Hendrickx Jan F A, Dewulf Bram B C, De Mey Nathalie, Carette Rik, Deloof Thierry, De Cooman Sofie, De Wolf Andre M
Department of Anesthesiology, Intensive Care and Pain Therapy, Onze Lieve Vrouw Hospital, Aalst, Belgium.
J Clin Anesth. 2008 Nov;20(7):501-7. doi: 10.1016/j.jclinane.2008.05.013. Epub 2008 Nov 18.
To determine if the previously described single-step O(2)/N(2)O fresh gas flow (FGF) sequence could be combined with a simple desflurane vaporizer (F(D)) sequence to maintain the end-expired desflurane (F(A)des) at 4.5% with the anesthesia delivery unit machine (ADU Anesthesia Machine(R); General Electric, Helsinki, Finland).
Prospective randomized clinical study.
Onze Lieve Vrouw Hospital, Aalst, Belgium, a large teaching hospital.
42 ASA physical status I and II patients requiring general endotracheal anesthesia and controlled mechanical ventilation.
In 18 patients undergoing general anesthesia with controlled mechanical ventilation, F(D) was determined to maintain F(A)des at 4.5% with O(2)/N(2)O FGF of two and 4 L per minute for three minutes and 0.3 and 0.4 L per minute thereafter. Using the same FGF sequence, we prospectively tested the F(D) schedule that approached this observed F(D) pattern with the fewest possible adjustments in another 24 patients.
F(D) of 6.5% for 15 minutes followed by 5.5% thereafter approximated the observed F(D) course well. When it was prospectively tested, the median (25th, 75th percentiles) performance error was -1% (-5.1%, 5.2%); absolute performance error, 7.1% (3.9%, 9.5%); divergence, -6.6% per hour (23.1%, 3.1%/h); and wobble, 2.2% (1.8%, 3.2%). Because F(A)des increased above 4.9%, F(D) was decreased in 5 patients after 23 minutes (0.5% decrement once or twice); in two patients, F(D) was temporarily increased. In one patient, FGF was temporarily increased because the bellows volume became insufficient.
One O(2)/N(2)O rotameter FGF setting change from 6 to 0.7 L per minute after three minutes and one desflurane F(D) change from 6.5% to 5.5% after 15 minutes maintained anesthetic gas concentrations within predictable and clinically acceptable limits during the first 20 minutes.
确定先前描述的单步氧气/氧化亚氮新鲜气体流量（FGF）序列是否可以与简单的地氟醚蒸发器（F(D)）序列相结合，以使用麻醉输送单元机器（ADU麻醉机(R)；通用电气，芬兰赫尔辛基）将呼气末地氟醚（F(A)des）维持在4.5%。
前瞻性随机临床研究。
比利时阿尔斯特的Onze Lieve Vrouw医院，一家大型教学医院。
42例美国麻醉医师协会（ASA）身体状况为I级和II级、需要全身气管内麻醉和控制机械通气的患者。
在18例接受全身麻醉并控制机械通气的患者中，确定F(D)，以在每分钟2升和4升的氧气/氧化亚氮FGF下维持F(A)des在4.5%达三分钟，此后为每分钟0.3升和0.4升。使用相同的FGF序列，我们在另外24例患者中前瞻性地测试了以最少可能调整接近该观察到的F(D)模式的F(D)方案。
15分钟内6.5%的F(D)，此后为5.5%，很好地近似了观察到的F(D)过程。当进行前瞻性测试时，中位数（第25、75百分位数）性能误差为-1%（-5.1%，5.2%）；绝对性能误差为7.1%（3.9%，9.5%）；偏差为每小时-6.6%（23.1%，3.1%/小时）；摆动为2.2%（1.8%，3.2%）。由于F(A)des升至4.9%以上，23分钟后5例患者的F(D)降低（0.5%的降幅一次或两次）；2例患者的F(D)暂时升高。1例患者因风箱容积不足而暂时增加了FGF。
三分钟后将氧气/氧化亚氮转子流量计FGF设置从每分钟6升改为0.7升，15分钟后将地氟醚F(D)从6.5%改为5.5%，可在最初20分钟内将麻醉气体浓度维持在可预测且临床可接受的范围内。
