Feasibility and Safety Properties of Metabolic-Flow Anesthesia Driven by Automated Gas Control<sup>®</sup> in Pediatric Patients: A Prospective Observational Study
<i>Background and Objectives</i>: Metabolic-flow (<0.35 L/min) anesthesia is practiced more often as manufacturers provide newer technologies, yet the benefits of metabolic-flow anesthesia have not been fully investigated. This study aimed to investigate the feasibility and safety of...
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2025-04-01
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| author | Emre Sertaç Bingül Meltem Savran Karadeniz Emre Şentürk İrem Vuran Yaz Ayşe Gülşah Atasever Mukadder Orhan Sungur |
| author_facet | Emre Sertaç Bingül Meltem Savran Karadeniz Emre Şentürk İrem Vuran Yaz Ayşe Gülşah Atasever Mukadder Orhan Sungur |
| author_sort | Emre Sertaç Bingül |
| collection | DOAJ |
| description | <i>Background and Objectives</i>: Metabolic-flow (<0.35 L/min) anesthesia is practiced more often as manufacturers provide newer technologies, yet the benefits of metabolic-flow anesthesia have not been fully investigated. This study aimed to investigate the feasibility and safety of automated gas control (AGC<sup>®</sup>) mode, which provides metabolic-flow anesthesia, in a pediatric population. <i>Materials and Methods</i>: Pediatric surgery patients between 1 and 10 years of age were included in this prospective observational trial. After intravenous induction and safe orotracheal intubation, AGC<sup>®</sup> was initiated, and total sevoflurane consumption (mL) and wash-in speed-based sevoflurane consumption data were collected to measure feasibility. For safety, inspired (F<sub>i</sub>O<sub>2</sub>), alveolar (F<sub>A</sub>O<sub>2</sub>), and expired (F<sub>E</sub>O<sub>2</sub>) oxygen concentration data, and inspired and alveolar sevoflurane (F<sub>i</sub>Sevo and F<sub>A</sub>Sevo, respectively) concentration data, were recorded. Changes in fresh gas flow (FGF) throughout the procedure and postoperative recovery data were also compared. <i>Results</i>: A total of 130 patients were eligible for this study, and 121 patients were included in the analyses; 30 patients had a wash-in speed of 4 (WI4) and 91 patients had a wash-in speed of 8 (WI8) at follow-up. The total mean sevoflurane consumption was 9.35 ± 4.93 mL for a median surgery duration of 100 min. WI8 patients consumed more sevoflurane (9.92 ± 5.08 mL vs. 7.79 ± 4.19 mL, <i>p</i> = 0.04). At the 15th and 30th minutes, the FGF dropped under minimal flow and metabolic flow limits, respectively (<i>p</i> < 0.001). The times to extubation and obeying commands were shorter in WI8 patients (8 (5–10) vs. 11 (5–15) <i>p</i> = 0.03, and 9.5 (5–10.5) vs. 13 (9–17) <i>p</i> < 0.01). <i>Conclusions</i>: Maintenance with AGC<sup>®</sup> may offer up to 40 h of anesthesia, considering that the volume of a sevoflurane bottle is 250 mL, reflecting exceptional savings compared to conventional anesthesia management. Metabolic flow anesthesia driven by AGC<sup>®</sup> is feasible and safe in pediatric anesthesia practice. |
| format | Article |
| id | doaj-art-568797acaecc42598fa008cf1fb722f0 |
| institution | DOAJ |
| issn | 1010-660X 1648-9144 |
| language | English |
| publishDate | 2025-04-01 |
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| spelling | doaj-art-568797acaecc42598fa008cf1fb722f02025-08-20T03:14:32ZengMDPI AGMedicina1010-660X1648-91442025-04-0161578610.3390/medicina61050786Feasibility and Safety Properties of Metabolic-Flow Anesthesia Driven by Automated Gas Control<sup>®</sup> in Pediatric Patients: A Prospective Observational StudyEmre Sertaç Bingül0Meltem Savran Karadeniz1Emre Şentürk2İrem Vuran Yaz3Ayşe Gülşah Atasever4Mukadder Orhan Sungur5Department of Anaesthesiology and Reanimation, Istanbul University Istanbul Faculty of Medicine, Millet St. Surgical Sciences Building, 34093 Istanbul, TurkeyDepartment of Anaesthesiology and Reanimation, Istanbul University Istanbul Faculty of Medicine, Millet St. Surgical Sciences Building, 34093 Istanbul, TurkeyDepartment of Anaesthesiology and Reanimation, Istanbul University Istanbul Faculty of Medicine, Millet St. Surgical Sciences Building, 34093 Istanbul, TurkeyDepartment of Anaesthesiology and Reanimation, Istanbul University Istanbul Faculty of Medicine, Millet St. Surgical Sciences Building, 34093 Istanbul, TurkeyDepartment of Anaesthesiology, KU Leuven, 3000 Leuven, BelgiumDepartment of Anaesthesiology and Reanimation, Istanbul University Istanbul Faculty of Medicine, Millet St. Surgical Sciences Building, 34093 Istanbul, Turkey<i>Background and Objectives</i>: Metabolic-flow (<0.35 L/min) anesthesia is practiced more often as manufacturers provide newer technologies, yet the benefits of metabolic-flow anesthesia have not been fully investigated. This study aimed to investigate the feasibility and safety of automated gas control (AGC<sup>®</sup>) mode, which provides metabolic-flow anesthesia, in a pediatric population. <i>Materials and Methods</i>: Pediatric surgery patients between 1 and 10 years of age were included in this prospective observational trial. After intravenous induction and safe orotracheal intubation, AGC<sup>®</sup> was initiated, and total sevoflurane consumption (mL) and wash-in speed-based sevoflurane consumption data were collected to measure feasibility. For safety, inspired (F<sub>i</sub>O<sub>2</sub>), alveolar (F<sub>A</sub>O<sub>2</sub>), and expired (F<sub>E</sub>O<sub>2</sub>) oxygen concentration data, and inspired and alveolar sevoflurane (F<sub>i</sub>Sevo and F<sub>A</sub>Sevo, respectively) concentration data, were recorded. Changes in fresh gas flow (FGF) throughout the procedure and postoperative recovery data were also compared. <i>Results</i>: A total of 130 patients were eligible for this study, and 121 patients were included in the analyses; 30 patients had a wash-in speed of 4 (WI4) and 91 patients had a wash-in speed of 8 (WI8) at follow-up. The total mean sevoflurane consumption was 9.35 ± 4.93 mL for a median surgery duration of 100 min. WI8 patients consumed more sevoflurane (9.92 ± 5.08 mL vs. 7.79 ± 4.19 mL, <i>p</i> = 0.04). At the 15th and 30th minutes, the FGF dropped under minimal flow and metabolic flow limits, respectively (<i>p</i> < 0.001). The times to extubation and obeying commands were shorter in WI8 patients (8 (5–10) vs. 11 (5–15) <i>p</i> = 0.03, and 9.5 (5–10.5) vs. 13 (9–17) <i>p</i> < 0.01). <i>Conclusions</i>: Maintenance with AGC<sup>®</sup> may offer up to 40 h of anesthesia, considering that the volume of a sevoflurane bottle is 250 mL, reflecting exceptional savings compared to conventional anesthesia management. Metabolic flow anesthesia driven by AGC<sup>®</sup> is feasible and safe in pediatric anesthesia practice.https://www.mdpi.com/1648-9144/61/5/786pediatric anesthesiainhalation anesthesiametabolic flow anesthesiaautomated gas controlrecoverylow-flow anesthesia |
| spellingShingle | Emre Sertaç Bingül Meltem Savran Karadeniz Emre Şentürk İrem Vuran Yaz Ayşe Gülşah Atasever Mukadder Orhan Sungur Feasibility and Safety Properties of Metabolic-Flow Anesthesia Driven by Automated Gas Control<sup>®</sup> in Pediatric Patients: A Prospective Observational Study Medicina pediatric anesthesia inhalation anesthesia metabolic flow anesthesia automated gas control recovery low-flow anesthesia |
| title | Feasibility and Safety Properties of Metabolic-Flow Anesthesia Driven by Automated Gas Control<sup>®</sup> in Pediatric Patients: A Prospective Observational Study |
| title_full | Feasibility and Safety Properties of Metabolic-Flow Anesthesia Driven by Automated Gas Control<sup>®</sup> in Pediatric Patients: A Prospective Observational Study |
| title_fullStr | Feasibility and Safety Properties of Metabolic-Flow Anesthesia Driven by Automated Gas Control<sup>®</sup> in Pediatric Patients: A Prospective Observational Study |
| title_full_unstemmed | Feasibility and Safety Properties of Metabolic-Flow Anesthesia Driven by Automated Gas Control<sup>®</sup> in Pediatric Patients: A Prospective Observational Study |
| title_short | Feasibility and Safety Properties of Metabolic-Flow Anesthesia Driven by Automated Gas Control<sup>®</sup> in Pediatric Patients: A Prospective Observational Study |
| title_sort | feasibility and safety properties of metabolic flow anesthesia driven by automated gas control sup r sup in pediatric patients a prospective observational study |
| topic | pediatric anesthesia inhalation anesthesia metabolic flow anesthesia automated gas control recovery low-flow anesthesia |
| url | https://www.mdpi.com/1648-9144/61/5/786 |
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