在低流量麻醉诱导期间使用0.5L新鲜气流和8%七氟醚的过压冲洗法的可行性、安全性和有效性：一项随机描述性研究。
Feasibility, safety and efficiency of an over-pressure wash-in method using fresh gas flow 0.5 L and sevoflurane 8% during initiation of low-flow anaesthesia: A randomised, descriptional study.
作者信息
Joshiraj Bandi, Hegde Harihar V, Marimuthu Sriramamoorthy R, Paul Manisha, George Neethu
机构信息
Department of Anaesthesia and Intensive Care, Royal Hospital, Muscat, Sultanate of Oman.
出版信息
Indian J Anaesth. 2025 Jun;69(6):580-586. doi: 10.4103/ija.ija_83_25. Epub 2025 May 14.
BACKGROUND AND AIMS
Low-flow anaesthesia (LFA) typically involves a high fresh gas flow (FGF) of 4-6 L/min during the wash-in phase. We aimed to assess the feasibility, safety, and efficiency of an over-pressure wash-in method (FGF = 0.5 L and sevoflurane = 8%) of LFA. The primary objective was the time required to achieve a fraction of alveolar sevoflurane (FAS) =2% (target). Secondary objectives included breathing system stability, ephedrine use, and gas consumption.
METHODS
After obtaining ethical clearance and consent, 48 patients aged 18-65 years were randomised to two groups: 'conventional' (Group C) and 'over-pressure' (Group OP). During the wash-in phase, FGF was set at 6 L/min with a sevoflurane vaporiser dial (FVS) of 3% in Group C and at 0.5 L/min with an FVS of 8% in Group OP. After achieving a FAS of 2%, FGF was reduced to 0.5 L/min in Group C, and FVS was adjusted to 4% in both groups, which were maintained for 15 min. The unpaired -test was used to compare quantitative, normally distributed data, while the Mann-Whitney U test was used to compare quantitative, discrete data. A value of less than 0.05 was considered statistically significant.
RESULTS
Data from 45 patients (23 in Group C and 22 in Group OP) were analysed. The mean T was significantly less in Group C than in Group OP [314 (SD: 145) vs 478 (SD: 100) s, < 0.001]. The breathing system was 'stable' in a significantly higher number of patients (number, percentage) in Group OP compared to Group C (19, 86.4% vs 8, 34.8%) ( = 0.001). The number of vaporiser dial adjustments was significantly different ( = 0.005). The mean consumption of oxygen [50.7 (SD: 6.6) vs 36.4 (SD: 1.2) L, < 0.001], air [19.2 (SD: 6.8) vs 4.0 (SD: 0.3) L, < 0.001], and sevoflurane [6.7 (SD: 2) vs 3.3 (SD: 1) mL, < 0.001] was significantly higher in Group C compared to Group OP.
CONCLUSION
Our method of over-pressure wash-in during LFA initiation is simple, feasible, safe, efficient, economical, and environmentally friendly.
背景与目的
低流量麻醉（LFA）通常在预充期采用4 - 6L/min的高新鲜气体流量（FGF）。我们旨在评估LFA的一种超压预充方法（FGF = 0.5L且七氟醚 = 8%）的可行性、安全性和效率。主要目标是达到肺泡七氟醚分数（FAS）= 2%（目标值）所需的时间。次要目标包括呼吸回路稳定性、麻黄碱使用情况和气体消耗。
方法
在获得伦理批准和患者同意后，将48例年龄在18 - 65岁的患者随机分为两组：“传统组”（C组）和“超压组”（OP组）。在预充期，C组将FGF设置为6L/min，七氟醚挥发罐刻度（FVS）为3%；OP组将FGF设置为0.5L/min，FVS为8%。在达到FAS为2%后，C组将FGF降至0.5L/min，两组均将FVS调整至4%，并维持15分钟。采用非配对t检验比较定量的正态分布数据，采用曼 - 惠特尼U检验比较定量的离散数据。P值小于0.05被认为具有统计学意义。
结果
分析了45例患者的数据（C组23例，OP组22例）。C组达到目标的平均时间T显著短于OP组[314（标准差：145）秒对478（标准差：100）秒，P < 0.001]。与C组相比，OP组呼吸回路“稳定”的患者数量（例数、百分比）显著更多（19例，86.4%对8例，34.8%）（P = 0.001）。挥发罐刻度调整次数有显著差异（P = 0.005）。C组的氧气平均消耗量[50.7（标准差：6.6）L对36.4（标准差：1.2）L，P < 0.001]、空气平均消耗量[19.2（标准差：6.8）L对4.0（标准差：0.3）L，P < 0.001]和七氟醚平均消耗量[6.7（标准差：2）mL对3.
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