Minimal fixed flow anesthesia for off-pump coronary artery bypass surgery: A parallel randomized trail
Objectives: The aim of the present study was to test a safety of a fixed minimal (0.5 l/min) fresh gas flow (FGF) anesthesia as a method ensuring adequate oxygenation during off-pump coronary artery bypass grafting operations. Design: A randomized, prospective study. Setting: Single-center clinical...
| Main Authors: | , , , |
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| Format: | Article |
| Language: | English |
| Published: |
Elsevier
2023-11-01
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| Series: | Heliyon |
| Online Access: | http://www.sciencedirect.com/science/article/pii/S2405844023093891 |
| _version_ | 1797429668605853696 |
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| author | Ioseb Begashvili Merab Kiladze Christina Ejibishvili George Grigolia |
| author_facet | Ioseb Begashvili Merab Kiladze Christina Ejibishvili George Grigolia |
| author_sort | Ioseb Begashvili |
| collection | DOAJ |
| description | Objectives: The aim of the present study was to test a safety of a fixed minimal (0.5 l/min) fresh gas flow (FGF) anesthesia as a method ensuring adequate oxygenation during off-pump coronary artery bypass grafting operations. Design: A randomized, prospective study. Setting: Single-center clinical hospital affiliated with a university. Participants: 208 patients underwent off-pump coronary artery bypass surgery. Interventions: All patients received endotracheal inhalational anesthesia with fixed minimal FGF. Half of them were anesthetized by sevoflurane and another half by isoflurane. The fresh (carrier) gas was pure oxygen in the control groups and a mixture of medical air and oxygen (FiO2 0.8) in the trial groups. Measurements and main results: In the control groups inhaled oxygen concentration changed minimally during the operation. In the trial groups in 28.8 % of cases inhaled oxygen concentration dropped below preliminary margin (0.4). Body surface area (BSA) (B = 38.7; p = 0.002) and patient's age (B = −0.47; p = 0.004) were retained into final logistic regression model as independent predictors. We divided BSA into subcategories and analyzed data by survival cox regression with Forward LR method. Patients with BSA>2.3 (Exp.B = 183) and BSA [2.2–2.3] (Exp.B = 59) had high chance to get less than 0.4 of inhaled oxygen concentration compared to the patients with BSA <2.0 (p < 0.001).Exp(B) or OR for the patients’ age as independent predictor tested in multiple logistic regression was 0.628 In other words, for every year less the patient had 1/0.628 = 1.6 times more chance to reach the preliminary low margin (0.4) of oxygenation. Conclusions: Fixed minimal FGF 0.5 l/min with FiO2 0.8 may not be sufficient for the younger patients with BSA >2.0 to maintain inhaled oxygen concentration above 0.4. Using pure oxygen as a carrier gas during fixed minimal flow long term anesthesia is much safer and more reliable. |
| first_indexed | 2024-03-09T09:16:29Z |
| format | Article |
| id | doaj.art-0a63bf97874a489caebb68d1aa2ffdf2 |
| institution | Directory Open Access Journal |
| issn | 2405-8440 |
| language | English |
| last_indexed | 2024-03-09T09:16:29Z |
| publishDate | 2023-11-01 |
| publisher | Elsevier |
| record_format | Article |
| series | Heliyon |
| spelling | doaj.art-0a63bf97874a489caebb68d1aa2ffdf22023-12-02T07:05:23ZengElsevierHeliyon2405-84402023-11-01911e22181Minimal fixed flow anesthesia for off-pump coronary artery bypass surgery: A parallel randomized trailIoseb Begashvili0Merab Kiladze1Christina Ejibishvili2George Grigolia3Tbilisi 5th clinical hospital, Department of cardiac anesthesia and intensive care. PhD student of Ivane Javakhishvili Tbilisi state university. Address: Temqa - XI, I Quarter, 5th clinical hospital “Open Heart”, 0102 Tbilisi, Georgia; Corresponding author.Professor of Ivane Javakhishvili Tbilisi state university, Chief of the department of surgery at American hospital Tbilisi, GeorgiaTbilisi 5th clinical hospital, Department of cardiac anesthesia and intensive care, PhD student of Ivane Javakhishvili Tbilisi state university, GeorgiaTbilisi 5th clinical hospital, Head of the department of cardiac anesthesia and intensive care, GeorgiaObjectives: The aim of the present study was to test a safety of a fixed minimal (0.5 l/min) fresh gas flow (FGF) anesthesia as a method ensuring adequate oxygenation during off-pump coronary artery bypass grafting operations. Design: A randomized, prospective study. Setting: Single-center clinical hospital affiliated with a university. Participants: 208 patients underwent off-pump coronary artery bypass surgery. Interventions: All patients received endotracheal inhalational anesthesia with fixed minimal FGF. Half of them were anesthetized by sevoflurane and another half by isoflurane. The fresh (carrier) gas was pure oxygen in the control groups and a mixture of medical air and oxygen (FiO2 0.8) in the trial groups. Measurements and main results: In the control groups inhaled oxygen concentration changed minimally during the operation. In the trial groups in 28.8 % of cases inhaled oxygen concentration dropped below preliminary margin (0.4). Body surface area (BSA) (B = 38.7; p = 0.002) and patient's age (B = −0.47; p = 0.004) were retained into final logistic regression model as independent predictors. We divided BSA into subcategories and analyzed data by survival cox regression with Forward LR method. Patients with BSA>2.3 (Exp.B = 183) and BSA [2.2–2.3] (Exp.B = 59) had high chance to get less than 0.4 of inhaled oxygen concentration compared to the patients with BSA <2.0 (p < 0.001).Exp(B) or OR for the patients’ age as independent predictor tested in multiple logistic regression was 0.628 In other words, for every year less the patient had 1/0.628 = 1.6 times more chance to reach the preliminary low margin (0.4) of oxygenation. Conclusions: Fixed minimal FGF 0.5 l/min with FiO2 0.8 may not be sufficient for the younger patients with BSA >2.0 to maintain inhaled oxygen concentration above 0.4. Using pure oxygen as a carrier gas during fixed minimal flow long term anesthesia is much safer and more reliable.http://www.sciencedirect.com/science/article/pii/S2405844023093891 |
| spellingShingle | Ioseb Begashvili Merab Kiladze Christina Ejibishvili George Grigolia Minimal fixed flow anesthesia for off-pump coronary artery bypass surgery: A parallel randomized trail Heliyon |
| title | Minimal fixed flow anesthesia for off-pump coronary artery bypass surgery: A parallel randomized trail |
| title_full | Minimal fixed flow anesthesia for off-pump coronary artery bypass surgery: A parallel randomized trail |
| title_fullStr | Minimal fixed flow anesthesia for off-pump coronary artery bypass surgery: A parallel randomized trail |
| title_full_unstemmed | Minimal fixed flow anesthesia for off-pump coronary artery bypass surgery: A parallel randomized trail |
| title_short | Minimal fixed flow anesthesia for off-pump coronary artery bypass surgery: A parallel randomized trail |
| title_sort | minimal fixed flow anesthesia for off pump coronary artery bypass surgery a parallel randomized trail |
| url | http://www.sciencedirect.com/science/article/pii/S2405844023093891 |
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