Desflurane consumption during automated closed-circuit delivery is higher than when a conventional anesthesia machine is used with a simple vaporizer-O2-N2O fresh gas flow sequence

Cooman, Sofie De; Mey, Nathalie De; Dewulf, Bram B.C.; Carette, Rik; Deloof, Thierry; Sosnowski, Maurice; Wolf, André M. De; Hendrickx, Jan F. A.

doi:10.1186/1471-2253-8-4

Cited by 20 publications

(16 citation statements)

References 6 publications

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“…In our study, a more standardized algorithm of manual control was applied, which clearly affected our findings. The results presented by De Cooman [11] are comparable to our data. The author demonstrated increased consumption of inhalational anaesthetic during anaesthesia with the automated control module of end tidal concentration of inhalational anaesthetic.…”

Section: Discussionsupporting

confidence: 82%

Porównanie zużycia gazów anestetycznych oraz stabilności znieczulenia przy użyciu automatycznej i ręcznej kontroli przebiegu znieczulenia

Skalec

Górecka-Dolny

Zieliński

et al. 2017

Anaesthesiol Intensive Ther

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Background: The automatic control module of end-tidal volatile agents (EtC) was designed to reduce the consumption of anaesthetic gases, increase the stability of general anaesthesia and reduce the need for adjustments in the settings of the anaesthesia machine. The aim of this study was to verify these hypotheses. Methods: The course of general anaesthesia with the use of the EtC module was analysed for haemodynamic stability, depth of anaesthesia, end-expiratory concentration of anaesthetic, number of ventilator key presses, fentanyl supply, consumption of volatile agents and anaesthesia and operation times. These data were compared with the data obtained during general anaesthesia controlled manually and were processed with statistical tests. Results: Seventy-four patients underwent general anaesthesia for scheduled operations. Group AUTO-ET (n = 35) was anaesthetized with EtC, and group MANUAL-ET (n = 39) was controlled manually. Both populations presented similar anaesthesia stability. No differences were noted in the time of anaesthesia, saturation up to MAC 1.0 or awakening. Data revealed no differences in mean EtAA or the fentanyl dose. The AUTO-ET group exhibited fewer key presses per minute, 0.0603 min -1 , whereas the MANUAL-ET exhibited a value of 0.0842 min -1 ; P = 0.001. The automatic group consumed more anaesthetic and oxygen per minute (sevoflurane 0.1171 mL min -1 ; IQR: 0.0503; oxygen 1.8286 mL min -1 , IQR: 1,3751) than MANUAL-ET (sevoflurane 0.0824 mL min -1 , IQR: 0.0305; oxygen 1,288 mL min -1 , IQR: 0,6517) (P = 0.0028 and P = 0.0171, respectively). Conclusion: Both methods are equally stable and safe for patients. The consumption of volatile agents was significantly increased in the AUTO-ET group. EtC considerably reduces the number of key presses.

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Section: Discussionsupporting

confidence: 82%

Porównanie zużycia gazów anestetycznych oraz stabilności znieczulenia przy użyciu automatycznej i ręcznej kontroli przebiegu znieczulenia

Skalec

Górecka-Dolny

Zieliński

et al. 2017

Anaesthesiol Intensive Ther

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“…De Cooman et al [13] have argued that FGF fixed at 0.7 l.min )1 in MCA mode would decrease the volatile consumption below that obtained in TCA mode with the Zeus Ò . However, in their study, the desflurane end-tidal concentration chosen in the Zeus Ò TCA group was higher than the concentration chosen for MCA group, thus biasing their results in favour of the latter.…”

Section: Discussionmentioning

confidence: 99%

“…TCA appeared extremely cost effective: desflurane and O 2 consumption during surgery were halved and N 2 O consumption was reduced to a fifth. Because of the initial wash-in phase, the benefit of TCA on total volatile consumption is likely negligible for short duration surgery and the longer the procedure lasts, the more cost-effective TCA is likely to be [12,13].…”

Section: Discussionmentioning

confidence: 99%

Assessing the clinical or pharmaco‐economical benefit of target controlled desflurane delivery in surgical patients using the Zeus^® anaesthesia machine*

et al. 2009

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SummaryThe Zeus Ò anaesthesia machine includes an auto-control mode which allows targeting of end-tidal volatile and inspired oxygen concentrations. We assessed the clinical benefits and economic impact of this target-controlled anaesthesia compared with conventional manually controlled anaesthesia. Eighty patients were randomly assigned to receive desflurane either with a fresh gas flow set by the anaesthetist or in auto-control mode. Drug delivery was adjusted to maintain bispectral index between 40-60 units and systolic arterial pressure under 15 mmHg above its pre-induction value (upper limit) and over 90 mmHg (lower limit). Blood pressure was maintained in the desired range for 89% and 91% of the maintenance period for auto-control and manual control respectively (p = 0.49). Bispectral index was in the desired range for 82% and 79% of the maintenance period, for auto-control and manual control respectively (p = 0.46). Oxygen consumption was more than halved by the use of auto-control mode, and mean (SD) desflurane consumption during surgery was 0.07 (0.04) vs 0.2 (0.07) ml.min

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“…One alternative is a system that automatically targets a drug related end-point. The Dräger Zeus [12] provides this functionality with automatic control of end-tidal levels, although one study suggests that this approach may not be as efficient as some forms of manual control [13]. A third approach is systems which provide information on drug levels without a control function.…”

Section: Discussionmentioning

confidence: 99%

The effect of predictive display on the control of step changes in effect site sevoflurane levels*

Kennedy¹,

McKellow²,

French

2010

Anaesthesia

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SummaryGraphical displays of past and future levels of drugs may be a useful adjunct to manual dosing. We have previously found that a display of predicted future values speeds step changes in end-tidal sevoflurane. In this study anaesthetists made step changes of 0.3% in effect site sevoflurane, with and without the display and as increases and decreases. We analysed 91 changes. When the predictive display was present, users made larger vaporiser dial changes of 3.9% vs 3.1% (95% CI for the difference )1.3% to )0.01%, p = 0.046) reflected in larger end-tidal changes (95% CI for the difference )0.009 vol% to )0.34 vol%, p = 0.06). There was no difference in the speed of change (220 vs 227 s (95% CI for the difference )51 to 32 s)), or in the accuracy of the change. In this study the predictive display influenced the magnitude of the step changes made by anaesthetists but did not affect the speed or overall accuracy of the change. A wide variety of pharmacokinetic ⁄ pharmacodynamic model systems have been developed for use in anaesthesia. Their main aim is to assist drug dosing either in an 'advisory' mode, where model-based drug levels are displayed to the user or, in 'target controlled infusion' (TCI) systems, which directly control drug administration automatically to maintain a given level preset by the user. Most systems focus on intravenous agents and many provide information on both plasma and 'effect site' levels, frequently providing a display of the history along with predictions of future levels. Providing this type of feedback to the user may improve control [1,2]. We have developed a similar approach for inhalational agents and our overarching hypothesis is that there is similar value in providing users with both forward prediction and real-time effect site levels for inhalational as for intravenous agents. These studies have added value with the recent introduction of commercial systems that incorporate some of these functions.We have developed and described a system that uses measured fresh gas flow rates and vaporiser dial settings in conjunction with a model of anaesthetic uptake and distribution [3] to provide forward prediction of end-tidal sevoflurane levels. Trends are displayed of a large number of monitored variables including inspired and expired concentrations of inhalational anaesthetics (Fig. 1). The predictive display rapidly demonstrates the effects of any change in input settings on both end-tidal and effect site levels. Our experience is that this permits the user to choose vaporiser and fresh gas flow settings that rapidly achieve and maintain a desired target without risk of significant overshoot, and our overall aim was to quantify this effect. We have previously shown that anaesthetists made specified changes in end-tidal sevoflurane more rapidly when this display was present but with no effect on the quality of the change [4]. We have now extended this system to include estimates of past and future effect site (C eff ), not just end-tidal, levels of sevoflurane [5]. Forward pre...

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Desflurane consumption during automated closed-circuit delivery is higher than when a conventional anesthesia machine is used with a simple vaporizer-O2-N2O fresh gas flow sequence

Cited by 20 publications

References 6 publications

Porównanie zużycia gazów anestetycznych oraz stabilności znieczulenia przy użyciu automatycznej i ręcznej kontroli przebiegu znieczulenia

Porównanie zużycia gazów anestetycznych oraz stabilności znieczulenia przy użyciu automatycznej i ręcznej kontroli przebiegu znieczulenia

Assessing the clinical or pharmaco‐economical benefit of target controlled desflurane delivery in surgical patients using the Zeus^® anaesthesia machine*

The effect of predictive display on the control of step changes in effect site sevoflurane levels*

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Desflurane consumption during automated closed-circuit delivery is higher than when a conventional anesthesia machine is used with a simple vaporizer-O2-N2O fresh gas flow sequence

Cited by 20 publications

References 6 publications

Porównanie zużycia gazów anestetycznych oraz stabilności znieczulenia przy użyciu automatycznej i ręcznej kontroli przebiegu znieczulenia

Porównanie zużycia gazów anestetycznych oraz stabilności znieczulenia przy użyciu automatycznej i ręcznej kontroli przebiegu znieczulenia

Assessing the clinical or pharmaco‐economical benefit of target controlled desflurane delivery in surgical patients using the Zeus® anaesthesia machine*

The effect of predictive display on the control of step changes in effect site sevoflurane levels*

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Assessing the clinical or pharmaco‐economical benefit of target controlled desflurane delivery in surgical patients using the Zeus^® anaesthesia machine*