concentrations were 4.76% vs. 4.58%.…”

Section: Comparison Of Inspired and End-tidal Desflurane Concentrationssupporting

confidence: 61%

“…We monitored the inspired and end tidal concentrations of O 2 , N 2 O and CO 2 . A similar study was done by Johansson et al 4 in 2001 to determine inspired and end tidal concentrations of desflurane at 1 and 2 L/min fresh gas flow. They studied 56 patients (28 patients in each group) scheduled for elective surgery of an expected anaesthesia time of at least 120 min.…”

Section: Discussionmentioning

confidence: 83%

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Pharmacokinetics of Desflurane in Clinical Setting: At Two Different Flow Rate

Potdar¹,

Kamat²,

Mahevi³

2018

Journal of Research &Amp; Innovation in Anesthesia

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Introduction: Desflurane due to its favorable quality of quick wash in and wash out has gained popularity as a preferred inhalational anesthetic agent for low flow anesthesia (LFA) which can be costeffective, minimizing the operation theatre pollution. This study was conducted to assess the pharmacokinetic effects and safety of desflurane in lower flow rates. Aim:To compare the pharmacokinetics of desflurane by assessing its inspired and end tidal concentrations at fresh gas flow (FGF) of 1 and 1.5 L/min.To compare the inspired and end tidal concentrations of oxygen, nitrous oxide at 1 and 1.5 L/min FGF, to assess the safety as per adequate oxygenation and depth of anesthesia, haemodynamic stability, consumption of gases, MAC values and incidence of awareness.Materials and methods: One hundred patients were included and divided into two groups of 50 each of ASA grades I and II undergoing general anesthesia for laparoscopic abdominal surgeries. They were maintained with FGF of group A-1 L/min, group B-1.5 L/min All patients were monitored for hemodynamics, entropy, inspired and expired concentration of desflurane, oxygen, nitrous oxide, MAC values at FGF depending on the group with O 2 :N 2 O 50:50 and 5% desflurane. The recovery parameters, side effects and awareness were noted. Results:We found that Inspired and end tidal concentrations of desflurane were significantly different for both groups, but the difference between inspired and end tidal concentrations and ratio of end tidal to vaporizer setting were comparable as the duration of anesthesia increases suggesting saturation being achieved. The inspired and end tidal concentrations of oxygen were significantly different but were maintained at adequately safe levels. Hemodynamics were maintained and comparable in both the groups. The MAC values and requirements of desflurane, oxygen and nitrous oxide were higher in group B and recovery took significantly longer time. The incidence of side effects were comparable and none of the patients experienced awareness. Conclusion:The pharmacokinetics of desflurane favour the use of LFA. Conducting anaesthesia at a FGF 1 L/min was equally safe and there was no added advantage of using 1.5 L/min FGF. In today's modern era low flow anesthesia can be safely practiced and reduces the cost and environmental pollution.Clinical significance: Desflurane can be used efficiently at lower rates with the advantage of reducing the cost and not jeopardising the safety as per the oxygenation, hemodynamic stability and depth of anesthesia.

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Section: Comparison Of Inspired and End-tidal Desflurane Concentrationssupporting

confidence: 61%

Section: Discussionmentioning

confidence: 83%

Pharmacokinetics of Desflurane in Clinical Setting: At Two Different Flow Rate

Potdar¹,

Kamat²,

Mahevi³

2018

Journal of Research &Amp; Innovation in Anesthesia

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“…After achieving the required F A D, the FGF can be reduced to a low flow anesthesia range of 0.5–1 L/min and the target F A D can be simply maintained by setting the desflurane above the F A D by 1%–2%. 3 , 18 …”

Section: Discussionmentioning

confidence: 99%

1-1-12 one-step wash-in scheme for desflurane low flow anesthesia: performance without nitrous oxide

Sathitkarnmanee

Tribuddharat

Nonlhaopol

et al. 2015

DDDT

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BackgroundWe reported a 1-1-12 wash-in scheme for desflurane-nitrous oxide (N2O) low flow anesthesia that is simple, rapid, and predictable. There remain some situations where N2O should be avoided, which limits the generalizability of this wash-in scheme. The objective of our study was to determine the performance of this scheme in contexts where N2O is not used.MethodsWe recruited 106 patients scheduled for elective surgery under general anesthesia. After induction and intubation, wash-in was started with a fresh gas flow of air:O2 1:1 L/min and a vaporizer concentration of desflurane of 12%. Controlled ventilation was then adjusted to maintain PACO2 at 30–35 mmHg.ResultsThe alveolar concentration of desflurane (FAD) rose rapidly from 0% to 6% in 4 minutes in the same pattern as observed in our previous study in which N2O was used. An FAD of 7% was achieved in 6 minutes. An FAD of 1% to 7% occurred at 0.6, 1, 1.5, 2, 3, 4, and 6 minutes. The rise in heart rate during wash-in was statistically significant, although not clinically so. There was a slight but statistically significant decrease in blood pressure, but this had no clinical significance.ConclusionPerformance of the 1-1-12 wash-in scheme is independent of the use of N2O. Respective FADs of 1%, 2%, 3%, 4%, 5%, 6%, and 7% can be expected at 0.6, 1, 1.5, 2, 3, 4, and 6 minutes.

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“…The fact that this scheme can achieve F A D of 6% within 4 min makes it ideal for inhalation anesthesia initiation without hyperexcitation. After achieving the required specific target, one can reduce the FGF to LFA range of 0.5 to 1 L min −1 and maintain the target F A D by simply setting the FD above the target by 1-2% [3, 12]. …”

Section: Discussionmentioning

confidence: 99%

1-1-12 One-Step Wash-In Scheme for Desflurane-Nitrous Oxide Low-Flow Anesthesia: Rapid and Predictable Induction

Sathitkarnmanee

Tribuddharat

Suttinarakorn

et al. 2014

BioMed Research International

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Background. We propose a 1-1-12 wash-in scheme for desflurane-nitrous oxide (N2O) low-flow anesthesia. The objective of our study was to determine the time to achieve alveolar concentration of desflurane (FAD) at 1, 2, 3, 4, 5, and 6%. Methods. We enrolled 106 patients scheduled for elective surgery under general anesthesia. After induction and intubation, wash-in was started with a fresh gas flow (FGF) of N2O : O2 1 : 1 L min−1 and vaporizer concentration of desflurane (FD) of 12%. Ventilation was controlled to maintain PACO2 at 30–35 mmHg. Results. The FAD rose rapidly from 0 to 4% in 2 min in a linear manner in 0.5 min increments. An FAD of 6% was achieved in 4 min in a linear fashion from FAD of 4% but in 1 min increments. An FAD of 1 to 6% occurred at 0.6, 1, 1.5, 2, 3, and 4 min. Heart rate during wash-in showed a statistically, albeit not clinically, significant pattern of increase. By contrast, blood pressure slightly decreased during this period. Conclusions. We developed a 1-1-12 wash-in scheme using a FGF of N2O : O2 1 : 1 L min−1 and FD of 12% for desflurane-nitrous oxide low-flow anesthesia. A respective FAD of 1, 2, 3, 4, 5, and 6% can be expected at 0.6, 1, 1.5, 2, 3, and 4 min.

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Low-flow anaesthesia with desflurane: kinetics during clinical procedures

Abstract: There is a significant difference between the inspired and end-tidal concentrations of desflurane when fresh gas inflows were 1.0 and 2.0 L min-1, but not for the ratio of inspired/end-tidal.

Cited by 12 publications

References 22 publications

Pharmacokinetics of Desflurane in Clinical Setting: At Two Different Flow Rate

Pharmacokinetics of Desflurane in Clinical Setting: At Two Different Flow Rate

1-1-12 one-step wash-in scheme for desflurane low flow anesthesia: performance without nitrous oxide

1-1-12 One-Step Wash-In Scheme for Desflurane-Nitrous Oxide Low-Flow Anesthesia: Rapid and Predictable Induction

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Low-flow anaesthesia with desflurane: kinetics during clinical procedures

Abstract: There is a significant difference between the inspired and end-tidal concentrations of desflurane when fresh gas inflows were 1.0 and 2.0 L min-1, but not for the ratio of inspired/end-tidal.

Cited by 12 publications

References 22 publications

Pharmacokinetics of Desflurane in Clinical Setting: At Two Different Flow Rate

Pharmacokinetics of Desflurane in Clinical Setting: At Two Different Flow Rate

1-1-12 one-step wash-in scheme for desflurane low flow anesthesia: performance without nitrous&nbsp;oxide

1-1-12 One-Step Wash-In Scheme for Desflurane-Nitrous Oxide Low-Flow Anesthesia: Rapid and Predictable Induction

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1-1-12 one-step wash-in scheme for desflurane low flow anesthesia: performance without nitrous oxide