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COMPARISON OF HIGH FLOW AND LOW FLOW DESFLURANE ANESTHESIA IN TYMPANOPLASTY OPERATION

Year 2011, Volume: 5 Issue: 1, 12 - 21, 20.04.2011

Abstract

Introduction: The goal of this study was to compare the effects of low-flow desflurane anesthesia and high-flow anesthesia on consumption of anesthetic agent, hemodynamic parameters, respiratory parameters and postoperative recovery profiles.

Materials and methods: Following ethics committee approval, 60 ASA I - II patients, who were 18-65 y and to undergo elective tympanoplasty surgery by the same surgeon were included in this prospective, randomized, double blind clinical trial. At the preoperative visit, details of the anesthetic technique and the study protocol were fully explained, and written consent was obtained from each patient prior to the study. Before each surgery, anesthesia circuits leakage control and calibration of gas monitors were performed. Single-use anesthesia circuit was used for each patient and bacteria filter was applied routinely. CO2 absorbent was changed for each patient. All patients were premedicated and in the operating room an IV catheter was inserted and standard monitors were applied (GE Datex-Ohmeda S/5™ Anesthesia Monitor, Helsinki, Finland). For induction of anesthesia, 1 mg / kg lidocaine (Aritmal ®% 2), 2 mg / kg propofol (Diprivan ®), 0.125 mcg/kg/min remifentanil (Ultiva®) infusion, and 0.6 mg / kg rocuronium bromide (Esmeron®) were administered intravenously. All cases were mechanically ventilated with a tidal volume of 8-10 ml/kg and the ventilatory rate of 12/dk with ADU (Datex-Ohmeda® S / 5 Anesthesia) anesthesia device in all cases, the gas analyzer was connected to the monitor. To provide denitrogenation rapidly fresh gas flow of 6 L/ min (O2/Air = 2/4) in the form of 4-6% desflurane was adjusted the first 10 min after induction of anesthesia. After tenth minutes, the patients were divided randomly into two equal groups. Anesthesia was continued with desflurane 2 % in 66 % air with oxygen with a fresh gas flow of 6 L/ min in the first group (Group-Y (n = 30)), and in the second group(Group-D (n = 30)) a fresh gas flow of 1 L/ min were adjusted.

Results: Sixty patients were enrolled in this study with 30 patients in each group; the groups were similar with respect to age, weight, height, ASA physical status, and duration of surgery and anesthesia. There were no significant differences among the groups in terms of ETCO2, inspired CO2 and COHb levels. In the low-flow group, total consumption of desflurane were 52% less than the control group. We found that the circuit heat and humidity has higher values in the low flow group according to the control group.

Conclusion: We didn’t find significant clinical differences between the two methods in terms of oxygenation, hemodynamic parameters, ETCO2, arterial blood gas values. In cases of tympanoplasty, we can say that administration of low flow desflurane anesthesia is safe with systems providing monitorization of inspired and expired gas.

References

  • 1. Baxter AD. Low and minimal flow in-halational anaesthesia.Can J Anaesth 1997;44:643-53
  • 2. Baum JA. Low-flow anaesthesia: The sensible and judicious use of inhalation anaesthetics. Acta Anaesthesiol Scand 1997; 41: 264-7.
  • 3. Donlon JV. Anesthesia for Eye, Ear, Nose, and Throat Surgery. In: Miller RD(ed).Anesthesia. Fifth edition. New York: Churchill Livingstone; 2000: 2173-2198.
  • 4. Aldrete JA. The post-anesthesia recovery score revisited. J Clin Anesth 1995; 7:89-91.
  • 5. Odin I, Feiss P. Low flow and economics of inhalational Anesthesia. Best Practisce & Research Clinical Anaesthesiology 2005;19:399-413.
  • 6. Baum J A . Low Flow Anaesthesia, 2 nd edn. Oxford : Butterworth - Heinemann ,2001.
  • 7. Avramov M N, Griffin JD et al. The effect of fresh gas flow and anesthetich technique on the ability to control acute hemodynamic responses during sug-ery. Anesth. Analg. 1998;87: 666-70
  • 8. Degoute CS, Ray MJ, Manchon M, Dubreuil C, Banssillon V. Remifentanil and controlled hypotension; comparison with nitroprusside or esmolol during tympanoplasty Can J Anaesth. 2001; 48(1 ):20-7.
  • 9. Richa F, Yazigi A, Sleilaty G, Yazbeck P. Comparison between dexmedeto-midine and remifentanil for controlled hypotension during tympanoplasty. Eur J Anaesthesiol. 2008; 25(5): 369-74.
  • 10. Baum JA. Low - flow Anesthesia: Theory, practice, technical preconditions, advantages, and foreign gas accumu-lutation. J. Anesth. 1999; 13:166-174.
  • 11. Baum J, Berghoff M, Stanke HG, Pe-termeyer M, Kalff G. Low-flow anaesthesia with desflurane (German). An-aesthesist 1997; 46: 287-293
  • 12. Fan SZ, Lin YW, Chang WS, Tang CS. An evaluation of the contributions by fresh gas flow rate, carbon dioxide concentration and desflurane partial pressure to carbon monoxide concentration during low fresh gas flows to a circle anaesthetic breathing system. Eur J Anaesthesiol. 2008;25(8):620-6.
  • 13. Stabernack CR, Brown R, Laster MJ, Dudziak R, Eger El 2nd. Absorbents differ enormously in their capacity to produce compount A and CO. Anesth. Analg. 2000; 90: 1428-35.
  • 14. Bonome C, Belda J, Alvarez-Refojo F, Soro M, Fernândez-Goti C, Cortes A. Low flow Anesthesia and reduced animal size increase carboxyhemoglobin. Anesth analg. 1999; 89: 909-16.
  • 15. Keijzer C., Perez R.S., de Lange J.J. Carbon monoxide production from desflurane and six types of carbon dioxide absorbents in a petient model. Acta Anaesthesiol Scand 2005;49:815-18.
  • 16. Tang CS, Fan SZ.,Chan CC. Smoking status and body size icrease carbon monoxide... Anesth. Analg. 2001 ;92: 542-47.
  • 17. Woehick HJ, Connolly LA, Cinque-grani MP, Dunning MB 3rd, Hoffmann RG, Acute smoking increases ST depression in humans during general anesthesia. Anesth. Analg. 1999; 89: 856-60.
  • 18. Cherian A , Badhe A. Low flow Anesthesia at a fixed flow rate. Acta Anaesthesiol Scand 2009;53:1348-53.
  • 19. Kleeman PP. The climatisation of anesthetic gases under condition of high flow to low flow. Acta Anaesthesiol Belg. 1999; 41(3): 189-200.
  • 20. Di Flippo A, Minoni C, et all. Variations of esphageal temperature during general anesthesia with a low flow circuit. Minerva Anesth. 1995;61(9):351-4.
  • 21. Bengtsson JP, Bengtsson A, Sonander H. Humudity of the Bain and circle systems reassessed . Anesth. Analg. 1998; 69: 83-6.
  • 22. Bengtsson JP, Bengtsson A, Stenqvist O. The circle system as a humudifier. British Journal of Anaesthesia 1989; 63: 453-7.

TİMPANOPLASTİ OPERASYONLARINDA YÜKSEK AKIMLI ve DÜŞÜK AKIMLI DESFLURAN ANESTEZİSÎNİN KARŞILAŞTIRILMASI

Year 2011, Volume: 5 Issue: 1, 12 - 21, 20.04.2011

Abstract

Giriş: Çalışmamızda, timpanoplasti operasyonlarında düşük akımlı desfluran anestezisi ile yüksek akımlı yöntemi karşılaştırarak anestezik ajan tüketimi, hemodinami, solunumsal parametreler ve postoperatif derlenmeye etkilerini değerlendirmeyi amaçladık.

Materyal Metod: Çalışmamızda etik kurul izni alındıktan sonra 18-65 yaş arası elektif koşullarda timpanoplasti operasyonu planlanan ASA l-ll risk grubundaki toplam 60 gönüllü hasta yer aldı. Hastalar ameliyat öncesi dönemde uygulanacak olan anestezi tipi hakkında bilgilendirilerek, onlara işleme ve çalışmaya dair izin formları imzalatıldı. Her operasyondan önce, anestezi devrelerinin kaçak kontrolü ve gaz monitörlerinin kalibrasyonu yapıldı. Rutin uyguladığımız şekilde, her olgu için tek kullanımlık anestezi devresi ve bakteri filtresi kullanıldı. Her hastada CO2 absorbanı değiştirildi. Tüm olgulara operasyondan önce pre-medikasyon yapıldı. Hastalara standart monitorizasyon uygulandı. Anestezi indüksiyonu için 1 mg/kg lidokain (Aritmal® % 2), 2 mg/kg propofol (Diprivan®), 0.125 mcg/kg/dk Remifentanil (Ultiva®) infüzyonu, ve 0.6 mg/kg rokuronyum bromür (Esmeron®) iv uygulanarak BİS değeri 40-60 arasında olduğunda laringoskop ile entübasyon yapıldı. Endotrakeal entübasyondan sonra tüm olgular ADU (Datex-Ohmeda® S/5 Anesthesia) anestezi cihazında tidal volüm 8-10 ml/kg ve solunum sayısı 12 /dk olacak şekilde % 50 O2 - % 50 hava ile solutulmaya başlandı. Taze gaz akımı denitrojenizasyonunu sağlamak ve anesteziyi hızla derinleştirmek amacıyla, anestezi indüksiyonu sonrası ilk 10 dk. için, 6 It/dk (O2/Hava=2/4) içinde % 4-6 desfluran şeklinde ayarlandı. Hastaların tamamına remifentanil (Ultiva®) 0.125 mcg/kg/dk dozunda infüzyonu yapıldı. Birinci grup hastaya (Grup-Y (n=30)), anestezi uygulamasının devamı için; % 33 O2 ve % 66 hava karışımı içinde % 4-6 desfluran ile taze gaz akımı 6 İt /dk (O2/Hava=2/4) olacak şekilde devam edilirken, ikinci grup hastada (Grup-D (n=30)) ise 10. dk.’dan sonra akım hızı FiO2 değeri %30’un üzerinde olacak şekilde 1 It/dk’ya (O2/ Hava=0.5/0.5) indirildi ve % 4-6 desfluran uygulandı.

Bulgular: . Gruplardaki olgular arasında sosyo demografik özellikler açısından istatistiksel olarak anlamlı fark yoktur. Her iki grup arasında inspire edilen CO2, ETCO2 ve COHb düzeyleri açısından fark bulunmamıştır. Desfluranın toplam tüketimi düşük akımlı grupta kontrol grubuna göre %52 az bulunmuştur. İki grup arasında yaptığımız karşılaştırmada düşük akım grubunda düşük akımın başlangıcından itibaren kontrol grubuna göre devre ısı ve nem değerlerinin yüksek olduğunu bulduk.

Sonuç: Sonuç olarak bu çalışmada ASA l-ll grubunda timpanoplasti operasyonu geçiren hastalarda düşük akım ve yüksek akımlı desfluran anestezisinin bulgularını değerlendirdik. İki yöntem arasında oksijenasyon, hemodinamik parametreler, ETCO2, kan gazı değerleri açısından klinik olarak anlamlı farklılık bulamadık. Timpanoplasti vakalarında inspire ve ekspire edilen gaz monitörizasyonu sağlayan sistemlerle düşük akımlı desfluran anestezi uygulamasının güvenli olduğunu söyleyebiliriz.

Dr. Ayşe LAFÇI Dr. Levent ÖZTÜRK Dr. Abdulkadir BUT

References

  • 1. Baxter AD. Low and minimal flow in-halational anaesthesia.Can J Anaesth 1997;44:643-53
  • 2. Baum JA. Low-flow anaesthesia: The sensible and judicious use of inhalation anaesthetics. Acta Anaesthesiol Scand 1997; 41: 264-7.
  • 3. Donlon JV. Anesthesia for Eye, Ear, Nose, and Throat Surgery. In: Miller RD(ed).Anesthesia. Fifth edition. New York: Churchill Livingstone; 2000: 2173-2198.
  • 4. Aldrete JA. The post-anesthesia recovery score revisited. J Clin Anesth 1995; 7:89-91.
  • 5. Odin I, Feiss P. Low flow and economics of inhalational Anesthesia. Best Practisce & Research Clinical Anaesthesiology 2005;19:399-413.
  • 6. Baum J A . Low Flow Anaesthesia, 2 nd edn. Oxford : Butterworth - Heinemann ,2001.
  • 7. Avramov M N, Griffin JD et al. The effect of fresh gas flow and anesthetich technique on the ability to control acute hemodynamic responses during sug-ery. Anesth. Analg. 1998;87: 666-70
  • 8. Degoute CS, Ray MJ, Manchon M, Dubreuil C, Banssillon V. Remifentanil and controlled hypotension; comparison with nitroprusside or esmolol during tympanoplasty Can J Anaesth. 2001; 48(1 ):20-7.
  • 9. Richa F, Yazigi A, Sleilaty G, Yazbeck P. Comparison between dexmedeto-midine and remifentanil for controlled hypotension during tympanoplasty. Eur J Anaesthesiol. 2008; 25(5): 369-74.
  • 10. Baum JA. Low - flow Anesthesia: Theory, practice, technical preconditions, advantages, and foreign gas accumu-lutation. J. Anesth. 1999; 13:166-174.
  • 11. Baum J, Berghoff M, Stanke HG, Pe-termeyer M, Kalff G. Low-flow anaesthesia with desflurane (German). An-aesthesist 1997; 46: 287-293
  • 12. Fan SZ, Lin YW, Chang WS, Tang CS. An evaluation of the contributions by fresh gas flow rate, carbon dioxide concentration and desflurane partial pressure to carbon monoxide concentration during low fresh gas flows to a circle anaesthetic breathing system. Eur J Anaesthesiol. 2008;25(8):620-6.
  • 13. Stabernack CR, Brown R, Laster MJ, Dudziak R, Eger El 2nd. Absorbents differ enormously in their capacity to produce compount A and CO. Anesth. Analg. 2000; 90: 1428-35.
  • 14. Bonome C, Belda J, Alvarez-Refojo F, Soro M, Fernândez-Goti C, Cortes A. Low flow Anesthesia and reduced animal size increase carboxyhemoglobin. Anesth analg. 1999; 89: 909-16.
  • 15. Keijzer C., Perez R.S., de Lange J.J. Carbon monoxide production from desflurane and six types of carbon dioxide absorbents in a petient model. Acta Anaesthesiol Scand 2005;49:815-18.
  • 16. Tang CS, Fan SZ.,Chan CC. Smoking status and body size icrease carbon monoxide... Anesth. Analg. 2001 ;92: 542-47.
  • 17. Woehick HJ, Connolly LA, Cinque-grani MP, Dunning MB 3rd, Hoffmann RG, Acute smoking increases ST depression in humans during general anesthesia. Anesth. Analg. 1999; 89: 856-60.
  • 18. Cherian A , Badhe A. Low flow Anesthesia at a fixed flow rate. Acta Anaesthesiol Scand 2009;53:1348-53.
  • 19. Kleeman PP. The climatisation of anesthetic gases under condition of high flow to low flow. Acta Anaesthesiol Belg. 1999; 41(3): 189-200.
  • 20. Di Flippo A, Minoni C, et all. Variations of esphageal temperature during general anesthesia with a low flow circuit. Minerva Anesth. 1995;61(9):351-4.
  • 21. Bengtsson JP, Bengtsson A, Sonander H. Humudity of the Bain and circle systems reassessed . Anesth. Analg. 1998; 69: 83-6.
  • 22. Bengtsson JP, Bengtsson A, Stenqvist O. The circle system as a humudifier. British Journal of Anaesthesia 1989; 63: 453-7.
There are 22 citations in total.

Details

Primary Language Turkish
Subjects Anaesthesiology
Journal Section Research Article
Authors

Levent Öztürk

Publication Date April 20, 2011
Published in Issue Year 2011 Volume: 5 Issue: 1

Cite

APA Öztürk, L. (2011). TİMPANOPLASTİ OPERASYONLARINDA YÜKSEK AKIMLI ve DÜŞÜK AKIMLI DESFLURAN ANESTEZİSÎNİN KARŞILAŞTIRILMASI. Türk Tıp Dergisi, 5(1), 12-21.

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