الفهرس 
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Abstract
The introduction of new anesthetic machines with built-in closed loop
algorithms for the automatic control of inspired oxygen and end tidal anesthetic
concentration will further enhance the feasibility of minimal flow techniques.
Primary goal is to evaluate the Economic impact of adopting the AGC software
compared to the manual low flow anesthetic technique on inhalational agent
consumption (ml/h), (both guided by an anesthesia depth monitor), and soda lime
consumption during major liver resection.
This is a Clinical Trial and Diagnostic Test Accuracy study with Local Ethics
Committee of Faculty of Medicine, Menoufia University at 2 July 2018. The study was
conducted at the Anaesthesia Department of the National Liver Institute, Menoufia
University between July 2018 and December 2018. This trial was also registered at the
Pan African Clinical Trial registry (PACTR201907566720877).
Hemodynamics BP, HR, SVR and COP were recorded: At baseline before
induction (T0), after induction (T1), 2 hours from induction (T2), 3 hours from
induction(T3), 4 hours from induction(T4) and at end of surgery(T5).
Anesthesia duration in hour, total anesthetic gas consumption (sevoflurane) [ml]
will be obtained from machine log. The total number of interventions needed by
anesthesiologist intraoperative and through recovery to modify target sevoflurane and/or
FGF during anesthetic period was also recorded.
The incidence of perioperative hypoxia (SpO2<94%), hypercapnia (EtCO2>40
mmHg) was recorded and alarms as circle leakage.
Total economic cost in both groups was calculated according to the British
National Formula announced prices. Total cost in Egyptian market in pounds, time from
terminating sevoflurane delivery until extubation (minutes or seconds) and accidental
awareness during anesthesia.
The study will include a minimal of 40 patients admitted to the operating room
and scheduled electively for an elective liver resection under general inhalational
anesthesia into 2 groups: Automatic Gas Control (AGC) group and Manual Control
(MC) group.
Results are presented as Median [IQ]. 44 patients, demographic in AGC vs
Manual group age {58(47-60) vs 57(47-60) year, p=0,480 Anesthesia time 4(3.5-4) vs
4(3.5-4.5) p=0,447 Total number of Anesthesia intervention 5.5(5-7) vs 12.5(11-14)
p=0.000` Sevoflurane Consumption 23(21-28) vs 36.5 (35-40) p=0,00 Time from
extubation 8 (6-9) vs 14 (9-19) p=0,00 Soda lime Consumption 255(210-280) vs
230(210-270).
Conclusion can be summarized in the following: AGC decrease inhalational
Anesthetic agent with good economic impact also not affecting hemodynamics nor
sodalime consumption. We could not detect additional hazard over patient safety.