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A824
October 14, 2007 2:00 PM - 4:00 PM Room Hall D, Area K, |
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| Return of Airway Reflexes Following Titration of Sevoflurane and Desflurane | ||||||||||||||||||||||||||||||||
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Shahbaz R. Arain, M.D., Thomas J. Ebert, M.D., Ph.D. Anesthesiology, Medical College of Wisconsin & VA Medical Ctr, Milwaukee, Wisconsin |
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Introduction. The return of protective airway reflexes following general anesthesia is an important endpoint. It minimizes the risk of aspiration on emergence. It is likely that anesthetics with a low blood:gas partition coefficient and a rapid emergence profile might be associated with a more rapid return of protective airway reflexes after anesthesia. Titration of anesthesia with processed EEG monitoring (BIS monitor) also might improve the speed to return of protective reflexes. This prospective, randomized, blinded, single-center study evaluated the time to return of swallowing ability (a surrogate marker for return of airway reflexes) following desflurane or sevoflurane anesthesia guided intraoperatively and titrated at the end of surgery with the aid of a BIS monitor (Aspect Medical Systems). Methods. Informed consent was obtained from 40 patients. Approximately 30 min prior to induction of anesthesia, each patient was asked to swallow 20 ml of water. Standard anesthetic premedications of midazolam (0.06 mg/kg) and fentanyl (0.75 mcg/kg) were given. Induction of anesthesia was with 2 mg/kg propofol and 0.75 mcg/kg fentanyl, and laryngeal mask airway (LMA) insertion followed the loss of consciousness. Patients received 50:50 N2O:oxygen at 2 L/min FGF and were randomized to receive desflurane or sevoflurane for maintenance at a BIS-guided concentration of 45-50 intraoperatively and 50-55 during the last 15 min of the surgical procedure. In recovery, a blinded observer recorded the time to the patient's response to a verbal command. Exactly 2 min after a positive response and removal of LMA, the patient was given 20 ml of water to swallow, and success or failure was recorded. If the patient failed, the swallow test was repeated at 6, 10, and 14 min, until successful. Results. 36 males and 4 females (55 years ± 15) successfully swallowed the 20 ml water preoperatively. Demographic data and surgical procedures were not different between groups. Both groups achieved similar intraop BIS numbers and emergence times were similar. Both had similar cardiopulmonary responses intra- and postoperatively, with the exception of heart rate, which was significantly higher in the desflurane group in early recovery. Time to successful swallowing was not different between groups (chi square analysis).[table1]Discussion. Earlier work has suggested an advantage of desflurane over sevoflurane in time to achieve swallowing success.1 The present study indicates that BIS guided titration of anesthetic concentration equalized the time to ability to swallow between desflurane and sevoflurane despite the higher percent of MAC in the sevoflurane group and the lower blood:gas partition coefficient of desflurane. References. 1. Eshima McKay R, et al. A&A. 100:697-700, 2005. Airway reflexes return more rapidly after desflurane anesthesia than after sevoflurane anesthesia. Anesthesiology 2007; 107: A824 |
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