title: Derivation and prospective testing of a two-step sevoflurane-O2-N2O low fresh gas flow sequence.
abstract: Simple vaporiser setting (F(D)) and fresh gas flow (FGF) sequences make the practice of low-flow anaesthesia not only possible but also easy to achieve. We sought to derive a sevoflurane F(D) sequence that maintains the end-expired sevoflurane concentration (F(A)sevo) at 1.3% using the fewest possible number of F(D) adjustments with a previously described O2-N2O FGF sequence that allows early FGF reduction to 0.7 l min(-1). In 18 ASA physical status I to IH patients, F(D) was determined to maintain F(A)sevo at 1.3% with 2 l min(-1) O2 and 4 l min(-1) N2O FGF for three minutes, and with 0.3 and 0.4 l min(-1) thereafter. Using the same FGF sequence, the F(D) schedule that approached the 1.3% F(A)sevo pattern with the fewest possible adjustments was prospectively tested in another 18 patients. The following F(D) sequence approximated the F(D) course well: 2% from zero to three minutes, 2.6% from three to 15 minutes and 2.0% after 15 minutes. When prospectively tested, median (25th; 75th percentile) performance error was 0.8 (-2.9; 5.9)%, absolute performance error 6.7 (3.3; 10.6)%, divergence 18.2 (-5.6; 27.4)%.h(-1) and wobble 4.4 (1.7; 8.1) %. In one patient, FGF had to be temporarily increased for four minutes. One O2/N2O rotameter FGF setting change from 6 to 0.7 l min(-1) at three minutes and two sevoflurane F(D) changes at three and 15 minutes maintained predictable anaesthetic gas concentrations during the first 45 minutes in all but one patient in our study.
authors.affiliation: Department of Anaesthesiology, Intensive Care and Pain Therapy, University of Maastricht, Maastricht, The Netherlands.
authors.forename: T
authors.initials: T
authors.lastname: van Zundert
authors.forename: A
authors.initials: A
authors.lastname: Brebels
authors.forename: J
authors.initials: J
authors.lastname: Hendrickx
authors.forename: R
authors.initials: R
authors.lastname: Carette
authors.forename: S
authors.initials: S
authors.lastname: De Cooman
authors.forename: S
authors.initials: S
authors.lastname: Gatt
authors.forename: A
authors.initials: A
authors.lastname: De Wolf
mesh_terms: D000328:Adult; D000769:Anesthesia, Inhalation / Q000379:methods; D018685:Anesthetics, Inhalation / Q000008:administration & dosage*; D005260:Female; D006801:Humans; D008297:Male; D008738:Methyl Ethers / Q000008:administration & dosage*; D008875:Middle Aged; D009609:Nitrous Oxide / Q000008:administration & dosage*; D011446:Prospective Studies; D000077149:Sevoflurane; D013997:Time Factors
chemical_list: D018685:Anesthetics, Inhalation; D008738:Methyl Ethers; D000077149:Sevoflurane; D009609:Nitrous Oxide