Comparison between Low Flow and High Flow Sevoflurane Isocapnic Technique to Achieve Early Recovery after Surgery (ERAS)
Abstract
Objective. The purpose of this study was to compare recovery time between low flow and high flow sevoflurane isocapnic anesthesia techniques, as well as the total consumption of sevoflurane.
Design. This study was an observational single-blind randomized trial
Setting. Operating room.
Patients. Total 40 patients from both gender, 18 to 60 years old, BMI 18.5-29.99 kg/m2 with physical status ASA I or II, that scheduled for elective surgery under general anesthesia approximately between 3-5 hours were selected for this study.
Intervention. Selected patients divided randomly into two groups (n=20 each). First group was given low flow sevoflurane, delivered with initial flow 6 L/min until MAC 0.9 or expiration level of sevoflurane 2.2 vol% then reduced flow to 0.5 L/min; second group with high flow technique  4L/min after induction.
Measurement. The duration of operation, duration of anesthesia, time reaching of BIS 75, eye-opening with command, extubation, moving into the recovery room and when reaching Modified Aldrete score 10.
Main Results: Based on statistics, sample characteristics, hemodynamic conditions, length of anesthesia and number of fentanyl were not significantly different. There was a significant difference on post anesthesia recovery time between low flow and high flow anesthesia time BIS 75: 1.7 (± 0.801) vs 7.05 (± 3.956), p<0.001, eye-opening time: 5.45 (± 3.82) vs. 14.86 (± 7.945 ), p<0.001, extubation time: 5.8 (± 2.783) vs. 15.29 (± 8.776), p<0.001, moving into recovery room: 15.35 (± 5.133) vs. 23.52 (± 12.213), p=0.021, time reaching modified aldrete 10: 8.95 (± 4.211) vs. 29 (± 18,091), p<0.001).
Conclusion: Recovery time after general anesthesia using low flow sevoflurane isocapnic anesthesia technique is faster than the high flow anesthesia technique with less sevoflurane consumption.
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Senapathi, T., Suarjaya, I., Pradhana, A., Makmur, E. Low Flow Anesthesia Will Gain Eras (Enhanced Recovery After Surgery). Bali Journal of Anesthesiology 2017; 1(3): 51-54. DOI:10.15562/bjoa.v1i3.24
Melnyk M, Casey RG, Black P, Koupparis AJ. Enhanced Recovery After Surgery (ERAS) protocols: Time to change practice?. Journal of the Canadian Urological Association 2011. p. 342–8. DOI: 10.5489/cuaj.11002
Hönemann C, Hagemann O, Doll D. Inhalational Anesthesia With The Low Fresh Gas Flow. Indian J Anaesth 2013;57(4):345. DOI: 10.4103/0019-5049.118569
Yasny JS, White J. Environmental Implications Of Anesthetic Gases. Anesth Prog 2012;59(4):154–8. DOI: 10.2344/0003-3006-59.4.154
Biro P. Calculation of Volatile Anesthetics Consumption From Agent Concentration And Fresh Gas Flow. Acta Anaesthesiol Scand 2014;58(8):968–72. DOI: 10.1111/aas.12374
Azami T, Preiss D, Somogyi R, et al. Calculation Of O2 Consumption During Low-Flow Anesthesia From Tidal Gas Concentrations, Flowmeter, And Minute Ventilation. J Clin Monit Comput 2004;18(5–6):325–32. DOI: 10.1007/s10877-005-4299-1
Ebert T, Robinson BJ, Unrich TD et al. Recovery From Sevoflurane: A Comparison to Isoflurane and Propofol Anesthesia. Anesthesiology 1998;89:1524–31. Available from: http://anesthesiology.pubs.asahq.org/article.aspx?articleid=1946827
Smith I, Nathanson M, White PF. Sevoflurane—A Long-Awaited Volatile Anesthetic. Br J Anaesth 1996;76:435–45. Available from: https://pdfs.semanticscholar.org/102b/f65b53690239589fbf30687e249c8e77c5a6.pdf
Srivastava M, Chowdhury I, Bhargava AK. Emergence and Recovery Characteristics After Low Flow Anaesthesia With Desflurane and Sevoflurane in Cancer Patients Administered Combined Epidural and General Anaesthesia. Ann Int Med Dent Res 2017;3(3). DOI: 10.21276/aimdr.2017.3.3.AN10
Watson KR, Shah M V. Clinical Comparison Of “Single Agent†Anesthesia With Sevoflurane Versus Target-Controlled Infusion Of Propofol. Br J Anaesth 2000;85(4):541–6. DOI: 10.1093/bja/85.4.541
Delgadoâ€Herrera L, Ostroff RD, and Rogers SA, Sevoflurane: Approaching the Ideal Inhalational Anesthetic A Pharmacologic, Pharmacoeconomic, and Clinical Review. CNS Drug Reviews 2001; 7: 48-120. DOI:10.1111/j.1527-3458.2001.tb00190.x
Kelley SD. Second Edition Monitoring Consciousness Using the Bispectral Index TM (BISTM) During Anesthesia 2012; 48. Available from: http://aristotle.learningmate.com/cvd07/bis/index.html
Nunes RR, Chaves IMM, Alencar JCG, et al. Bispectral Index and Other Processed Parameters of Electroencephalogram: an Update. Rev Bras Anestesiol Rev Artic Rev Bras Anestesiol 2012;62(1):105–17. DOI: http://dx.doi.org/10.1590/S0034-70942012000100014
Mantha S, Padmaja D. Monitoring of neuromuscular junction. Indian J Anaesth 2002; 46(4): 279-288. Available from: http://www.ijaweb.org/temp/IndianJAnaesth464279-7456181_204241.pdf
Moi D. Residual Neuromuscular Blockade Anaesthesia Tutorial of the Week 290 26 Th August 2013. 2013:1–8. Available from: https://pdfs.semanticscholar.org/d155/fcaa8305f380fbf571bb0b56affda4798459.pdf?_ga=2.209474386.1532511554.1527554738-2041838569.1527554738
Katznelson R, Minkovich L, Friedman Z, Fedorko L, Beattie WS, Fisher JA. Accelerated Recovery From Sevoflurane Anesthesia With Isocapnic Hyperpnoea. Anesth Analg 2008;106(2):486–91. DOI: 10.1213/ane.0b013e3181602dd4
Booysen S. THE RECOVERY ROOM “PITSTOP OR PITFALLâ€. Department of Anaesthetics University of Kwazulu Natal. 2009; Available from: http://anaesthetics.ukzn.ac.za/Libraries/FMM_R_B_2009/The_Recovery_Room_Dr_S_Booysen.sflb.ashx
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