Desfluranetheimplementation - Dr. a. Alisher Ppt 15.08.2011

7/29/2019 Desfluranetheimplementation - Dr. a. Alisher Ppt 15.08.2011

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The Implementation

of DESFLURANE

Dr. Alisher Agzamov MD PhD


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DESFLURANE


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Desflurane for LMA removal

in anaesthetised adults Makkar JK, Arora S, Jain K, Wig J; ED50

of desflurane for laryngeal maskairway removal in anaesthetised

adults;Anaesthesia (Jul 2011)


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in anaesthetised adults

The end-tidal concentration ranged

from 2.1% to 5.3%. of DS allows

removal of the LMA in 50% ofanaesthetised adults (ED50);


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in anaesthetised adults

32 female patients;

Aged: 30-50 years;

Undergoing intracavity caesium

implants for cervical carcinoma under

GA.


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Desflurane for LMA removal inanaesthetised adults

Anaesthesia was induced with

Propofol 2-3 mg/kg;

And maintained with DS in a 50% N2O-

O2 mixture.


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At the end of surgery, a predetermined

target end-tidal DS concentration

(starting at 4%) was maintained for 10min using Dixon's up-down method

and the LMA was removed.


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The target end-tidal concentration in

the next patient was increased ordecreased by 0.5% depending upon

the response of the previous patient.


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DESFLURANE Removal of the LMA without coughing,

clenching, biting, movement or any

adverse airway event during or within1 min after removal was considered to

be successful.


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DESFLURANE The LMA successfully removed in 50%

(ED50) and 95% (ED95) of the

anaesthetised adults at end-tidal DSconcentrations of:

2.4% (95% CI 1.3-2.9) and

3.8% (3.1-9.6).


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Desflurane & Sevoflurane

Apuhan T, Yildirim YS, Aksoy F, Borin O,

Ozturan O; The effects of desflurane

and sevoflurane on the peri- andpostoperative bleeding of

adenotonsillectomy patients;

International Journal of PediatricOtorhinolaryngology (Mar 2011)


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Desflurane & Sevoflurane It has been compared the effects of

volatile anesthetics, Desflurane and

Sevoflurane on intra-operative andpostoperative bleeding in patients who

underwent tonsillectomy and

adenoidectomy.


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Desflurane & Sevoflurane 400 children (190 girl and 210 boys);

Aged between 2 and 16 years;

Were included in this clinical trial.

The patients underwent conventional

cold tonsillectomy and curettageadenoidectomy under GA.


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Desflurane & Sevoflurane For the maintenance of anaesthesia,

the patients were randomized into two

groups: DS group and

SV group, Each groups including 200 patients.


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Desflurane & Sevoflurane DS concentration: 4% and 6% (0.7-0.9

MAC);

Whereas SV concentration: 2% and2.5% (0.7-0.9 MAC).


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Desflurane & Sevoflurane The amount of perioperative bleeding

in milliliters was measured by usingseparate aspirator bags for each

patient.


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Desflurane & Sevoflurane DS caused significantly lower amount

of perioperative bleeding compared toSV (p=0.03).


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Desflurane & Sevoflurane No significant difference was

observed between the two groups in

terms of age, body mass index andoperation duration, respectively

(p=0.20, p=0.49, p=0.07).


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Desflurane & Sevoflurane DS leads to a lower amount of

intraoperative bleeding than SV duringtonsillectomy and adenoidectomy

operations.


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The Ad Hoc Introduction of

Desflurane Eberhart LH, Gerlach H, Knaber R, KochT, Morin AM, Rhr F, Wagner S, Wulf H,

Zoremba M; Implementation of newstandards in anaesthesia : Exemplified

by the ad hoc introduction of

desflurane in 10 German hospitals;Der Anaesthesist (Nov 2010)


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The Ad Hoc Introduction of Desflurane According to numerous

pharmacoeconomic studies new

anaesthesia techniques can improverecovery times;

And thus can have a positive

economic impact on patient turnover.


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The Ad Hoc Introduction of Desflurane However, artificial study protocols do

not always match real world situations

and thus the practical impact of suchstudies remains unclear.


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The Ad Hoc Introduction of Desflurane At 10 hospitals exclusively using SV as a

volatile anaesthetic, the ad hoc implementation

of DS was studied with respect to post-

anaesthetic recovery times (primary endpoint);


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The Ad Hoc Introduction of Desflurane And postoperative outcome measured by the

Quality of Recovery Score- (QoR-)40, on the first

postoperative day was investigated.


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The Ad Hoc Introduction of Desflurane Patients undergoing elective surgical

procedures under GA with:

Sevoflurane (n=186) or

Desflurane (n=176)

was started immediately after a period of a few

days after introducing the new drug to all

patients.


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The Ad Hoc Introduction of Desflurane

Except for the volatile anaesthetic the

anaesthetic procedure was performedaccording to local standing operating

procedures.

Ad H I t d ti f


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Ad Hoc Introduction of

Desflurane

All parameters indicating the

immediate postanaesthetic recoverywere superior in the patients receiving

DS (mean SD).


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The Ad Hoc Introduction of Desflurane Time to extubation was accelerated

from:

8.79.7 min.to

6.26.8 min.


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The Ad Hoc Introduction of Desflurane Times to recalling name and date of

birth were accelerated by:

2.6 min, and 3.8 min, respectively.


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The Ad Hoc Introduction of Desflurane Transferring the patients from the OT

to the PARU was:

17.311.5 min after SV and 13.77.8 min after anaesthesia with

DS.


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The Ad Hoc Introduction of Desflurane Eligibility for discharge according to a

modified Aldrete score was reached

after: 10398 and

7976 min, respectively.


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The Ad Hoc Introduction of Desflurane

The postoperative recovery (QoR 40

questionnaire) did not differ 24 h later.


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The Ad Hoc Introduction of Desflurane The implementation of a new drug (DS

to substitute SV) can improve speed of

recovery immediately after terminationof anaesthesia even after a very short

period of introducing the new

technique but has no positive longterm effects.


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The Ad Hoc Introduction of Desflurane The results of this trial performed

under a real world scenario (health

service research) without tightstandardization by an artificial study

protocol supports the results

originating from randomizedcontrolled clinical trials.


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The effects of LF and HF IA N2O and DS on

mucociliary activity and pulmonary function tests

Bilgi M, Goksu S, Mizrak A, Cevik C, GulR, Koruk S, Sahin L; Comparison of the

effects of low-flow and high-flowinhalational anaesthesia with nitrousoxide and desflurane on mucociliary

activity and pulmonary function tests;European Journal of Anaesthesiology(Nov 2010)

The effects of LF and HF IA N2O and DS


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on mucociliary activity and pulmonary

function tests

It has been investigated the effects of

inhalational anaesthesia using lowand high gas flow rates of N2O and DS

on mucociliary clearance and

pulmonary function.



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The effects of LF and HF IA N2O and DSon mucociliary activity and pulmonary

function tests

50 patients, ASA physical status I-II,

Age: 18 - 70 years.

Patients were assigned randomly toone of two study groups.


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Desflurane


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Desflurane


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Desflurane



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function tests

The fresh gas flow rate was 1 L/min

(0.5 L/min O2 + 0.5 L/min N2O + DS) in

group 1 and;

3 L/min (1.5 L/min O2 + 1.5 L/min N2O+ DS) in group 2.


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function tests

Patients' haemodynamic parameters

and changes in the humidity and

temperature of the inspired gaseswere recorded and the saccharin

clearance time was measured before

and after anaesthesia.


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Desflurane



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function tests

Respiratory parameters

Body Temperature

ETCO2 concentration and

Inspired and Expired O2 and

N2O concentrations were alsorecorded.


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Desflurane


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function tests

The FVC and FEV in 1 s were

significantly lower and the saccharinclearance time was significantly

longer in group 2 compared to group 1

(P


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e e ects o a d O a d Son mucociliary activity and pulmonary

function tests

There were statistically significant

differences between the groups

regarding the humidity andtemperature of the inspired gases

(P


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function tests

Respiratory function and mucociliary

clearance are better preserved in a

low-flow anaesthesia technique thanin high-flow anaesthesia with N2O and

DS.



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function tests

A low-flow anaesthesia technique with

N2O and DS provide an importantclinical advantage because it provides

appropriately heated and humidified

gases to the tracheobronchial tree.

Desfluranetheimplementation - Dr. a. Alisher Ppt 15.08.2011

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Transcript of Desfluranetheimplementation - Dr. a. Alisher Ppt 15.08.2011