End-tidal control of

inhalation anesthetics
Al-Refaey Kandeel
Lecturer of anesthesia and Surgical intensive care
Mansoura university
Liver transplant team
 Economic burden
20% of anesthesia related costs
 Closed loop control in Anesthesia

1950
Effect site versus plasma concentration

Real-time anesthetic concentration

MAC equivalent of IV agents

Surrogate measures
End-tidal vs. Brain concentration
End-tidal control mode
 Donor hepatectomy in Mansoura

 60-70 cases per year

 inhalational anesthesia

 Rocuronium + Fentanyl infusion

 TOF + BIS

 End-tidal control
This our theat
 Hypothesis

END-TIDAL CONTROL OF SEVOLFLURANE WOULD

Save anesthetic agents

Economic benefit

Save time for patient care

 IRB approval

Pilot study

Patient recruitment
 Study groups

Manual group End tidal group

 FGF 2 l.min-1  Min. 2 l.min-1

 FiSev 2%  EtSev 1.5%

 Fio2 o.4  Eto2 0.35

• BIS kept 40-60

• Hemodynamics maintained
 Data collected

 Preoperative characteristics

 Intraoperative hemodynamics

 Anesthetic gas consumption

 Button presses
Results
Anesthetic gases consumption
Cost benefit
Interventions ((press buttons))
literature
 Conclusion

Et-control mode during anaesthesia of living donor

hepatectomy significantly lowers sevoflurane

consumption and decreases required user interventions

without hazard over patient safety

THANK YOU