The effect of low flow anesthesia with sevoflurane on oxidative status: A prospective, randomized study

Hülya Kaşıkara; Ayça T. Dumanlı Özcan; Cemile K. Biçer; Almila Şenat; Abdüssamet Yalçın; Cemile Altın; Şemsi Mustafa Aksoy; Abdülkadir But

doi:10.15537/smj.2022.43.3.20210876

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Figure 1
- Flow chart of the study.

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Table 1

- Comparison of the groups in terms of specific demographic and clinical characteristics.

Characteristics	Low-flow group (n=32)	Mid-flow group (n=25)	High-flow group (n=25)	P-value
Characteristics	Mean±SD			P-value
Age (year)	41.40±12.96	41.72±10.75	43.81±11.72	0.700*
Body weight (kg)	7.80±12.80	69.08±10.97	71.34±11.37	0.757*
Height (cm)	165.44±7.41	161.88±6.50	162.75±8.83	0.240*
Gender (F/M), n	17/8	23/2	26/6	0.100**
ASA (I/II), n	19/6	20/5	24/8	0.900**
Duration of surgery (min)	86.60±13.21	93.00±17.97	85.31±14.36	0.149*
Duration of anesthesia (min)	97.40±13.08	101.80±15.19	95.63±14.65	0.269*

*One way ANOVA test, **Chi-square test, F/M: female/male, ASA: American Society of Anesthesiologists, SD: standard deviation

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Table 2

- Comparison of heart rates (minute) within and between groups.

Time	Low-flow group (n=32)	Mid-flow group (n=25)	High-flow group (n=25)	P-value¹
Time	Mean±SD			P-value¹
Baseline	84.18±12.06^‡	79.00±11.42^‡	88.36±11.22^‡	0.112*
Induction	80.95±12.45	81.81±12.60^‡	81.84±10.35^‡	0.965*
Intubation	88.77±10.10^‡	86.81±12.48^‡	92.47±15.63^‡	0.466*
5th min	79.54±8.48	77.81±13.90	83.68±14.11^‡	0.372*
10th min	76.68±9.02	71.18±11.00	75.73±13.74	0.414*
15th min	72.81±8.81^‡	67.45±11.50^‡	69.94±10.37^‡	0.332*
30th min	71.45±7.35^‡	65.81±12.54^‡	67.00±9.26^‡	0.176*
60th min	71.09±6.26^†,‡	63.00±8.55^†,‡	67.26±8.61^‡	0.021*
90th min	71.26±7.72^‡	66.50±11.08^‡	72.58±9.10^‡	0.249*
P-value²	<0.001**	<0.001**	<0.001**

*One-way ANOVA test (post-hoc: ^†Bonferroni), **repeated measures ANOVA test (post-hoc: ^‡Bonferroni), SD: standard deviation

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Table 3

- Comparison of mean arterial pressures (mmHg) within and between groups.

Time	Low-flow group (n=32)	Mid-flow group (n=25)	High-flow group (n=25)	P-value¹
Time	Mean±SD			P-value¹
Baseline	101.45±12.50^†	96.22±9.67	105.00±8.21^†	0.146*
Induction	83.27±10.98	87.44±15.31	89.58±11.31^†	0.261*
Intubation	93.59±17.70	90.88±15.50	98.94±11.32	0.383*
5th min	85.13±10.50	88.66±4.63	88.94±16.00	0.574*
10th min	84.54±8.94	80.00±7.41	82.70±14.36	0.575*
15th min	84.13±10.59	82.11±12.98	84.88±15.32	0.872*
30th min	78.77±9.04	78.88±13.18	81.88±12.17^†	0.655*
60th min	82.50±11.10	86.00±10.38	80.88±11.68^†	0.545*
90th min	85.46±11.05	86.75±9.31	88.53±9.64	0.731*
P-value²	<0.001**	0.260**	<0.001**

*One-way ANOVA test, **repeated measures ANOVA test (post-hoc: ^†Bonferroni), SD: standard deviation

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Table 4

- Comparison of the groups in terms of native thiol, total thiol, disulfide, disulfide/native thiol, disulfide/total thiol, native thiol/total thiol levels, albumin.

Time	Low-flow group (n=32)	Mid-flow group (n=25)	High-flow group (n=25)	P-value¹
Time	Mean±SD			P-value¹
Native thiol
T1	248.17±64.30^†	243.66±40.82^†	371.65±66.33^§	<0.001*
T2	229.18±58.06^†	257.37±71.45^†	342.10±47.78^§	<0.001**
T3	242.27±55.64^†,‡	298.74±99.87^†	371.71±67.08	<0.001**
P-value²	0.183**	0.141**	0.014**
Total thiol
T1	268.66±72.30^†	268.93±43.14^†	394.96±69.18	<0.001**
T2	247.17±61.31^†	275.23±73.88^†	370.67±53.79	<0.001**
T3	260.83±59.00^†,‡	319.61±103.00^†	393.61±70.77	<0.001**
P-value²	0.181**	0.178**	0.224**
Disulfide
T1	10.25±6.29	12.22±6.78	11.66±4.96	0.461*
T2	8.99±4.80^†	8.14±4.23^†	14.28±7.42	0.001*
T3	9.30±5.53	11.07±4.41	10.94±5.55	0.387*
P-value²	0.788**	0.383**	0.140**
Disulfide/native thiol percentage
T1	4.03±2.02	5.07±3.11^§,†	3.18±1.38	0.019*
T2	4.08±2.23	3.34±1.65^§	4.17±2.26	0.334**
T3	3.89±2.33	3.97±1.78	2.98±1.45	0.164*
P-value²	0.900**	0.038**	0.172**
Disulfide/total thiol percentage
T1	3.67±1.50	4.48±2.52^†	2.97±1.19	0.025**
T2	3.69±1.86	3.09±1.46	3.77±1.98	0.366**
T3	3.53±1.94	3.63±1.50	2.65±1.39	0.094*
P-value²	0.092**	0.297**	0.169**
Native thiol/total thiol percentage
T1	92.65±3.40	91.91±7.67	94.06±2.39	0.305*
T2	92.61±3.72	93.81±2.92	90.40±12.01	0.262*
T3	92.93±3.87	92.74±3.00	94.44±2.52	0.162*
P-value²	0.092**	0.064**	0.304**
Albumin
T1	3.03±0.47^†	2.97±0.35^†	3.78±0.17	<0.001*
T2	2.97±0.51^†	3.05±0.49†	3.73±0.17	<0.001*
T3	3.070.48^†	3.40±0.72^†	3.80±0.16	<0.001*
P-value²	0.335**	0.205**	0.332**

*Kruskal-Wallis test (Post hoc: Mann-Whitney U-test), **One-Way ANOVA test (post hoc: Bonferroni), ^§p-value² of <0.05 (compared to T1-T2, native tiol, high-flow group), ^†p-value¹ of <0.05 (compared to high flow group, disulfide level at time T2 in mid-flow and low flow group), ^§†p-value² of <0.05 (T2 compared to T1, disulfide/native thiol percentage), T1: pre-induction, T2: 60th minute after induction, T3: postoperative 2nd hour, SD: standard deviation