Desflurane enhances reactivity during the use of the laryngeal mask airway. Anesthesiology 2005 Sep;103(3):495-9
Date
09/01/2005Pubmed ID
16129973DOI
10.1097/00000542-200509000-00011Scopus ID
2-s2.0-24144465105 (requires institutional sign-in at Scopus site) 36 CitationsAbstract
BACKGROUND: Desflurane and sevoflurane have markedly different pungencies. The tested hypothesis was that patients breathing equivalent concentrations of desflurane or sevoflurane through a laryngeal mask airway (LMA) would have similar responses.
METHODS: After institutional review board approval and informed consent were obtained, 60 patients were enrolled and given intravenous midazolam (14 microg/kg) and fentanyl (1 microg/kg) 5 min before induction of anesthesia. The LMA was inserted at loss of consciousness after 2 mg/kg propofol. When spontaneous breathing returned, a randomly assigned volatile anesthetic was started at an inspired concentration of either 1.8% sevoflurane or 6% desflurane at a fresh gas flow of 6 l/min in air:oxygen (50:50). After 5 min, a controlled movement of the LMA took place. Three minutes later, the inspiratory anesthetic concentration was changed to either 3.6% sevoflurane or 12% desflurane for 3 min. A blinded observer recorded movements and airway events during the start of anesthetic, LMA movement, deepening of the anesthetic, and emergence before LMA removal.
RESULTS: There were no differences at anesthetic start and LMA movement. Desflurane titration to 12% increased heart rate, increased mean arterial blood pressure, and initiated frequent coughing (53% vs. 0% sevoflurane) and body movements (47% vs. 0% sevoflurane). During emergence, there was a twofold greater incidence of coughing and a fivefold increase in breath holding in the desflurane group.
CONCLUSIONS: When airway responses to sevoflurane and desflurane were compared in elective surgical patients breathing through an LMA, there were significantly more adverse responses with desflurane at 12% concentrations and during emergence.
Author List
Arain SR, Shankar H, Ebert TJAuthors
Thomas J. Ebert MD, PhD Adjunct Professor in the Anesthesiology department at Medical College of WisconsinHariharan Shankar MD Professor in the Anesthesiology department at Medical College of Wisconsin
MESH terms used to index this publication - Major topics in bold
AdultAged
Aged, 80 and over
Anesthetics, Inhalation
Blood Pressure
Heart Rate
Humans
Isoflurane
Laryngeal Masks
Methyl Ethers
Middle Aged