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Goal of Study:We aimed to assess the effect of different flow rates of low flow fresh gas mixtures on hemodynamic state, gas exchange parameters and recovery time during general anaesthesia of urogenital system operations in a single tertiary centre.Materials and methods:Sixty-two ASA Class I or II patients were enrolled for this study. The whole study population to whom low flow anaesthesia had been administered were subsequently gathered in three distinct -A, high flow, B, low flow, C, minimal flow- groups. Following induction, in all groups, 40% O2, 60% N2O and 1-2% sevoflurane mixtures were given in anaesthesia maintenance with a flow rate of 4 l/min for 10 minutes. Thereafter, flow rate was reduced to 2 l/min, 1 l/min and 0.5 l/min in Groups A, B and C, respectively. In minimal flow group concerning the risk of hypoxia, O2 concentration was enhanced to 60%. Hemodynamic data before and during anaesthesia, additionally, gas exchange and blood gas analysis parameters at 30th minute and before cessation of anesthesia were recorded. Recovery period was observed by a second physician and times of interest were noted.Results: Demographic characteristics were similar among study groups. Data regarding vital signs, gas exchange and blood gas analysis at the 30th minute and prior to cessation of anesthesia were mostly comparable. As expected, oxygenation parameters in blood gas analysis were significantly higher in group C during (pO2, mmHg, 168.6u00b143.9 vs 165.4u00b139.9 vs 245.5u00b151.5, p< 0.001; SaO2, %, 98.6u00b11.1 vs 98.3u00b11.2 vs 99.2u00b10.9, p=0.019) and at the end of operation (pO2, mmHg, 165.6u00b141.8 vs 152.7u00b164.3 vs 227.9u00b146.7, p< 0.001; SaO2, %, 98.1u00b11.4 vs 98.1u00b11.2 vs 98.8u00b11.1, p=0.028). Lactate levels were higher at low flow and minimal groups at 30th minute but this difference lost significance before cessation of anesthesia. In any circumstances all values were in normal limits (mmol/l, 1.04u00b10.56 vs 1.29u00b10.49 vs 1.33u00b10.46, p=0.038 and 1.08u00b10.48 vs 1.27u00b10.58 vs 1.22u00b10.52, p= 0.623; respectively).Aside from this, during operation, inspiratory sevoflurane levels were significantly higher in Group A (1.7u00b10.6 vs 1.3u00b10.3 vs 1.3u00b10.3, p=0.043). There were no significant differences between the groups in terms of recovery data.Conclusion: Widespread utilization of low flow anaesthesia is a cornerstone for the evolution of inhalation anaesthesia regarding the cost reduction efforts of public health policies and conservation of the personnelsu2019 health and air purity. 1 From this point of view, it is reasonable to suggest that less is better. Here we report the safety -by means of avoiding hypoxia, acidosis, hemodynamic disturbance and retarded recovery phase- of administering gas mixtures with sevoflurane even at very low flow rates, which meet the needs of modern inhalation anaesthesia.

WOS: 000344531300247, …

WOS: 000440416200016 PubMed ID: 29660267 ObjectiveRegarding the fact that rigid bronchoscopy is generally performed under general anaesthesia and this patient subgroup is remarkably morbid, encountering procedure and/or anaesthesia related complications are highly likely. Here, we aimed to assess factors influencing recovery and detect possible determinants of adverse event occurrence during these operations performed in a tertiary referral centre. MethodsEighty-one consecutive ASA I-IV patients were recruited for this investigation. In the operating theatre after induction of anaesthesia and advancement of the device, maintenance was provided with total intravenous anaesthesia. Neuromuscular blockage was invariably administered, and patients were ventilated manually. In addition to preoperative demographic and procedural characteristics, perioperative hemodynamic variables, recovery times and observed adverse events were noted. ResultsBasic demographic properties, ASA and Mallampati scores, and procedure specific variables as lesion localization, lesion and procedure type were comparable among groups assembled with reference to event occurrence. Patients who had experienced adverse event had higher heart rates. Recovery times were comparable between Event (-) and Event (+) groups. Relationship of recovery process were individually tested with all variables and only lesion type was detected to have an effect on respiration and extubation times. Among all parameters only procedural time seemed to be associated with adverse event occurrence (mins, 22.911.9 vs 41.6 +/- 28.8, P

Objective: Although various issues about low flow anaesthesia had been investigated previously, impact of different flow rates on perioperative follow-up and safety outcomes were not well-addressed. Here, we aimed to assess the influence of different flow rates of low flow fresh gas mixtures on hemodynamic state, gas exchange parameters and recovery time during general anaesthesia of urogenital system operations in a single tertiary centre. Materials and Methods: Sixty-two patients (American Society of Anaesthesiologists score I or II) to whom low flow anaesthesia with sevoflurane had been administered were subsequently gathered in three distinct -A, moderate flow (2 L/minimum), B, low flow (1 L/minimum), C, minimal flow (0.5 L/minimum) -groups. Hemodynamic data before and during anaesthesia, additionally, gas exchange and blood gas analysis parameters at 30th minute and before cessation of anaesthesia were recorded. Recovery period was observed by a second physician and times of interest were noted. Results: Demographic characteristics were similar among study groups. Most of the data regarding vital signs, gas exchange and blood gas analysis at the 30th minute and prior to cessation of anaesthesia were comparable. During operation, inspiratory sevoflurane levels were significantly higher in group A (1.7±0.6 vs 1.3±0.3 vs 1.3±0.3, p=0.043). There were no significant differences between the groups in terms of recovery data [time to spontaneous breathing (p=0.21), time to extubation (p=0.113), time to eye opening (p=0.5), time to verbal response (p=0.518) and time to reach a Modified Aldrete score of 9 or 10 (minimum, 13.7±6.8 vs 13.6±5.2 vs 14.8±4, p=0.717)]. Conclusion: Limiting the flow rate of gas mixture to 0.5 L/minutes in low flow anaesthesia maintenance may facilitate reduced utilization of volatile anaesthetics without a compromise in hemodynamic status and recovery process. Amaç: Düşük akımlı anesteziyle ilişkili birçok araştırma yapılmış olsa da, operasyon sırasında takip verileri ve güvenlik sonlanımları üzerine farklı akım hızlarının etkileri net olarak bilinmemektedir. Üçüncü basamak bir merkezde ürogenital sistem operasyonları sırasında uygulanan genel anestezi için düşük akımlı taze gaz karışımlarının farklı akım hızlarında kullanıldığı bu çalışmada, hemodinami, gaz değişim verileri ve derlenme zamanlarının gruplar arasında farklılık arz edip etmediği araştırılmıştır. Gereç ve Yöntemler: Sevofluran ile düşük akımlı anestezi uygulanan ardışık altmış iki hasta (Amerikan Anestezistler Derneği skoru I veya II) üç grupta toplandı: A, orta akım (2 L/dk), B, düşük akım (1 L/dk), C, minimal akım (0,5 L/dk). Operasyon öncesinde ve sırasında kaydedilen hemodinamik verilere ek olarak, 30. dakika ve anestezi sonlandırılmadan hemen önceki gaz değişim ve arter kan gazı değerleri incelendi. Derlenme ikinci bir hekim tarafından gözlendi ve gerekli süreler not edildi. Bulgular: Çalışma grupları arasında demografik özellikler benzerdi. Otuzuncu dakika ve anestezi sonlanımı öncesi vital bulgular, gaz değişim ve arter kan gazı analizi sonuçlarının çoğunluğu karşılaştırılabilir düzeydeydi. Operasyon sırasında, inspiratuvar sevofluran düzeyleri grup A’da anlamlı olarak daha yüksekti (%, 1,7±0,6 ve 1,3±0,3 ve 1,3±0,3, p=0,043). Derlenme zamanları açısından gruplar arasında fark tespit edilmedi [spontan soluma zamanı (p=0,21), ekstübasyon zamanı (p=0,113), göz açma zamanı (p=0,5), sözel yanıt zamanı (p=0,518) ve Modifiye Aldrete skoru 9 veya 10’a ulaşmaya kadar geçen süre (dk, 13,7±6,8 ve 13,6±5,2 ve 14,8±4, p=0,717)]. Sonuç: Düşük akımlı anestezi idamesinde gaz karışımının akım hızını 0,5 L/dk’ya kadar düşürmek, hemodinamik istikrar ve derlenme sürecine ilişkin herhangi bir taviz vermeden volatil anestetik ajanların tüketiminin azaltılmasına yardımcı olabilir.