Brazilian Journal of Anesthesiology
https://bjan-sba.org/article/doi/10.1016/j.bjane.2021.05.012
Brazilian Journal of Anesthesiology
Original Investigation

Comparison of minimal-flow sevoflurane versus desflurane anesthesia: randomized clinical trial

Comparação de anestesia de fluxo mínimo com sevoflurano e desflurano: ensaio clínico randomizado

Berna Ayanoğlu Taş; Ceren Şanlı Karip; Süheyla Abitağaoğlu; Mehmet Celal Öztürk; Dilek Erdoğan Arı

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Abstract

Background and objectives: Minimal-flow anesthesia provides various advantages, such as reduced environmental pollution, proper humidification and warming of anesthetic gases, and reduced costs. The aim of this study was to compare the cost-effectiveness of minimal-flow sevoflurane and desflurane anesthesia and their effects on hemodynamics, postoperative recovery, respiratory parameters, and liver and kidney functions.

Methods: A total of 60 ASA I-II patients aged 18-70 years who underwent posterior spinal instrumentation were included in the study. The patients were divided into Group S (sevoflurane) and Group D (desflurane). After anesthesia induction, the gas flow was initiated at a rate of 4 L.min-1 using a concentration of 8% in Group D and 3.5% in Group S, and the time to reach 0.8 MAC was recorded. The gas flow was then switched to minimal flow. Patient hemodynamic and respiratory parameters, body temperatures and arterial blood gas levels were recorded. The integrated pulmonary index (IPI) was monitored postoperatively. Biochemical findings were recorded 12 hours after the operation. The amount of bleeding and blood transfused, and the costs involved were calculated.

Results: The patients’ demographic characteristics, duration of surgery, hemodynamic parameters, IPI values, body temperatures, and arterial blood gas levels were similar at all time points. Biochemical findings, amount of bleeding and amount of blood transfused were similar between the two groups. The mean cost was lower in Group S than in Group D (p = 0.007).

Conclusion: The study found no significant difference in terms of reliability between minimal-flow sevoflurane and desflurane anesthesia. Furthermore, the procedure was found to be more cost-effective for Group S than for Group D.

Keywords

Anesthesia, Rebreathing, Desflurane, Sevoflurane

Resumo

Justificativa e objetivos: A anestesia com fluxo mínimo oferece várias vantagens, como redução da poluição ambiental, umidificação e aquecimento adequados dos gases anestésicos e redução de custos. O objetivo deste estudo foi comparar o custo-efetividade da anestesia com sevoflurano e desflurano com fluxo mínimo e seus efeitos na hemodinâmica, recuperação pós-operatória, parâmetros respiratórios e funções hepáticas e renais.

Métodos: Um total de 60 pacientes ASA I-II com idades entre 18-70 anos submetidos a instrumentação espinhal posterior foram incluídos no estudo. Os pacientes foram divididos em Grupo S (sevoflurano) e Grupo D (desflurano). Após a indução da anestesia, o fluxo de gás foi iniciado a uma taxa de 4 L.min-1 usando uma concentração de 8% no Grupo D e 3,5% no Grupo S, e o tempo para atingir 0,8 CAM foi registrado. O fluxo de gás foi então alterado para fluxo mínimo. Os parâmetros hemodinâmicos e respiratórios do paciente, a temperatura corporal e os níveis de gases no sangue arterial foram registrados. O índice pulmonar integrado (IPI) foi monitorado no pós-operatório. Os achados bioquímicos foram registrados 12 horas após a operação. A quantidade de sangramento e sangue transfundido e os custos envolvidos foram calculados.

Resultados: As características demográficas dos pacientes, duração da cirurgia, parâmetros hemodinâmicos, valores de IPI, temperatura corporal e níveis de gases no sangue arterial foram semelhantes em todos os momentos. Os achados bioquímicos, quantidade de sangramento e quantidade de sangue transfundido foram semelhantes entre os dois grupos. O custo médio foi menor no Grupo S do que no Grupo D (p = 0,007).

Conclusão: O estudo não encontrou diferença significativa em termos de confiabilidade entre a anestesia com fluxo mínimo com sevoflurano e desflurano. Além disso, o procedimento foi considerado de maior custo-benefício para o Grupo S do que para o Grupo D.
 

Palavras-chave

Anestesia, Rebreathing, Desflurano, Sevoflurano

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Submitted date:
05/16/2019

Accepted date:
05/22/2021

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