Brief review: Theory and practice of minimal fresh gas flow anesthesia

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• 作者：Metha Brattwall MD ; PhD (1)
  Margareta Warrén-Stomberg PhD (2)
  Fredrik Hesselvik MD ; PhD (3)
  Jan Jakobsson MD ; PhD (3) (4)
  
• 刊名：Canadian Journal of Anesthesia/Journal canadien d'anesth篓娄sie
• 出版年：2012
• 出版时间：August 2012
• 年：2012
• 卷：59
• 期：8
• 页码：785-797
• 全文大小：368KB
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• 作者单位：Metha Brattwall MD, PhD (1)
  Margareta Warrén-Stomberg PhD (2)
  Fredrik Hesselvik MD, PhD (3)
  Jan Jakobsson MD, PhD (3) (4)
  
  1. Department of Anesthesiology & Intensive care, Institution for clinical sciences, Sahlgrenska Academy, Gothenburg, Sweden
  2. Institute of Health and care Sciences, University of Gothenburg/the Sahlgrenska Academy, Gothenburg, Sweden
  3. Department of Anesthesiology and Intensive Care, Danderyd Hospital, 182 88, Danderyd, Stockholm, Sweden
  4. Department of Anaesthesia & Intensive Care, Institution for Physiology & Pharmacology, Karolinska Institutet, Stockholm, Sweden
  

文摘

Purpose The aim of this brief review is to provide an update on the theory regarding minimal fresh gas flow techniques for inhaled general anesthesia. The article also includes an update and discussion of the practical aspects associated with minimal-flow anesthesia, including the advantages, potential limitations, and safety considerations of this important anesthetic technique. Principal findings Reducing the fresh gas flow to?<?1 L·min? during maintenance of anesthesia is associated with several benefits. Enhanced preservation of temperature and humidity, cost savings through more efficient utilization of inhaled anesthetics, and environmental considerations are three key reasons to implement minimal-flow and closed-circuit anesthesia, although potential risks are hypoxic gas mixtures and inadequate depth of anesthesia. The basic elements of the related pharmacology need to be considered, especially pharmacokinetics of the inhaled anesthetics. The third-generation inhaled anesthetics, sevoflurane and desflurane, have low blood and low tissue solubility, which facilitates rapid equilibration between the alveolar and effect site (brain) concentrations and makes them ideally suited for low-flow techniques. The use of modern anesthetic machines designed for minimal-flow techniques, leak-free circle systems, highly efficient CO2 absorbers, and the common practice of utilizing on-line real-time multi-gas monitor, including essential alarm systems, allow for safe and cost-effective minimal-flow techniques during maintenance of anesthesia. The introduction of new anesthetic machines with built-in closed-loop algorithms for the automatic control of inspired oxygen and end-tidal anesthetic concentration will further enhance the feasibility of minimal-flow techniques. Conclusions With our modern anesthesia machines, reducing the fresh gas flow of oxygen to 0.3-0.5 L·min? and using third-generation inhaled anesthetics provide a reassuringly safe anesthetic technique. This environmentally friendly practice can easily be implemented for elective anesthesia; furthermore, it will facilitate cost savings and improve temperature homeostasis.