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Author Spotlight: A Non-Intubated Video-Assisted Thoracoscopic Surgery with Multimodal Analgesia and Sevoflurane Inhalation Anesthesia
Published on: May 26, 2023
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Target-Controlled Inhalational Anesthesia-Isoflurane Consumption with Adequacy of Anesthesia Monitoring in
Reshma Vithayathil1, Keelara Shivalingaiah Savitha2, Nischala Dixit2
1Department of Anaesthesia, CMC, Vellore, Tamil Nadu, India.
Anesthesia, Essays and Researches
|October 17, 2022
Summary
Multimodal analgesia (MMA) combined with end-tidal anesthesia (EtCA) and adequacy of anesthesia (AoA) monitoring significantly reduces isoflurane consumption in laparoscopic cholecystectomy patients. This approach offers a more environmentally conscious and potentially cost-effective anesthetic strategy.
Area of Science:
- Anesthesiology
- Environmental Health
- Surgical Care
Background:
- Growing concerns over chlorofluorocarbon environmental impact drive the need to minimize inhalational anesthetic use.
- Multimodal analgesia (MMA) targets all pain processing elements, while end-tidal controlled anesthesia (EtCA) is a low-flow technique using newer anesthesia workstations.
- Adequacy of anesthesia (AoA) monitoring, derived from entropy and surgical pleth index, assesses anesthetic depth and analgesia levels.
Purpose of the Study:
- To evaluate the reduction in isoflurane consumption using MMA with EtCA and AoA monitoring compared to conventional anesthesia.
- To assess the efficacy of a combined MMA and EtCA approach in minimizing anesthetic gas usage.
Main Methods:
- A prospective randomized controlled trial involving 60 patients undergoing laparoscopic cholecystectomy.
- Patients were divided into MMA and conventional groups, both receiving preemptive analgesia. The MMA group received additional paracetamol and clonidine.
- Intraoperative management utilized EtCA with AoA monitoring for both groups.
Main Results:
- Mean isoflurane consumption was significantly lower in the MMA group (8.9 ± 4.1 mL) compared to the conventional group (12.7 ± 5.3 mL) (P = 0.002).
- The duration of anesthesia showed no significant clinical difference between the groups (P = 0.931).
Conclusions:
- End-tidal controlled anesthesia combined with multimodal analgesia significantly reduces isoflurane consumption.
- This anesthetic strategy presents a viable option for minimizing environmental impact and potentially reducing costs in surgical procedures.
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