The safety and efficacy of minimal-flow desflurane anesthesia during prolonged laparoscopic surgery

Sang Yoong Park, Chan Jong Chung, Jung Hoon Jang, Jae Young Bae, So Ron Choi, Sang Yoong Park, Chan Jong Chung, Jung Hoon Jang, Jae Young Bae, So Ron Choi

Abstract

Background: Minimal-flow anesthesia can meet the demands of a modern society that is more sensitive to environmental protection and economic burdens. This study compared the safety and efficacy of minimal-flow desflurane anesthesia with conventional high-flow desflurane anesthesia for prolonged laparoscopic surgery.

Methods: Forty-six male patients (ASA physical status II or III) undergoing laparoscopic urologic surgery for more than 6 hours were randomly divided into two groups: the high-flow (HF) group and the minimal-flow (MF) group. The HF group was continuously administered a fresh gas flow of 4 L/min. In the MF group, a fresh gas flow of 4 L/min was administered for the first 20 minutes and was thereafter lowered to 0.5 L/min. Inspiratory and expiratory desflurane concentrations, respiratory variables, and hemodynamic variables were continuously monitored during administration of anesthesia. Measurements of carboxyhemoglobin (COHb) concentration and arterial blood gas analysis were performed every 2 hours during anesthesia. Serum aspartate aminotransferase (AST), alanine aminotransferase (ALT), blood urea nitrogen (BUN) and creatinine were measured on the first and second day after the surgery.

Results: Demographic data and duration of anesthesia were not different between the two groups. Significant differences were not observed between the two groups in terms of hemodynamic variables, respiratory variables, and inspiratory and expiratory desflurane concentrations. Inspiratory O(2) concentration was maintained lower in the MF group than in the HF group (43-53% vs. 53-59%; P < 0.05). Compared with the HF group, COHb concentrations was higher (P < 0.05), but not increased from the baseline value in the MF group. Serum AST, ALT, BUN, and creatinine were not significantly different between the two groups.

Conclusions: In prolonged laparoscopic surgery, no significant differences were found in safety and efficacy between minimal-flow and high-flow desflurane anesthesia.

Keywords: Desflurane; Laparoscopic surgery; Minimal-flow anesthesia.

Figures

Fig. 1
Fig. 1
Changes in heart rate (HR), systolic blood pressure (sBP), and diastolic blood pressure (dBP) during laparoscopic surgery. Values are expressed as mean ± SD. pre-MF: pre-minimal-flow, pre-Pn: pre-pneumoperitoneum, Pn+5, 60, and 120: 5, 60, and 120 minutes after pneumoperitoneum, Pn-e: end of pneumoperitoneum, post-Pn: post pneumoperitoneum, End: before emergence.
Fig. 2
Fig. 2
Changes in inspiratory and expiratory desflurane concentrations. Values are expressed as mean ± SD. pre-MF: pre-minimal flow, pre-Pn: pre-pneumoperitoneum, Pn+5, 60, and 120: 5, 60, and 120 minutes after pneumoperitoneum, Pn-e: end of pneumoperitoneum, post-Pn: post pneumoperitoneum, End: before emergence.
Fig. 3
Fig. 3
Changes in inspiratory oxygen concentrations. Values are expressed as mean ± SD. pre-MF: pre-minimal flow, pre-Pn: pre-pneumoperitoneum, Pn+5, 60, and 120: 5, 60, and 120 minutes after pneumoperitoneum, Pn-e: end of pneumoperitoneum, post-Pn: post pneumoperitoneum, End: before emergence. *P < 0.05 compared with preop values.
Fig. 4
Fig. 4
Changes in COHb concentrations. Values are expressed as mean ± SD. COHb: carboxyhemoglobin. Tbaseline: before induction at room air, T2, T4, and T6: 2, 4, and 6 hours after induction, Trecovery: recovery room after extubation. *P < 0.05 compared with high flow values.

References

    1. Lee JK, Um SY, Chung CJ, Chin YJ. Comparison of enflurane consumptions and costs in low-flow and high-flow anesthesia. Korean J Anesthesiol. 1999;37:574–579.
    1. Chung CJ, Ko DK, Lee HJ, Lee SI. Clinical evaluation of low flow enflurane anesthesia in infants. Korean J Anesthesiol. 2000;39:523–527.
    1. Choi SR, Cho WJ, Chin YJ, Chung CJ. The effects of prolonged minimal-flow sevoflurane anesthesia on postoperative hepatic and renal function. Korean J Anesthesiol. 2008;54:501–506.
    1. Virtue RW. Minimal flow nitrous anesthesia. Anesthesiology. 1974;40:196–198.
    1. Fang ZX, Eger EI, 2nd, Laster MJ, Chortkoff BS, Kandel L, Ionescu P. Carbon monoxide production from degradation of desflurane, enflurane, isoflurane, halothane, and sevoflurane by soda lime and Baralyme. Anesth Analg. 1995;80:1187–1193.
    1. Baxter PJ, Kharasch ED. Rehydration of desiccated Baralyme prevents carbon monoxide formation from desflurane in an anesthesia machine. Anesthesiology. 1997;86:1061–1065.
    1. Knolle E, Heinze G, Gilly H. Carbon monoxide formation in dry soda lime is prolonged at low gas flow. Anesth Analg. 2001;93:488–493.
    1. Baxter AD. Low and minimal flow inhalational anaesthesia. Can J Anaesth. 1997;44:643–652.
    1. Shiraishi Y, Ikeda K. Uptake and biotransformation of sevoflurane in humans: a comparative study of sevoflurane with halothane, enflurane, and isoflurane. J Clin Anesth. 1990;2:381–386.
    1. Yasuda N, Lockhart SH, Eger EI, 2nd, Weiskopf RB, Johnson BH, Freire BA, et al. Kinetics of desflurane, isoflurane, and halothane in humans. Anesthesiology. 1991;74:489–498.
    1. Mchaourab A, Arain SR, Ebert TJ. Lack of degradation of sevoflurane by a new carbon dioxide absorbent in humans. Anesthesiology. 2001;94:1007–1009.
    1. Liu J, Laster MJ, Eger EI, 2nd, Taheri S. Absorption and degradation of sevoflurane and isoflurane in a conventional anesthetic circuit. Anesth Analg. 1991;72:785–789.
    1. Langbein T, Sonntag H, Trapp D, Hoffmann A, Malms W, Röth EP, et al. Volatile anaesthetics and the atmosphere: atmospheric lifetimes and atmospheric effects of halothane, enflurane, isoflurane, desflurane and sevoflurane. Br J Anaesth. 1999;82:66–73.
    1. Oyaro N, Sellevag SR, Nielsen CJ. Atmospheric chemistry of hydrofluoroethers: Reaction of a series of hydrofluoroethers with OH radicals and Cl atoms, atmospheric lifetimes, and global warming potentials. J Phys Chem A. 2005;109:337–346.
    1. Ryan SM, Nielsen CJ. Global warming potential of inhaled anesthetics: application to clinical use. Anesth Analg. 2010;111:92–98.
    1. Wald NJ, Idle M, Boreham J, Bailey A. Carbon monoxide in breath in relation to smoking and carboxyhaemoglobin levels. Thorax. 1981;36:366–369.
    1. Frink EJ, Jr, Nogami WM, Morgan SE, Salmon RC. High carboxyhemoglobin concentrations occur in swine during desflurane anesthesia in the presence of partially dried carbon dioxide absorbents. Anesthesiology. 1997;87:308–316.
    1. Soro M, García-Pérez ML, Ferrandis R, Aguilar G, Belda EJ. Closed-system anaesthesia for laparoscopic surgery: is there a risk for carbon monoxide intoxication? Eur J Anaesthesiol. 2004;21:483–488.
    1. Baum J, Sachs G, vd Driesch C, Stanke HG. Carbon monoxide generation in carbon dioxide absorbents. Anesth Analg. 1995;81:144–146.
    1. Strauss JM, Bannasch W, Hausdorfer J, Bang S. The evolution of carboxyhemoglobin during long-term closed-circuit anesthesia. Anaesthesist. 1991;40:324–327.

Source: PubMed

Szponzorok és közreműködők

Egészségi állapot

Kábítószer-beavatkozások

3
Iratkozz fel