A Reyes1, M López1, F de la Gala1, M I Canal Alonso2, S Agustí1, M Zaballos3. 1. Servicio de Anestesiología-Reanimación y Terapéutica del Dolor, Hospital Universitario Gregorio Marañón, Madrid, España. 2. Servicio de Anestesiología-Reanimación y Terapéutica del Dolor, Hospital Universitario Gregorio Marañón, Madrid, España; Universidad Complutense de Madrid, Madrid, España. 3. Servicio de Anestesiología-Reanimación y Terapéutica del Dolor, Hospital Universitario Gregorio Marañón, Madrid, España; Universidad Complutense de Madrid, Madrid, España. Electronic address: mati@plagaro.net.
Abstract
OBJECTIVE: To determine the end-tidal desflurane concentration required for tracheal extubation in anaesthetised adults. MATERIAL AND METHODS: After hospital Ethics Committee approval, eighteen ASA I-II adult patients (19-65 years of age), who had been scheduled for elective ambulatory surgery were included in the study. Anaesthesia was induced with propofol 2.5mg.kg-1, fentanyl 2μg.kg-1, and rocuronium 0.6mg.kg-1 for intubation. Maintenance of anaesthesia was provided by desflurane in oxygen and air (40:60), and remifentanil at 0.05-0.25μg.kg-1.min1. Neuromuscular function was monitored with train-of-four (TOF) nerve stimulation and acceleromyography. At the end of the surgery neuromuscular blockade was reversed with sugammadex 2-4mg.kg-1 in accordance with the TOF ratio. The concentration of desflurane at which extubation was attempted was determined by using Dixon's up-and-down method with 0.5% as a step size. Smooth extubation was defined as one without coughing, teeth clenching, gross purposeful movements, and no breath-holding or laryngospasm within 1min of tracheal extubation. RESULTS: It was found that the end-tidal concentration of desflurane was 3.17±0.18% (95% CI: 3%-3.35%) for successful extubation in 50% of adults. CONCLUSION: Extubation in patients receiving desflurane may be feasible at 0.62 minimum alveolar concentration.
OBJECTIVE: To determine the end-tidal desflurane concentration required for tracheal extubation in anaesthetised adults. MATERIAL AND METHODS: After hospital Ethics Committee approval, eighteen ASA I-II adult patients (19-65 years of age), who had been scheduled for elective ambulatory surgery were included in the study. Anaesthesia was induced with propofol 2.5mg.kg-1, fentanyl 2μg.kg-1, and rocuronium 0.6mg.kg-1 for intubation. Maintenance of anaesthesia was provided by desflurane in oxygen and air (40:60), and remifentanil at 0.05-0.25μg.kg-1.min1. Neuromuscular function was monitored with train-of-four (TOF) nerve stimulation and acceleromyography. At the end of the surgery neuromuscular blockade was reversed with sugammadex 2-4mg.kg-1 in accordance with the TOF ratio. The concentration of desflurane at which extubation was attempted was determined by using Dixon's up-and-down method with 0.5% as a step size. Smooth extubation was defined as one without coughing, teeth clenching, gross purposeful movements, and no breath-holding or laryngospasm within 1min of tracheal extubation. RESULTS: It was found that the end-tidal concentration of desflurane was 3.17±0.18% (95% CI: 3%-3.35%) for successful extubation in 50% of adults. CONCLUSION: Extubation in patients receiving desflurane may be feasible at 0.62 minimum alveolar concentration.