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Coasting: worth the effort?

J F A Hendrickx1, S De Cooman, A A J Van Zundert

  • 1Department of Anesthesiology, Intensive Care and Pain Therapy, Onze Lieve Vrouwziekenhuis, Aalst, Belgium. jcnwahendrickx@yahoo.com

Acta Anaesthesiologica Belgica
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Summary
This summary is machine-generated.

New anesthesia machines with a "coasting mode" can maintain anesthetic levels briefly at the end of surgery. This technique, using desflurane in O2/air, shows potential for modest drug savings without increasing provider workload.

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Area of Science:

  • Anesthesiology
  • Pharmacology

Background:

  • Anesthesia machines increasingly incorporate automated features to optimize drug delivery and patient care.
  • The efficacy of a
  • coasting mode
  • in maintaining anesthetic depth at the end of surgical procedures under closed-circuit conditions is not well-established.

Purpose of the Study:

  • To evaluate the duration and effectiveness of desflurane coasting in maintaining anesthetic levels at the end of a procedure.
  • To determine the relationship between the duration of anesthesia maintenance and the subsequent decrement time of end-expired desflurane concentration.

Main Methods:

  • Sixty-nine patients undergoing surgery were allocated to nine groups based on the start time of desflurane coasting (4-100 minutes into anesthesia).
  • Anesthesia was maintained with 4.5% desflurane in O2/air using a conventional machine before initiating coasting in a closed circuit.
  • Decrement times were measured as the time for end-expired desflurane to reach 70%, 60%, 50%, and 40% of its maintenance value.

Main Results:

  • Decrement times increased with longer anesthesia durations and showed significant variability.
  • After 64 minutes of anesthesia maintenance, end-expired desflurane remained above 70%, 60%, 50%, and 40% for an average of 10.3, 16.0, 25.0, and 45.4 minutes, respectively.
  • Coasting effectively maintained anesthetic concentrations for a limited period post-initiation.

Conclusions:

  • Desflurane coasting can provide a brief period of sustained anesthesia at the conclusion of surgical procedures.
  • Automated coasting modes may offer modest desflurane savings per patient, potentially becoming substantial when aggregated across numerous procedures.
  • This technique appears to maintain anesthesia without increasing the clinical workload for anesthesia providers.