British Journal of Anaesthesia, Vol 82, Issue 6 852-856, Copyright © 1999 by The Board of Management and Trustees of the British Journal of Anaesthesia
S. Inomata, Y. Yaguchi, M. Taguchi and H. Toyooka
Sevoflurane has a non-pungent odour and provides smooth induction of
anaesthesia. In contrast, isoflurane is irritating to the airway when used
for induction, and this may also be evident during emergence from
anaesthesia. We measured the end-tidal concentration of anaesthetic that
prevented response to extubation in 50% of patients (MACEX) in adults
receiving either sevoflurane or isoflurane. Airway complications during
emergence from anaesthesia were also noted. We studied 51 adult patients,
ASA 1, aged 36-59 yr. Patients received sevoflurane (n = 29) or isoflurane
(n = 22) for elective intraocular surgery. The concentration at which
extubation was attempted was determined by a modification of Dixon's
up-and-down method. When tracheal extubation was accomplished without
coughing and gross purposeful muscular movements within 1 min after
extubation, it was considered a smooth tracheal extubation. Patients who
developed breath-holding or laryngospasm immediately after tracheal
extubation were regarded as not having been extubated smoothly. In
addition, patients were observed for respiratory events during the
remainder of the emergence period. MACEX values for sevoflurane and
isoflurane were 1.07% and 0.83%, respectively. ED95 values of sevoflurane
and isoflurane were 2.04% and 1.19%, respectively. In 12 patients in the
isoflurane group, extubation was smooth but six patients had coughing
episodes during the remainder of the emergence period. In contrast, one of
15 patients in the sevoflurane group in whom tracheal extubation was smooth
coughed later (P = 0.035). Airway obstruction was frequent when tracheal
extubation was performed at end-tidal concentrations exceeding 1 MACEX for
each anaesthetic.
CLINICAL INVESTIGATIONS
End-tidal sevoflurane concentration for tracheal extubation (MACEX) in adults: comparison with isoflurane
Department of Anaesthesiology, Institute of Clinical Medicine, University of Tsukuba, Tsukuba City, Ibaraki 305, Japan
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