The Implementation of DESFLURANE

Dr. Alisher Agzamov MD PhD

DESFLURANE

Desflurane for LMA removal in anaesthetised adults

Makkar JK, Arora S, Jain K, Wig J; ED50 of desflurane for laryngeal mask airway removal in anaesthetised adults; Anaesthesia (Jul 2011)

Desflurane for LMA removal in anaesthetised adults

The end-tidal concentration ranged from 2.1% to 5.3%. of DS allows removal of the LMA in 50% of anaesthetised adults (ED50);

Desflurane for LMA removal in anaesthetised adults

32 female patients; Aged: 30-50 years; Undergoing intracavity caesium implants for cervical carcinoma under GA.

Desflurane for LMA removal in anaesthetised adults

Anaesthesia was induced with Propofol 2-3 mg/kg; And maintained with DS in a 50% N2OO2 mixture.

Desflurane for LMA removal in anaesthetised adults

At the end of surgery, a predetermined target end-tidal DS concentration (starting at 4%) was maintained for 10 min using Dixon's up-down method and the LMA was removed.

Desflurane for LMA removal in anaesthetised adults

The target end-tidal concentration in the next patient was increased or decreased by 0.5% depending upon the response of the previous patient.

DESFLURANE
Removal of the LMA without coughing, clenching, biting, movement or any adverse airway event during or within 1 min after removal was considered to be successful.

DESFLURANE
The LMA successfully removed in 50% (ED50) and 95% (ED95) of the anaesthetised adults at end-tidal DS concentrations of: 2.4% (95% CI 1.3-2.9) and 3.8% (3.1-9.6).

Desflurane & Sevoflurane

Apuhan T, Yildirim YS, Aksoy F, Borin O, Ozturan O; The effects of desflurane and sevoflurane on the peri- and postoperative bleeding of adenotonsillectomy patients; International Journal of Pediatric Otorhinolaryngology (Mar 2011)

Desflurane & Sevoflurane

It has been compared the effects of volatile anesthetics, Desflurane and Sevoflurane on intra-operative and postoperative bleeding in patients who underwent tonsillectomy and adenoidectomy.

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 curettage adenoidectomy under GA.

Desflurane & Sevoflurane

For the maintenance of anaesthesia, the patients were randomized into two groups: DS group and SV group, Each groups including 200 patients.

Desflurane & Sevoflurane

DS concentration: 4% and 6% (0.7-0.9 MAC); Whereas SV concentration: 2% and 2.5% (0.7-0.9 MAC).

Desflurane & Sevoflurane

The amount of perioperative bleeding in milliliters was measured by using separate aspirator bags for each patient.

Desflurane & Sevoflurane

DS caused significantly lower amount of perioperative bleeding compared to SV (p=0.03).

Desflurane & Sevoflurane

No significant difference was observed between the two groups in terms of age, body mass index and operation duration, respectively (p=0.20, p=0.49, p=0.07).

Desflurane & Sevoflurane

DS leads to a lower amount of intraoperative bleeding than SV during tonsillectomy and adenoidectomy operations.

The Ad Hoc Introduction of Desflurane

Eberhart LH, Gerlach H, Knaber R, Koch T, Morin AM, Rhr F, Wagner S, Wulf H, Zoremba M; Implementation of new standards in anaesthesia : Exemplified by the ad hoc introduction of desflurane in 10 German hospitals; Der Anaesthesist (Nov 2010)

The Ad Hoc Introduction of Desflurane

According to numerous pharmacoeconomic studies new anaesthesia techniques can improve recovery times; And thus can have a positive economic impact on patient turnover.

The Ad Hoc Introduction of Desflurane

However, artificial study protocols do not always match real world situations and thus the practical impact of such studies remains unclear.

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 postanaesthetic recovery times (primary endpoint);

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.

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.

The Ad Hoc Introduction of Desflurane

Except for the volatile anaesthetic the anaesthetic procedure was performed according to local standing operating procedures.

Ad Hoc Introduction of Desflurane

All parameters indicating the immediate postanaesthetic recovery were superior in the patients receiving DS (mean SD).

The Ad Hoc Introduction of Desflurane

Time to extubation was accelerated from: 8.79.7 min. to 6.26.8 min.

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.

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.

The Ad Hoc Introduction of Desflurane

Eligibility for discharge according to a modified Aldrete score was reached after: 10398 and 7976 min, respectively.

The Ad Hoc Introduction of Desflurane

The postoperative recovery (QoR 40 questionnaire) did not differ 24 h later.

The Ad Hoc Introduction of Desflurane

The implementation of a new drug (DS to substitute SV) can improve speed of recovery immediately after termination of anaesthesia even after a very short period of introducing the new technique but has no positive long term effects.

The Ad Hoc Introduction of Desflurane

The results of this trial performed under a real world scenario (health service research) without tight standardization by an artificial study protocol supports the results originating from randomized controlled clinical trials.

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, Gul R, Koruk S, Sahin L; Comparison of the effects of low-flow and high-flow inhalational anaesthesia with nitrous oxide 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 on mucociliary activity and pulmonary function tests It has been investigated the effects of inhalational anaesthesia using low and high gas flow rates of N2O and DS on mucociliary clearance and pulmonary function.

The effects of LF and HF IA N2O and DS on mucociliary activity and pulmonary function tests 50 patients, ASA physical status I-II, Age: 18 - 70 years. Patients were assigned randomly to one of two study groups.

Desflurane

Desflurane

Desflurane

The effects of LF and HF IA N2O and DS on mucociliary activity and pulmonary 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.

The effects of LF and HF IA N2O and DS on mucociliary activity and pulmonary function tests Patients' haemodynamic parameters and changes in the humidity and temperature of the inspired gases were recorded and the saccharin clearance time was measured before and after anaesthesia.

Desflurane

The effects of LF and HF IA N2O and DS on mucociliary activity and pulmonary function tests Respiratory parameters Body Temperature ETCO2 concentration and Inspired and Expired O2 and N2O concentrations were also recorded.

Desflurane

The effects of LF and HF IA N2O and DS on mucociliary activity and pulmonary function tests The FVC and FEV in 1 s were significantly lower and the saccharin clearance time was significantly longer in group 2 compared to group 1 (P<0.05).

The effects of LF and HF IA N2O and DS on mucociliary activity and pulmonary function tests There were statistically significant differences between the groups regarding the humidity and temperature of the inspired gases (P<0.05).

The effects of LF and HF IA N2O and DS on mucociliary activity and pulmonary function tests Respiratory function and mucociliary clearance are better preserved in a low-flow anaesthesia technique than in high-flow anaesthesia with N2O and DS.

The effects of LF and HF IA N2O and DS on mucociliary activity and pulmonary function tests A low-flow anaesthesia technique with N2O and DS provide an important clinical advantage because it provides appropriately heated and humidified gases to the tracheobronchial tree.