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

Sathitkarnmanee, Thepakorn; Tribuddharat, Sirirat; Nonlhaopol, Duangthida; Thananun, Maneerat; Somdee, Wilawan

doi:10.2147/dddt.s78233

Cited by 11 publications

(14 citation statements)

References 17 publications

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“…The changes in heart rate and blood pressure during the wash-in process are similar to the 1-1-12 wash-in scheme for desflurane [15,16] (i.e., slightly increasing initially then gradually decreasing as presented in Fig. 5).…”

Section: Discussionsupporting

confidence: 57%

“…Comparing with a similar 1-1-12 wash-in scheme for desflurane LFA which uses desflurane 12% (2 MAC) [15,16], the current 1-1-8 sevoflurane wash-in scheme uses a higher MAC (8% or 4 MAC) of sevoflurane. The reasons are that (a) sevoflurane has greater blood and fat solubility than desflurane, leading to higher body tissue uptake, which results in a longer time to achieve an equivalent MAC; and, (b) sevoflurane has a 3 times lower MAC value, hence 4 MAC of sevoflurane was used to augment a concentration effect [11].…”

Section: Discussionmentioning

confidence: 99%

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1-1-8 one-step sevoflurane wash-in scheme for low-flow anesthesia: simple, rapid, and predictable induction

et al. 2020

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Background: Sevoflurane is suitable for low-flow anesthesia (LFA). LFA needs a wash-in phase. The reported sevoflurane wash-in schemes lack simplicity, target coverage, and applicability. We proposed a one-step 1-1-8 washin scheme for sevoflurane LFA to be used with both N 2 O and Air. The objective of our study was to identify time for achieving each level of alveolar concentration of sevoflurane (F A S) from 1 to 3.5% in both contexts. Methods: We recruited 199 adults requiring general anesthesia with endotracheal intubation and controlled ventilation-102 in group N 2 O and 97 in group Air. After induction and intubation, a wash-in was started using a fresh gas flow of O 2 :N 2 O or O 2 :Air at 1:1 L•min − 1 plus sevoflurane 8%. The ventilation was controlled to maintain end-tidal CO 2 of 30-35 mmHg. Results: The rising patterns of F A S and inspired concentration of sevoflurane (F I S) are similar, running parallel between the groups. The F A S/F I S ratio increased from 0.46 to 0.72 within 260 s in group N 2 O and from 0.42 to 0.69 within 286 s in group Air. The respective time to achieve an F A S of 1, 1.5, 2, 2.5, 3, and 3.5% was 1, 1.5, 2, 3, 3.5, and 4.5 min in group N 2 O and 1, 1.5, 2, 3, 4, and 5 min in group Air. The heart rate and blood pressure of both groups significantly increased initially then gradually decreased as F A S increased. Conclusions: The 1-1-8 wash-in scheme for sevoflurane LFA has many advantages, including simplicity, coverage, swiftness, safety, economy, and that it can be used with both N 2 O and Air.

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Section: Discussionsupporting

confidence: 57%

Section: Discussionmentioning

confidence: 99%

1-1-8 one-step sevoflurane wash-in scheme for low-flow anesthesia: simple, rapid, and predictable induction

et al. 2020

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“…The changes in heart rate and blood pressure during the wash-in process are similar to the 1-1-12 wash-in scheme for desflurane [15][16] (i.e., slightly increasing initially then gradually decreasing as presented in Figure 4). The changes are statistically but not clinically significant.…”

Section: Discussionsupporting

confidence: 53%

“…Comparing with a similar 1-1-12 wash-in scheme for desflurane LFA which uses desflurane 12% (2 MAC) [15,16], the current 1-1-8 sevoflurane-N2O wash-in scheme uses a higher MAC (8% or 4 MAC) of sevoflurane. The reasons include (1) sevoflurane has greater blood and fat solubility than desflurane; leading to higher body tissue uptake, which results in a longer time to achieve an equivalent MAC, and (2) sevoflurane has a 3 times lower MAC value, hence we used 4 MAC of sevoflurane to augment a concentration effect.…”

Section: Discussionmentioning

confidence: 99%

1-1-8 one-step sevoflurane-nitrous oxide wash-in scheme for low-flow anesthesia: simple, rapid, and predictable induction

Tribuddharat

Sathitkarnmanee

Vattanasiriporn

et al. 2019

Preprint

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Background Sevoflurane is suitable for low-flow anesthesia (LFA). LFA needs a wash-in phase. The reported sevoflurane wash-in schemes lack simplicity, target coverage, and applicability. We proposed a one-step 1-1-8 wash-in scheme for sevoflurane-nitrous oxide (N2O) LFA. The objective of our study was to identify times to achieve every alveolar concentration of sevoflurane (FAS) from 1% to 3.5%. Methods We recruited 102 adults requiring general anesthesia with endotracheal intubation and controlled ventilation. After induction and intubation, a wash-in was started using a fresh gas flow of oxygen (O2):N2O at 1:1 L·min-1 plus sevoflurane 8%. The ventilation was controlled to maintain end-tidal carbon dioxide (CO2) of 30-35 mmHg. Results The rising patterns of FAS and inspired concentration of sevoflurane (FIS) are similar and parallel. The FAS/FIS ratio increased from 0.46 to 0.72 within 260 sec. The respective times to achieve FAS of 1%, 1.5%, 2%, 2.5%, 3% and 3.5% were 1, 1.5, 2, 3, 3.5, and 4.5 min. The heart rate and blood pressure significantly increased initially then gradually decreased as FAS increased. Conclusions The 1-1-8 wash-in scheme for sevoflurane has many advantages, including simplicity, coverage, swiftness, safety, and economy. A respective FAS of 1%, 1.5%, 2%, 2.5%, 3%, and 3.5% can be expected at 1, 1.5, 2, 3, 3.5, and 4.5 min. This scheme may be applied for LFA in the situation where anesthetic gas analyzer is not available.

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“…Several different methods have been proposed that enable LFA administration without prolonging wash-in time. [6][7][8] However, in these methods, high FGF rates are used during the wash-in period. The use of such high FGF rates during the early phase of anesthesia may increase the overall anesthetic agent consumption, although there is not much work on this topic.…”

Section: Introductionmentioning

confidence: 99%

Are high fresh gas flow rates necessary during the wash‐in period in low‐flow anesthesia?

Arslan

Gişi

Öksüz

et al. 2020

The Kaohsiung J of Med Scie

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In low-flow anesthesia (LFA), there is a wash-in period in which usually high fresh gas flow (FGF) rates are used to achieve the required initial concentration of anesthetic agent in the alveoli. The aim of this study was to compare the efficiency, safety and the consumption of desflurane in LFA using constant FGF (1 L/min) and conventional LFA using high FGF (4 L/min) during the wash-in period. Eighty patients, who were scheduled for elective surgery under general anesthesia with endotracheal intubation, were enrolled in the study. Wash-in was accomplished with 1 L/min FGF (50% O2, 50% air) and 18% desflurane in group 1; and by 4 L/min FGF (50% O2, 50% air) and 6% desflurane in group 2. Throughout the surgery, the vaporizer was adjusted to maintain 0.6 to 0.8 minimum alveolar concentration (MAC). The time required to reach 0.7 MAC was shorter in group 1 (160 seconds [135-181] vs 288 seconds [240-500], P < .001). In 6 patients in group 1 and 13 in group 2, vaporizer settings were adjusted to maintain 0.6 to 0.8 MAC (P = .

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

Cited by 11 publications

References 17 publications

1-1-8 one-step sevoflurane wash-in scheme for low-flow anesthesia: simple, rapid, and predictable induction

1-1-8 one-step sevoflurane wash-in scheme for low-flow anesthesia: simple, rapid, and predictable induction

1-1-8 one-step sevoflurane-nitrous oxide wash-in scheme for low-flow anesthesia: simple, rapid, and predictable induction

Are high fresh gas flow rates necessary during the wash‐in period in low‐flow anesthesia?

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