Effects of Changes in Alveolar Ventilation on Isoflurane Arterial Blood Concentration and Its Uptake into the Human Body

Lu, Chih Cherng; Lin, Tso Chou; Mu, Yu; Chen, Ta Liang; Lin, Chia-Yang; Chiang, Joseph S.; Ho, Shung Tai

doi:10.1159/000187719

Cited by 6 publications

(4 citation statements)

References 22 publications

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“…Our previous study demonstrated that the application of increased alveolar ventilation led to elevated arterial blood isoflurane concentrations at the time of the initial administration of isoflurane and therefore resulted in its accelerated uptake into the body (6). Similarly, Enekvist et al demonstrated that ventilation with larger tidal volumes under isocapnia increased the rate of the rise in the arterial blood concentrations of sevoflurane compared with the normal tidal volumes (7).…”

Section: Introductionmentioning

confidence: 99%

Hyperventilation accelerates the rise of arterial blood concentrations of desflurane in gynecologic patients

Lu¹,

Lin²,

Hsu³

et al. 2012

Clinics

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OBJECTIVES:Under a constant inspired concentration, the uptake of a volatile anesthetic into the arterial blood should mainly be governed by alveolar ventilation, according to the assumption that the patient's cardiac output remains stable during anesthesia. We investigated whether ventilation volume affects the rate of desflurane uptake by examining arterial blood concentrations.METHOD:Thirty female patients were randomly allocated into the following three groups: hyperventilation, normal ventilation and hypoventilation. Hemodynamic variables were measured using a Finometer, inspiratory and end-tidal concentrations of desflurane were measured by infrared analysis, and the desflurane concentration in the arterial blood (Ades) was analyzed by gas chromatography.RESULTS:During the first 10 minutes after the administration of desflurane, the Ades was highest in the hyperventilation group, and this value was significantly different from those obtained for the normal and hypoventilation groups. In addition, hyperventilation significantly increased the slope of Ades-over-time during the first 5 minutes compared with patients experiencing normal ventilation and hypoventilation, but there were no differences in these slopes during the periods from 5-10, 10-20 and 20-40 minutes after the administration of desflurane. This finding indicates that there were no differences in desflurane uptake between the three groups after the first 5 minutes within desflurane administration.CONCLUSIONS:Hyperventilation accelerated the rate of the rise in Ades following desflurane administration, which was time-dependent with respect to different alveolar ventilations levels.

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Section: Introductionmentioning

confidence: 99%

Hyperventilation accelerates the rise of arterial blood concentrations of desflurane in gynecologic patients

Lu¹,

Lin²,

Hsu³

et al. 2012

Clinics

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“…The rate of uptake of inhaled anesthetics depends on the alveolar concentration and ventilation 22-25 , blood solubility 5 and cardiac output 22 . Similarly, sevoflurane washout commences from the brain and body via the circulating blood into the alveolar space during elimination, allowing the lungs to ventilate it into the air.…”

Section: Discussionmentioning

confidence: 99%

Arterial blood and end-tidal concentrations of sevoflurane during the emergence from anesthesia in gynecologic patients

Lin¹,

Lu²,

Hsu³

et al. 2015

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OBJECTIVE:The end-tidal concentration of inhalation anesthetics is a clinical indicator for predicting the emergence from anesthesia. This study was conducted to assess the relationship between arterial blood and end-tidal sevoflurane concentrations during emergence.METHODS:Thirty-two female American Society of Anesthesiologists physical status I-II patients receiving general anesthesia for elective gynecologic surgery were included. A fixed dose of 3.5% inspiratory sevoflurane in 6 L min-1 oxygen was maintained until the end of surgery. At 20 and 10 minutes before and 0, 5, 10, 15, and 20 minutes after discontinuing sevoflurane, as well as at the time of eye opening by verbal command, defined as awakening, 1 ml arterial blood was obtained to measure its sevoflurane concentration by gas chromatography. Simultaneous inspiratory and end-tidal concentrations of sevoflurane were detected by an infrared analyzer and tested by Bland–Altman agreement analysis.RESULTS:The arterial blood concentrations of sevoflurane were similar to the simultaneous end-tidal concentrations during emergence: 0.36% (0.10) and 0.36% (0.08) sevoflurane at awakening, respectively. The mean time from discontinuing sevoflurane to eye opening was 15.8 minutes (SD 2.9, range 10-26) and was significantly correlated with the duration of anesthesia (52-192 minutes) (P = 0.006) but not with the body mass index or total fentanyl dose.CONCLUSION:The mean awakening arterial blood concentration of sevoflurane was 0.36%. The time to awakening was prolonged in accordance with the anesthetic duration within 3 hours. With well-assisted ventilation during emergence, the sevoflurane end-tidal concentration was nearly equal to its arterial blood concentration, which could be a feasible predictor for awakening.

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“…[19] Isoflurane in each blood sample was converted to the corresponding concentration, based on gas chromatographic measurements and blood-gas partition coefficient of isoflurane (λ) measured in each patient.…”

Section: Methodsmentioning

confidence: 99%

Awakening arterial blood and end-tidal concentrations of isoflurane in female surgical patients

Lin

Hsu

et al. 2016

Medicine

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Delayed extubation occurs after isoflurane anesthesia, especially following prolonged surgical duration. We aimed to determine the arterial blood concentrations of isoflurane and the correlation with end-tidal concentrations for predicting emergence from general anesthesia.Thirty-four American Society of Anesthesiologists physical status class I–II gynecologic patients were included. General anesthesia was maintained with a fixed 2% inspiratory isoflurane in 6 L/minute oxygen, which was discontinued after surgery. One milliliter of arterial blood was obtained for the determination of isoflurane concentration by gas chromatography at 20 and 10 minutes before and 0, 5, 10, 15, and 20 minutes after discontinuation, in addition to the time of eye opening to verbal command, defined as awakening. Inspiratory and end-tidal concentrations were simultaneously detected by an infrared analyzer.The mean awakening arterial blood concentration of isoflurane was 0.20%, which was lower than the simultaneous end-tidal concentration 0.23%. The differences between arterial and end-tidal concentrations during emergence fell into an acceptable range (±1.96 standard deviation). After receiving a mean time of 108-minute general anesthesia, the time to eye opening after discontinuing isoflurane was 18.5 minutes (range 11–30, median 18 minutes), without statistical significance with anesthesia duration (P = 0.078) and body mass index (P = 0.170).We demonstrated the awakening arterial blood concentration of isoflurane in female patients as 0.20%. With well-assisted ventilation, the end-tidal concentration could be an indicator for the arterial blood concentration to predict emergence from shorter duration of isoflurane anesthesia.

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Effects of Changes in Alveolar Ventilation on Isoflurane Arterial Blood Concentration and Its Uptake into the Human Body

Cited by 6 publications

References 22 publications

Hyperventilation accelerates the rise of arterial blood concentrations of desflurane in gynecologic patients

Hyperventilation accelerates the rise of arterial blood concentrations of desflurane in gynecologic patients

Arterial blood and end-tidal concentrations of sevoflurane during the emergence from anesthesia in gynecologic patients

Awakening arterial blood and end-tidal concentrations of isoflurane in female surgical patients

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