Minimal Flow Anesthesia, Its Place in Perioperative Management in Patients With Hiatal Hernia

Abstract

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).
 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.
 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.
 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.
 Conclusions. Personalized perioperative energy monitoring makes it safer to perform inhalation anesthesia with gas flow ≤0,5 l/min. in patients with HH.