Assessing the clinical or pharmaco-economical benefit of target controlled desflurane delivery in surgical patients using the Zeus anaesthesia machine.
The Zeus anaesthesia machine includes an auto-control mode which allows targeting of end-tidal volatile and inspired oxygen concentrations. We assessed the clinical benefits and economic impact of this target-controlled anaesthesia compared with conventional manually controlled anaesthesia. Eighty patients were randomly assigned to receive desflurane either with a fresh gas flow set by the anaesthetist or in auto-control mode. Drug delivery was adjusted to maintain bispectral index between 40-60 units and systolic arterial pressure under 15 mmHg above its pre-induction value (upper limit) and over 90 mmHg (lower limit). Blood pressure was maintained in the desired range for 89% and 91% of the maintenance period for auto-control and manual control respectively (p = 0.49). Bispectral index was in the desired range for 82% and 79% of the maintenance period, for auto-control and manual control respectively (p = 0.46). Oxygen consumption was more than halved by the use of auto-control mode, and mean (SD) desflurane consumption during surgery was 0.07 (0.04) vs 0.2 (0.07) ml.min(-1) in auto-control and manual control respectively (p < 0.0001). The number of drug delivery adjustments per hour was significantly lower in auto-control mode (mean (SD) 7 (2) vs 15 (12); p < 0.0001). Thus, the auto-control mode provided similar haemodynamic stability and bispectral control as did conventional manually controlled anaesthesia, but led to a reduction in gas and vapour consumption with a more clinically acceptable workload.
Lortat-Jacob
B
B
Department of Anaesthesia, Hôpital Bichat Claude Bernard, Assistance Publique-Hôpitaux de Paris, Paris, France.
Billard
V
V
Buschke
W
W
Servin
F
F
D000293:Adolescent; D000328:Adult; D000368:Aged; D000769:Anesthesia, Inhalation / Q000295:instrumentation* / Q000379:methods; D018685:Anesthetics, Inhalation / Q000008:administration & dosage*; D001794:Blood Pressure / Q000187:drug effects; D002985:Clinical Protocols; D000077335:Desflurane; D004334:Drug Administration Schedule; D016503:Drug Delivery Systems / Q000295:instrumentation*; D004569:Electroencephalography / Q000187:drug effects; D006801:Humans; D007530:Isoflurane / Q000008:administration & dosage / Q000031:analogs & derivatives*; D008875:Middle Aged; D016343:Monitoring, Intraoperative / Q000379:methods; D011446:Prospective Studies; D016526:Workload; D055815:Young Adult
D018685:Anesthetics, Inhalation; D000077335:Desflurane; D007530:Isoflurane