Comparison of recovery properties of desflurane and sevoflurane according to gender differences

BACKGROUND: The aim of this study was to investigate the recovery properties of desflurane and sevoflurane in patients undergoing elective surgery, according to the gender differences. METHODS: In the study, 160 ASA class I-II patients aged between 20 and 60 years were included. The patients were assigned into two groups according to their gender, and these groups were randomly divided into two groups according to a selected volatile anaesthetic agent. Intraoperative bispectral index, time of postoperative achievement for end-tidal concentrations of volatile agents to decline 50% (ET-AA%50), time for extubation, time for eye opening and orientation, and time for bispectral index values to reach control values were recorded. Aldrete scores and error points of a delayed memory recall test were determined. Results: Desflurane groups had a shorter ET-AA%50 time, extubation and eye-opening time in male and female patients compared to the sevoflurane groups, and these results were statistically significant (P < 0.05). In both the desflurane and sevoflurane groups, ET-AA%50 time, extubation and eye-opening time were shorter in male patients than in female patients, and these results were also statistically significant (P < 0.05). There were no significant differences among the groups in terms of Aldrete scores and error points of delayed memory recall test (P > 0.05). Conclusion: In conclusion, early recovery time was shorter in male patients compared to female patients in both the desflurane and sevoflurane groups. Additionally, in the desflurane groups it was shorter in the sevoflurane groups for both genders.     

Laryngeal mask airway can be inserted with inhaled desflurane induction

Purpose In this prospective, randomized, controlled trial, we investigated the reliability of laryngeal mask airway (LMA) insertion with inhaled desflurane.Methods Eighty patients undergoing elective surgery were randomized into two groups to receive either 2.5mg·kg^–1 propofol (n = 40) or tidal breath desflurane (n = 40) induction followed by LMA insertion. All patients received fentanyl 1µg·kg^–1 2min before induction. Inhalation of desflurane was started at 3% and increased by 3% every 3–5 breaths up to settings of 12%.Results Insertion of the LMA was faster in the propofol group (131.8s versus 228.6s, P < 0.01). The number of patients in whom the jaw opening was described as good (95% versus 72.5%, P = 0.27, for the desflurane and propofol groups, respectively) and the ease of LMA insertion described as good (87.5% versus 72.5%, P = 0.6) were comparable. The LMA was inserted in a single attempt in the majority of patients in both groups (80% versus 77.5%, P = 0.90). There were more complications at insertion in the propofol group than in the desflurane group (2.5% versus 19.5%, P < 0.01), especially for apnea (7.5% versus 70%, P < 0.01) and excitatory movements (2.5% versus 25%, P < 0.01). There were significant decreases in the mean arterial pressure in the propofol group compared to baseline data over the first 5min of induction. Mean arterial pressure, heart rate, and S_{p O 2} remained stable during the same period in the desflurane group.Conclusion We demonstrated that inhaled desflurane when used with caution in a controlled manner provided acceptable conditions for LMA insertion.     

Inhibitory effects of desflurane and sevoflurane on contractions of isolated gravid rat myometrium under oxytocin stimulation

BACKGROUND: We studied the inhibitory effects of desflurane and sevoflurane on oxytocin-induced contractions of isolated gravid rat myometrium. METHODS: Twenty strips were obtained from rats and these were randomly assigned into two groups. The effects of desflurane and sevoflurane were evaluated by treating strips with oxytocin alone 2x10-9 M or with oxytocin after desflurane and sevoflurane at 0.5, 1, and 2 MAC. RESULTS: Oxytocin significantly increased the amplitude and duration of contractions (P< 0.05), but it did not increase the frequency. The duration (84%, 79%), amplitude (90%, 84%) and frequency (88%, 75%) were inhibited at 2 MAC of desflurane and sevoflurane, respectively. CONCLUSION: These results suggest that the in vitro application of desflurane and sevoflurane similarly inhibit oxytocin-induced myometrial contractions of gravid rat in a dose-dependent manner.     

地氟醚复合麻醉对冠心病高危因素病人心率变异性的影响

目的研究地氟醚复合麻醉对冠心病高危因素病人自主神经系统功能的影响。方法30例择期腹部手术病人,术前确诊为冠心病高危人群。用动态心电图仪记录诱导前、呼气末地氟醚浓度在0.5、1.0、1.5、2.0MAC时的心率变异性。结果在低浓度地氟醚麻醉下低频功率明显高于基础值(P<0.05);随着吸入浓度增加,低频、高频功率均下降(P<0.05);LF/HF比值与基础值相比无明显变化(P>0.05)。结论地氟醚复合麻醉使自主神经活性呈进行性抑制,在辅用氧化亚氮、芬太尼情况下无明显交感兴奋作用。     

连续硬膜外腔阻滞对地氟醚麻醉期间交感神经活动的影响

目的 观察连续硬膜外阻滞对地氟醚诱发交感神经兴奋性增强反应的预防作用。方法 ３０例病人随机分为地氟醚组和连续硬膜外阻滞与地氟醚联合醉组,每组１５例。麻醉诱导气管内插管后,地氟醚组以挥罐设定浓度（ＦＤ）２％开始,并以每间隔３０ｓ递增１％的方法吸入地氟醚－氧,直至达到满足手术要求的浓度并维持麻醉;联合麻醉组在全麻诱导前于Ｔ９－１０或Ｔ１０－１１间隙行硬膜外穿刺置管,术中用利多卡因维持硬膜外阻滞,其余步     

地氟醚与安氟醚对小儿食管下段括约肌功能的影响

目的观察地氟醚与安氟醚麻醉对小儿食管下段括约肌(LES)功能的影响.方法26例行择期手术小儿,年龄3～7岁,ASAⅠ～Ⅱ级,术前无胃食管反流症状,亦未用术前药.静脉注射羟丁酸钠和阿曲库铵诱导插管后,随机分为地氟醚(D组)和安氟醚(E组)两组.在吸入地氟醚与安氟醚前以及当其吸入浓度分别达到0.5MAC、1.0MAC、1.5MAC时,用PaPolygraf HR胃肠动力监测系统测定下列数据LES压力(LESP)、胃压(GP)、屏障压(BrP)、长度(SL)、压力向量容积(PVV)和向量容积的三维立体图象.结果随地氟醚或安氟醚MAC的升高,D组各项指标与吸入前相比无明显变化(P＞0.05);而E组的LESP、BrP和PVV则呈进行性下降,与其基础值相比差异显著(＜0.01),并且也低于相同MAC的D组相应各值(＜0.01).结论地氟醚对小儿LES功能无明显影响而安氟醚对其影响较大,故有高度反流危险的小儿,以选用地氟醚维持麻醉更为安全.     

Incomplete atrioventricular dissociation and isorhythmic atrioventricular dissociation during general anesthesia with desflurane and remifentanil: A case report

We encountered a patient who experienced incomplete atrioventricular (A-V) dissociation and isorhythmic A-V dissociation during general anesthesia with desflurane and remifentanil. A 38-year-old man was scheduled to undergo extraction of both the upper and the right lower impacted wisdom teeth under general anesthesia. After anesthesia induction, we maintained anesthesia with desflurane and remifentanil. After 15 min, incomplete A-V dissociation was observed on electrocardiography (ECG). After atropine sulfate 0.3 mg was administered intravenously, isorhythmic A-V dissociation was observed. Atropine sulfate 0.2 mg was administered intravenously, and we observed normal ECG findings. Subsequently, no abnormal ECG findings were observed.     

Duration effect of desflurane anesthesia and its awakening time and arterial concentration in gynecologic patients

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 arterial blood was obtained for desflurane concentration determination by gas chromatography at 20 and 10 minutes before and 0, 5, 10, 15, and 20 minutes after the discontinuation of desflurane and at the time of eye opening upon verbal command, defined as awakening. Concentrations of inspiratory and end-tidal desflurane were simultaneously detected by an infrared analyzer.

RESULTS:

The mean arterial blood concentration of desflurane was 1.20% at awakening, which correlated with the awakening end-tidal concentration of 0.96%. The mean time from the discontinuation of desflurane to eye opening was 5.2 minutes (SD = 1.6, range 3-10), which was not associated with the duration of anesthesia (60-256 minutes), total fentanyl dose, or body mass index (BMI).

CONCLUSIONS:

The mean awakening arterial blood concentration of desflurane was 1.20%. The time to awakening was independent of anesthetic duration within four hours. Using well-assisted ventilation, the end-tidal concentration of desflurane was proven to represent the arterial blood concentration during elimination and could be a clinically feasible predictor of emergence from general anesthesia.     

脑电双频指数指导地氟醚与七氟醚麻醉的可行性

目的 了解脑电双频指数是否可用于指导地氟醚与七氟醚麻醉。方法 ４０例择期病人。随机分成四组（ｎ＝１０）；组１为地氟醚指导组（Ｄｅｓ－ｔ），组Ⅱ为地氟醚对照组（Ｄｅｓ－ｃ），组Ⅲ为七氟醚指导组（Ｓｅｖｏ－ｔ），组Ⅳ为七氟醚对照组（Ｓｅｖｏ－ｃ）。对照组公凭临床经验来调定地氟醚与七氟醚浓度。指导组则通过维持ＢＩＳ在６０左右来调定吸入麻醉药浓度。记录麻醉期间血压、心率及ＢＩＳ变化，并记录各麻醉药用量。结