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Comparison of automated and manual control methods in minimal flow anesthesia

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Abstract

Purpose

New-generation anesthesia machines administer inhalation anesthetics and automatically control the fresh gas flow (FGF) rate. This study compared the administration of minimal flow anesthesia (MFA) using the automatically controlled anesthesia (ACA) module of the Mindray A9 (Shenzhen, China) anesthesia machine versus manual control by an anesthesiologist.

Methods

We randomly divided 76 patients undergoing gynecological surgery into an ACA group (Group ACA) and a manually controlled anesthesia group (Group MCA). In Group MCA, induction was performed with a mixture of 40–60% O2 and air with a 4 L/min FGF until the minimum alveolar concentration (MAC) reached 1. Next, MFA was initiated with 0.5 L/min FGF. The target fraction of inspired oxygen (FiO2) value was 35–40%. In Group ACA, the MAC was defined as 1, and the FiO2 was adjusted to 35%. Depth of anesthesia, anesthetic agent (AA) consumption, time to achieve target end-tidal AA concentration, awakening times, and number of ventilator adjustments were analyzed.

Results

The two groups showed no statistically significant differences in depth of anesthesia or AA consumption (Group ACA: 19.1 ± 4.9 ml; Group MCA: 17.2 ± 4.5; p-value = 0.076). The ACA mode achieved the MAC target of 1 significantly faster (Group ACA: 218 ± 51 s; Group MCA: 314 ± 169 s). The number of vaporizer adjustments was 15 in the ACA group and 217 in the MCA group.

Conclusion

The ACA mode was more advantageous than the MCA mode, reaching target AA concentrations faster and requiring fewer adjustments to achieve a constant depth of anesthesia.

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Funding

This study was supported by Sakarya University Scientific Research Projects (BAP) Commission under project number 2022-7-25-62.

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Authors and Affiliations

  1. Faculty of Medicine, Anesthesiology and Reanimation Depertmant, Sakarya University, Sakarya, Turkey

    Rezan Şerefoğlu, Havva Kocayiğit, Onur Palabıyık & Ayça Taş Tuna

Authors
  1. Rezan Şerefoğlu
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  2. Havva Kocayiğit
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  3. Onur Palabıyık
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  4. Ayça Taş Tuna
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Contributions

K.H. conducted the statistical analysis of the data. P.O. applied power analysis with a sample patient group at the beginning of the study. Literature search was performed by R.Ş. T.T.A. reviewed and made revisions, outlining the main points of the study. All authors read and approved the final manuscript.

Corresponding author

Correspondence to Rezan Şerefoğlu.

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Competing interests

The authors declare no competing interests.

Conflict of interest

The authors declare that they have no conflicts of interest related to the present work.

Ethical approval

This study was conducted in accordance with the ethical approval of the Sakarya University Faculty of Medicine Clinical Research Ethics Committee, dated February 7, 2022, with protocol number 102934.

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Şerefoğlu, R., Kocayiğit, H., Palabıyık, O. et al. Comparison of automated and manual control methods in minimal flow anesthesia. J Clin Monit Comput (2024). https://doi.org/10.1007/s10877-024-01163-0

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