Reyes A, López M, de la Gala F, Canal Alonso M I, Agustí S, Zaballos M
Servicio de Anestesiología-Reanimación y Terapéutica del Dolor, Hospital Universitario Gregorio Marañón, Madrid, España.
Servicio de Anestesiología-Reanimación y Terapéutica del Dolor, Hospital Universitario Gregorio Marañón, Madrid, España; Universidad Complutense de Madrid, Madrid, España.
Rev Esp Anestesiol Reanim. 2017 Jan;64(1):13-18. doi: 10.1016/j.redar.2016.04.004. Epub 2016 Jul 15.
To determine the end-tidal desflurane concentration required for tracheal extubation in anaesthetised adults.
After hospital Ethics Committee approval, eighteen ASA I-II adult patients (19-65 years of age), who had been scheduled for elective ambulatory surgery were included in the study. Anaesthesia was induced with propofol 2.5mg.kg, fentanyl 2μg.kg, and rocuronium 0.6mg.kg for intubation. Maintenance of anaesthesia was provided by desflurane in oxygen and air (40:60), and remifentanil at 0.05-0.25μg.kg.min. Neuromuscular function was monitored with train-of-four (TOF) nerve stimulation and acceleromyography. At the end of the surgery neuromuscular blockade was reversed with sugammadex 2-4mg.kg in accordance with the TOF ratio. The concentration of desflurane at which extubation was attempted was determined by using Dixon's up-and-down method with 0.5% as a step size. Smooth extubation was defined as one without coughing, teeth clenching, gross purposeful movements, and no breath-holding or laryngospasm within 1min of tracheal extubation.
It was found that the end-tidal concentration of desflurane was 3.17±0.18% (95% CI: 3%-3.35%) for successful extubation in 50% of adults.
Extubation in patients receiving desflurane may be feasible at 0.62 minimum alveolar concentration.
确定麻醉成年患者气管拔管所需的呼气末地氟烷浓度。
经医院伦理委员会批准，纳入18例计划行择期门诊手术的美国麻醉医师协会（ASA）I-II级成年患者（19 - 65岁）。采用丙泊酚2.5mg/kg、芬太尼2μg/kg和罗库溴铵0.6mg/kg诱导麻醉以进行气管插管。通过在氧气和空气（40:60）中吸入地氟烷以及瑞芬太尼0.05 - 0.25μg·kg-1·min维持麻醉。采用四个成串刺激（TOF）神经刺激和加速度肌电图监测神经肌肉功能。手术结束时，根据TOF比值，用舒更葡糖2 - 4mg/kg逆转神经肌肉阻滞。以0.5%为步长，采用Dixon上下法确定尝试拔管时的地氟烷浓度。顺利拔管定义为气管拔管后1分钟内无咳嗽、牙关紧闭、明显的有意识动作、无屏气或喉痉挛。
发现50%成年患者成功拔管时，地氟烷的呼气末浓度为3.17±0.18%（95%CI：3% - 3.35%）。
接受地氟烷麻醉的患者在最低肺泡浓度为0.62时拔管可能是可行的。
