1-1-8 one-step sevoflurane wash-in scheme for low-flow anesthesia: simple, rapid, and predictable induction

Abstract Background Sevoflurane is suitable for low-flow anesthesia (LFA). LFA needs a wash-in phase. The reported sevoflurane wash-in schemes lack simplicity, target coverage, and applicability. We proposed a one-step 1-1-8 wash-in scheme for sevoflurane LFA to be used with both N 2 O and Air. The objective of our study was to identify time for achieving each level of alveolar concentration of sevoflurane (F A S) from 1% to 3.5% in both contexts.Methods We recruited 199 adults requiring general anesthesia with endotracheal intubation and controlled ventilation—102 in group N 2 O and 97 in group Air. After induction and intubation, a wash-in was started using a fresh gas flow of O 2 :N 2 O or O 2 :Air at 1:1 L·min -1 plus sevoflurane 8%. The ventilation was controlled to maintain end-tidal CO 2 of 30-35 mmHg.Results The rising patterns of F A S and inspired concentration of sevoflurane (F I S) are similar, running parallel between the groups. The F A S/F I S ratio increased from 0.46 to 0.72 within 260 sec in group N 2 O and from 0.42 to 0.69 within 286 sec in group Air. The respective time to achieve an F A S of 1%, 1.5%, 2%, 2.5%, 3%, and 3.5% was 1, 1.5, 2, 3, 3.5, and 4.5 min in group N 2 O and 1, 1.5, 2, 3, 4, and 5 min in group Air. The heart rate and blood pressure of both groups significantly increased initially then gradually decreased as F A S increased.Conclusions The 1-1-8 wash-in scheme for sevoflurane LFA has many advantages, including simplicity, coverage, swiftness, safety, economy, and that it can be used with both N 2 O and Air. A respective F A S of 1%, 1.5%, 2%, 2.5%, 3%, and 3.5% when used with N 2 O and Air can be expected at 1, 1.5, 2, 3, 3.5, and 4.5 min and 1, 1.5, 2, 3, 4, and 5 min. This scheme may be applied for sevoflurane LFA in situations where an anesthetic gas analyzer is unavailable.