Abstract:OBJECTIVES:To determine the awakening arterial blood concentration of desflurane and its relationship with the end-tidal concentration during emergence from various durations of general anesthesia.METHOD:In total, 42 American Society of Anesthesiologists physical status class I-II female patients undergoing elective gynecologic surgery were enrolled. General anesthesia was maintained with fixed 6% inspiratory desflurane in 6 l min-1 oxygen until shutoff of the vaporizer at the end of surgery. One milliliter of… Show more
“…In this study, the end-tidal concentrations of sevoflurane decreased more prominently in the initial 5 minutes after discontinuation, indicating a rapid alveolar washout, and then became consistently close to the arterial concentrations. Our previous study demonstrated that the end-tidal concentrations of desflurane are generally lower than the arterial blood concentrations during elimination in gynecologic patients 8 ; this effect is related to the lower blood-gas partition coefficient of 0.42 and tissue/blood partition coefficients of desflurane 5 . By determining the arterial blood concentration, we therefore identified that the end-tidal concentration of sevoflurane, which is close to 0.36%, is a reliable indicator for predicting emergence from general anesthesia.…”
Section: Discussionmentioning
confidence: 93%
“…During the elimination phase, sevoflurane washout progresses from the brain and body to the alveolar space and can be detected by the end-tidal concentration. Clinically, the end-tidal concentration of inhalation anesthetics has been a feasible indicator for predicting the emergence from general anesthesia, especially after desflurane anesthesia 8 . However, irregular respiration before awakening usually results in fluctuations of the end-tidal concentrations of inhalation anesthetics.…”
OBJECTIVE:The end-tidal concentration of inhalation anesthetics is a clinical indicator for predicting the emergence from anesthesia. This study was conducted to assess the relationship between arterial blood and end-tidal sevoflurane concentrations during emergence.METHODS:Thirty-two female American Society of Anesthesiologists physical status I-II patients receiving general anesthesia for elective gynecologic surgery were included. A fixed dose of 3.5% inspiratory sevoflurane in 6 L min-1 oxygen was maintained until the end of surgery. At 20 and 10 minutes before and 0, 5, 10, 15, and 20 minutes after discontinuing sevoflurane, as well as at the time of eye opening by verbal command, defined as awakening, 1 ml arterial blood was obtained to measure its sevoflurane concentration by gas chromatography. Simultaneous inspiratory and end-tidal concentrations of sevoflurane were detected by an infrared analyzer and tested by Bland–Altman agreement analysis.RESULTS:The arterial blood concentrations of sevoflurane were similar to the simultaneous end-tidal concentrations during emergence: 0.36% (0.10) and 0.36% (0.08) sevoflurane at awakening, respectively. The mean time from discontinuing sevoflurane to eye opening was 15.8 minutes (SD 2.9, range 10-26) and was significantly correlated with the duration of anesthesia (52-192 minutes) (P = 0.006) but not with the body mass index or total fentanyl dose.CONCLUSION:The mean awakening arterial blood concentration of sevoflurane was 0.36%. The time to awakening was prolonged in accordance with the anesthetic duration within 3 hours. With well-assisted ventilation during emergence, the sevoflurane end-tidal concentration was nearly equal to its arterial blood concentration, which could be a feasible predictor for awakening.
“…In this study, the end-tidal concentrations of sevoflurane decreased more prominently in the initial 5 minutes after discontinuation, indicating a rapid alveolar washout, and then became consistently close to the arterial concentrations. Our previous study demonstrated that the end-tidal concentrations of desflurane are generally lower than the arterial blood concentrations during elimination in gynecologic patients 8 ; this effect is related to the lower blood-gas partition coefficient of 0.42 and tissue/blood partition coefficients of desflurane 5 . By determining the arterial blood concentration, we therefore identified that the end-tidal concentration of sevoflurane, which is close to 0.36%, is a reliable indicator for predicting emergence from general anesthesia.…”
Section: Discussionmentioning
confidence: 93%
“…During the elimination phase, sevoflurane washout progresses from the brain and body to the alveolar space and can be detected by the end-tidal concentration. Clinically, the end-tidal concentration of inhalation anesthetics has been a feasible indicator for predicting the emergence from general anesthesia, especially after desflurane anesthesia 8 . However, irregular respiration before awakening usually results in fluctuations of the end-tidal concentrations of inhalation anesthetics.…”
OBJECTIVE:The end-tidal concentration of inhalation anesthetics is a clinical indicator for predicting the emergence from anesthesia. This study was conducted to assess the relationship between arterial blood and end-tidal sevoflurane concentrations during emergence.METHODS:Thirty-two female American Society of Anesthesiologists physical status I-II patients receiving general anesthesia for elective gynecologic surgery were included. A fixed dose of 3.5% inspiratory sevoflurane in 6 L min-1 oxygen was maintained until the end of surgery. At 20 and 10 minutes before and 0, 5, 10, 15, and 20 minutes after discontinuing sevoflurane, as well as at the time of eye opening by verbal command, defined as awakening, 1 ml arterial blood was obtained to measure its sevoflurane concentration by gas chromatography. Simultaneous inspiratory and end-tidal concentrations of sevoflurane were detected by an infrared analyzer and tested by Bland–Altman agreement analysis.RESULTS:The arterial blood concentrations of sevoflurane were similar to the simultaneous end-tidal concentrations during emergence: 0.36% (0.10) and 0.36% (0.08) sevoflurane at awakening, respectively. The mean time from discontinuing sevoflurane to eye opening was 15.8 minutes (SD 2.9, range 10-26) and was significantly correlated with the duration of anesthesia (52-192 minutes) (P = 0.006) but not with the body mass index or total fentanyl dose.CONCLUSION:The mean awakening arterial blood concentration of sevoflurane was 0.36%. The time to awakening was prolonged in accordance with the anesthetic duration within 3 hours. With well-assisted ventilation during emergence, the sevoflurane end-tidal concentration was nearly equal to its arterial blood concentration, which could be a feasible predictor for awakening.
“…Additionally, the wider range of MEP amplitudes at T2 with propofol, compared to any measurement in the control group, may indicate a persistent desflurane effect. However, based on data regarding the time frame of desflurane elimination, desflurane blood concentrations should reach clinically irrelevant levels after 20 min (Lin et al, 2013;Lu et al, 2013). Moreover, the protocol requires a maximum MAC of 0.6, which suggests even faster elimination.…”
“…(5) For inhalational anaesthetics, however, a time lag between end-tidal and brain concentrations has been identi ed and physiologically modelled through measurement of the inspiratory, end-tidal, and jugular bulb concentrations. (6)(7)(8) Accordingly, the body's uptake and elimination (9) of anaesthetics across the alveolar membrane and blood-brain barrier depend on the partition coe cient, (10)(11)(12) ventilation, (13) and cardiac output. (7) Sevo urane requires nearly 40 min to achieve a pharmacokinetic equilibrium between arterial and jugular bulb concentrations, indicating that no further brain uptake of inspiratory 3.5% sevo urane occurs after general anaesthesia induction.…”
Background: The A-Line Autoregressive Index (AAI), which is derived from auditory evoked potentials, has been used for determining anaesthetic depth. This study verified the correlation between AAI values and the corresponding end-tidal concentrations of sevoflurane during general anaesthesia induction.Methods: Thirty young male adults undergoing elective minor orthopaedic surgery were sequentially allocated to receive inspiratory 3%, 5%, or 6% sevoflurane for mask induction, followed by mechanical ventilation after tracheal intubation. The inspiratory, end-tidal, and estimated jugular bulb concentrations of sevoflurane were recorded at three target AAI values: below 20, below 10 and at the start of burst suppression.Results: The mean time to loss of consciousness in the 6% sevoflurane group was shorter than that in the 5% and 3% groups; however, the groups had comparable AAI values (range: 16–45). The 6% group had a higher end-tidal concentration (4.5% ± 0.2% vs. 3.8% ± 0.2%, P < 0.05) than did the 5% group, despite having the same target anaesthetic levels by AAI score ≤ 10, whereas the estimated jugular bulb concentrations were comparable (1.9% vs. 1.9%) in both groups. Conclusions: Following mechanical ventilation with inspiratory 3%, 5%, or 6% sevoflurane, the end-tidal concentrations were discrepant at the same end points of AAI levels, despite similar estimated jugular bulb concentrations of sevoflurane. Thus, conventional alveolar concentration may overestimate anaesthesia depth during rapid wash-in of sevoflurane.
scite is a Brooklyn-based organization that helps researchers better discover and understand research articles through Smart Citations–citations that display the context of the citation and describe whether the article provides supporting or contrasting evidence. scite is used by students and researchers from around the world and is funded in part by the National Science Foundation and the National Institute on Drug Abuse of the National Institutes of Health.