Non-invasive control of oxygen consumption during inhalation anesthesia of antireflux laparoscopic interventions by the method of Minimal flow

Authors

  • V. I. Chernii State Institution of Science “Research and Practical Centre of Preventive and Clinical Medicine” of State Administrative Department, Kyiv, Ukraine, https://orcid.org/0000-0002-9885-9248
  • I. V. Shtompel State Institution of Science “Research and Practical Centre of Preventive and Clinical Medicine” of State Administrative Department, Kyiv, Ukraine,

DOI:

https://doi.org/10.14739/2310-1237.2020.3.221817

Keywords:

sevoflurane, methods of Low flow, Minimal flow, oxygen consumption

Abstract

 

Aim: to study the features of the general anesthesia of antireflux laparoscopic interventions in abdominal surgery using sevoflurane by the method of Low flow, Minimal flow from the standpoint of the ERAS protocol.

Materials and methods. The study was conducted at State Institution of Science “Research and Practical Centre of Preventive and Clinical Medicine” of State Administrative Department, it was prospective and not randomized. Forty patients with esophageal hernia of the diaphragm, who underwent laparoscopic crurorraphy and Nissen fundoplication were examined. The age of patients ranged from 21 to 76 years. There were 10 men (25 %) and 30 women (75 %). Patients enrolled in the study had informed consent to be examined, tested, and processed. All patients underwent combined low-flow inhalation anesthesia with sevoflurane in combination with perioperative multimodal analgesia during surgery. Patients were divided into 2 groups. The first group – Low flow anesthesia (n = 20) included patients who underwent combined inhalation anesthesia with sevoflurane with a flow of fresh gas mixture (FGF) 1.0 l/min, the second group – Minimal flow anesthesia (n = 20 ) included patients who underwent combined inhalation anesthesia with sevoflurane with a fresh gas mixture (FGF) flow of 0.5 l/min. In the study, we analyzed monitoring indicators, which included registration of non-invasive blood pressure, heart rate, 5-lead electrocardiography, registration of peripheral oxygen saturation (SrO2) + plethysmogram, depth of anesthesia according to BIS, working pressure in the operating space. Gas exchange indicators – capnography, oxygen and sevoflurane concentration in the mixture during inhalation and exhalation, ventilation parameters were constantly monitored. The monitoring is supplemented by our developed and patented method of intraoperative non-invasive control of oxygen consumption by the patient during inhalation anesthesia in the operating room.

Formation, storage, analysis of electronic database, statistical data processing and visualization of research results were performed in license packages: MedStat v. 4. and Microsoft Office.

Results. In the study of oxygen consumption by patients of the first and second groups, it was found that at stages 3 and 4 of surgery VO2 was higher compared to stages 1, 2, 5, 6. Statistically significant differences in VO2 in the study periods in the first and second groups were not detected. In both subgroups, there was no significant statistical difference between the indicators of BIS at the stages of surgery during 2–6 stages of the study, which were at the level of the surgical stage of anesthesia.

Conclusions. Monitoring of oxygen consumption by the patient is one of the criteria of intraoperative safety of the patient and adequacy of anesthesia. Oxygen consumption by the patient at all the stages of surgery makes it possible to claim that use of the method of Minimal flow anesthesia is safe for the patient.

 

References

Bharatam, K. K., Raj, R., Subramanian, J. B., Vasudevan, A., Bodduluri, S., Sriraman, K. B., & Abineshwar, N. J. (2015). Laparoscopic nissen rossetti fundoplication: Possibility towards day care anti-reflux surgeries. Annals of Medicine and Surgery, 4(4), 384-387. https://doi.org/10.1016/j.amsu.2015.10.005

Markar, S. R., Naik, R., Malietzis, G., Halliday, L., Athanasiou, T., & Moorthy, K. (2017). Component analysis of enhanced recovery pathways for esophagectomy. Diseases of the esophagus, 30(10), 1-10. https://doi.org/10.1093/dote/dox090

Puccetti, F., Fumagalli, U., De Pascale, S., Melis, A., & Rosati, R. (2016). Comparative effectiveness and analysis of postoperative outcomes after enhanced recovery programme for oesophagectomy. Clinical Nutrition ESPEN, 12, e34. https://doi.org/10.1016/j.clnesp.2016.02.015

Giacopuzzi, S., Weindelmayer, J., Treppiedi, E., Bencivenga, M., Ceola, M., Priolo, S., Carlini, M., & de Manzoni, G. (2017). Enhanced recovery after surgery protocol in patients undergoing esophagectomy for cancer: a single center experience. Diseases of the esophagus, 30(4), 1-6. https://doi.org/10.1093/dote/dow024

Li, W., Zheng, B., Zhang, S., Chen, H., Zheng, W., & Chen, C. (2017). Feasibility and outcomes of modified enhanced recovery after surgery for nursing management of aged patients undergoing esophagectomy. Journal of thoracic disease, 9(12), 5212-5219. https://doi.org/10.21037/jtd.2017.11.110

Dogan, K., Kraaij, L., Aarts, E. O., Koehestanie, P., Hammink, E., van Laarhoven, C. J., Aufenacker, T. J., Janssen, I. M., & Berends, F. J. (2015). Fast-track bariatric surgery improves perioperative care and logistics compared to conventional care. Obesity surgery, 25(1), 28-35. https://doi.org/10.1007/s11695-014-1355-2

Park, J. H., Lee, J. S., Lee, J. H., Shin, S., Min, N. H., & Kim, M. S. (2016). Effect of the Prolonged Inspiratory to Expiratory Ratio on Oxygenation and Respiratory Mechanics During Surgical Procedures. Medicine, 95(13), e3269. https://doi.org/10.1097/MD.0000000000003269

Li, F., & Yuan, Y. (2015). Meta-analysis of the cardioprotective effect of sevoflurane versus propofol during cardiac surgery. BMC anesthesiology, 15, 128. https://doi.org/10.1186/s12871-015-0107-8

Bande, D., Sadurni, M., García, C., Carazo, J., Corcoy, M., & Montes, A. (2016). Is balanced analgesia (tramadol + paracetamol + dexketoprofen) a good option in laparoscopic colon surgery? Clinical Nutrition ESPEN, 12, e38-e39. https://doi.org/10.1016/j.clnesp.2016.02.029

Checketts, M. R., Alladi, R., Ferguson, K., Gemmell, L., Handy, J. M., Klein, A. A., Love, N. J., Misra, U., Morris, C., Nathanson, M. H., Rodney, G. E., Verma, R., Pandit, J. J., & Association of Anaesthetists of Great Britain and Ireland (2016). Recommendations for standards of monitoring during anaesthesia and recovery 2015: Association of Anaesthetists of Great Britain and Ireland. Anaesthesia, 71(1), 85-93. https://doi.org/10.1111/anae.13316

Pędziwiatr, M., Kisialeuski, M., Wierdak, M., Stanek, M., Natkaniec, M., Matłok, M., Major, P., Małczak, P., & Budzyński, A. (2015). Early implementation of Enhanced Recovery After Surgery (ERAS®) protocol - Compliance improves outcomes: A prospective cohort study. International journal of surgery, 21, 75-81. https://doi.org/10.1016/j.ijsu.2015.06.087

Feldheiser, A., Aziz, O., Baldini, G., Cox, B. P., Fearon, K. C., Feldman, L. S., Gan, T. J., Kennedy, R. H., Ljungqvist, O., Lobo, D. N., Miller, T., Radtke, F. F., Ruiz Garces, T., Schricker, T., Scott, M. J., Thacker, J. K., Ytrebø, L. M., & Carli, F. (2016). Enhanced Recovery After Surgery (ERAS) for gastrointestinal surgery, part 2: consensus statement for anaesthesia practice. Acta anaesthesiologica Scandinavica, 60(3), 289-334. https://doi.org/10.1111/aas.12651

Shtompel, I. V. & Chernii, V. I. (2020). Sposib intraoperatsiinoho neinvazyvnoho kontroliu spozhyvannia kysniu patsiientom pid chas inhaliatsiinoi anestezii [Method of intraoperative non-invasive control of oxygen consumption by patient during inhalation anesthesia]. Ukraine Patent UA 141845. https://base.uipv.org/searchINV/search.php?action=viewdetails&IdClaim=267987

https://base.uipv.org/searchINV/search.php?action=viewdetails&IdClaim=267999 – неправильне посилання

Pasichnyk, H. P. (2015). Osoblyvosti kisnevogo balansu ta tkanynnogo dihannya pru chirurgighnomu likuvanni adenoma gipofiza [Features of oxygen balance and tissue respiration in the surgical treatment of pituitary adenomas]. Medytsyna nevidkladnykh staniv, (7), 50-56. [In Ukrainian].

Sykes O. (2017). Metabolic oxygen requirements. Anaesthesia, 72(3), 415-416. https://doi.org/10.1111/anae.13819

Sen, O., Umutoglu, T., Aydın, N., Toptas, M., Tutuncu, A. C., & Bakan, M. (2016). Effects of pressure-controlled and volume-controlled ventilation on respiratory mechanics and systemic stress response during laparoscopic cholecystectomy. SpringerPlus, 5, 298. https://doi.org/10.1186/s40064-016-1963-5

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How to Cite

1.
Chernii VI, Shtompel IV. Non-invasive control of oxygen consumption during inhalation anesthesia of antireflux laparoscopic interventions by the method of Minimal flow. Pathologia [Internet]. 2020Dec.29 [cited 2024Dec.23];(3). Available from: http://pat.zsmu.edu.ua/article/view/221817

Issue

No. 3 (2020)

Section

Original research

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