Feasibility and Safety Properties of Metabolic-Flow Anesthesia Driven by Automated Gas Control® in Pediatric Patients: A Prospective Observational Study

Emre Sertaç Bingül; Meltem Savran Karadeniz; Emre Şentürk; İrem Vuran Yaz; Ayşe Gülşah Atasever; Mukadder Orhan Sungur

doi:10.3390/medicina61050786

Feasibility and Safety Properties of Metabolic-Flow Anesthesia Driven by Automated Gas Control^® in Pediatric Patients: A Prospective Observational Study

Medicina (Kaunas). 2025 Apr 24;61(5):786. doi: 10.3390/medicina61050786.

Authors

Emre Sertaç Bingül¹, Meltem Savran Karadeniz¹, Emre Şentürk¹, İrem Vuran Yaz¹, Ayşe Gülşah Atasever², Mukadder Orhan Sungur¹

Affiliations

¹ Department of Anaesthesiology and Reanimation, Istanbul University Istanbul Faculty of Medicine, Millet St. Surgical Sciences Building, 34093 Istanbul, Turkey.
² Department of Anaesthesiology, KU Leuven, 3000 Leuven, Belgium.

Abstract

Background and Objectives: 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^®) mode, which provides metabolic-flow anesthesia, in a pediatric population. Materials and Methods: 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^® was initiated, and total sevoflurane consumption (mL) and wash-in speed-based sevoflurane consumption data were collected to measure feasibility. For safety, inspired (F_iO₂), alveolar (F_AO₂), and expired (F_EO₂) oxygen concentration data, and inspired and alveolar sevoflurane (F_iSevo and F_ASevo, respectively) concentration data, were recorded. Changes in fresh gas flow (FGF) throughout the procedure and postoperative recovery data were also compared. Results: 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, p = 0.04). At the 15th and 30th minutes, the FGF dropped under minimal flow and metabolic flow limits, respectively (p < 0.001). The times to extubation and obeying commands were shorter in WI8 patients (8 (5-10) vs. 11 (5-15) p = 0.03, and 9.5 (5-10.5) vs. 13 (9-17) p < 0.01). Conclusions: Maintenance with AGC^® 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^® is feasible and safe in pediatric anesthesia practice.

Keywords: automated gas control; inhalation anesthesia; low-flow anesthesia; metabolic flow anesthesia; pediatric anesthesia; recovery.

Publication types

Observational Study

MeSH terms

Anesthesia, Closed-Circuit* / methods
Anesthetics, Inhalation / administration & dosage
Anesthetics, Inhalation / therapeutic use
Child
Child, Preschool
Feasibility Studies
Female
Humans
Infant
Male
Prospective Studies
Sevoflurane / administration & dosage
Sevoflurane / therapeutic use

Substances

Sevoflurane
Anesthetics, Inhalation