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The safety and efficacy of minimal-flow desflurane anesthesia during prolonged laparoscopic surgery
Sang Yoong Park1, Chan Jong Chung, Jung Hoon Jang
1Department of Anesthesiology and Pain Medicine, Dong-A University College of Medicine, Busan, Korea.
Background:
Minimal-flow anesthesia can meet the demands of a modern society that is more sensitive to environmental protection and economic burdens. This study compared the safety and efficacy of minimal-flow desflurane anesthesia with conventional high-flow desflurane anesthesia for prolonged laparoscopic surgery.
Methods:
Forty-six male patients (ASA physical status II or III) undergoing laparoscopic urologic surgery for more than 6 hours were randomly divided into two groups: the high-flow (HF) group and the minimal-flow (MF) group. The HF group was continuously administered a fresh gas flow of 4 L/min. In the MF group, a fresh gas flow of 4 L/min was administered for the first 20 minutes and was thereafter lowered to 0.5 L/min. Inspiratory and expiratory desflurane concentrations, respiratory variables, and hemodynamic variables were continuously monitored during administration of anesthesia. Measurements of carboxyhemoglobin (COHb) concentration and arterial blood gas analysis were performed every 2 hours during anesthesia. Serum aspartate aminotransferase (AST), alanine aminotransferase (ALT), blood urea nitrogen (BUN) and creatinine were measured on the first and second day after the surgery.
Results:
Demographic data and duration of anesthesia were not different between the two groups. Significant differences were not observed between the two groups in terms of hemodynamic variables, respiratory variables, and inspiratory and expiratory desflurane concentrations. Inspiratory O(2) concentration was maintained lower in the MF group than in the HF group (43-53% vs. 53-59%; P < 0.05). Compared with the HF group, COHb concentrations was higher (P < 0.05), but not increased from the baseline value in the MF group. Serum AST, ALT, BUN, and creatinine were not significantly different between the two groups.
Conclusions:
In prolonged laparoscopic surgery, no significant differences were found in safety and efficacy between minimal-flow and high-flow desflurane anesthesia.
Insights
Minimal-flow desflurane anesthesia is as safe and effective as high-flow anesthesia for long surgeries. This approach reduces environmental impact and costs without compromising patient outcomes.
Area of Science:
- Anesthesiology
- Surgical Innovation
- Environmental Health
Background:
- Minimal-flow anesthesia offers environmental and economic benefits.
- Growing demand for sustainable anesthetic practices.
- Need to evaluate minimal-flow desflurane anesthesia in prolonged surgeries.
Purpose of the Study:
- To compare the safety and efficacy of minimal-flow versus high-flow desflurane anesthesia.
- To assess patient outcomes in prolonged laparoscopic urologic surgery.
Main Methods:
- 46 male patients (ASA II-III) undergoing >6-hour laparoscopic urologic surgery.
- Randomized comparison of high-flow (4 L/min) and minimal-flow (0.5 L/min after 20 min) desflurane anesthesia.
- Continuous monitoring of anesthetic concentrations, respiratory/hemodynamic variables; regular COHb and blood gas analysis; post-op liver/renal function tests.
Main Results:
- No significant differences in hemodynamic, respiratory, or anesthetic concentration variables between groups.
- Minimal-flow group had lower inspiratory O2 concentrations.
- Carboxyhemoglobin (COHb) was higher in the minimal-flow group but remained within normal limits; no significant differences in liver/renal function tests.
Conclusions:
- Minimal-flow desflurane anesthesia is comparable in safety and efficacy to high-flow anesthesia for prolonged laparoscopic surgery.
- This method supports environmentally conscious and cost-effective anesthetic practices.
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