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British Journal of Anaesthesia, 1991, Vol. 66, No. 3 331-339
© 1991 The Board of Management and Trustees of the British Journal of Anaesthesia

research-article

IS THE END-TIDAL PARTIAL PRESSURE OF ISOFLURANE A GOOD PREDICTOR OF ITS ARTERIAL PARTIAL PRESSURE?

F. J. FREI, M.D., A. M. ZBINDEN, M.D., D. A. THOMSON, M.D., PH.D. and H. U. RIEDER, M.D.

Department of Anaesthesia, University of Basel/Kantonsspital CH-4031 Basel, Switzerland
Institute for Anaesthesiology and Intensive Care, Inselspital, University of Bern CH-3010 Bern, Switzerland

End-tidal partial pressure of isoflurane (PE'iso) may be used as a measure of anaesthetic depth. During uptake, an arterial partial pressure (Paiso) which is considerably less than PE'iso(Paiso/PE'iso«1) leads to underestimation of depth of anaesthesia and, during elimination, PE'iso/Paiso«1 will lead to an overestimation of anaesthetic depth. We measured Paiso/PE'iso during a 60-min uptake period of 1% isoflurane and PE'iso/Paiso during the subsequent 60-min elimination period in 26 patients (age 13–88 yr, ASA I–III) undergoing various surgical procedures. After 15 min of isoflurane uptake, Paiso/PE'iso of 26 patients was mean 0.78 (SD 0.10) and this increased only marginally at 60 min (0.79 (0.09)), whereas during elimination, PE'iso/Paiso was in the range 0.79 (0.14)–0.83 (0.11). Predictability of Paiso in a given patient is hindered by the high SD of Paiso/PE'iso and PE'iso/Paiso, but it may be improved by taking into account age, ASA physical status category, vital capacity, inspired minus end-tidal isoflurane partial pressure and arterial minus end-tidal carbon dioxide partial pressure during uptake; and obesity, end-tidal isoflurane partial pressure and arterial minus end-tidal carbon dioxide partial pressure during elimination. However, even with multiple regression analysis (to account for the various possible variables), clinically useful prediction of Paiso/PE'iso and PE'iso/Paiso in a particular patient is not possible (residual SD 0.084 and 0.113, respectively).


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