sevoflurane concentration
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QJM ◽  
2021 ◽  
Vol 114 (Supplement_1) ◽  
Author(s):  
Bassel Mohamed Essam Noureldin ◽  
Eman Mohamed Kamal Abo Seif ◽  
Omar Mohamed Mohamed Eltawansy ◽  
Mohamed Mohamed Abdel Fattah Ghoneim

Abstract Background Inhalation mask induction is a cornerstone of pediatric anesthesia. Because of their natural aversion to needles, healthy children are usually anesthetized by mask prior to intravenous insertion. The early insertion of an intravenous access provides a means for administering fluids and drugs if an untoward event occurs during inhalational induction. Sevoflurane is the inhalation agent most commonly used for mask inductions in pediatric anesthesia, having largely replaced halothane for this purpose. Objectives The aim of the study was to evaluate the optimum end tidal concentration of Sevoflurane at which an intravenous cannulation can be successfully attempted without movement in pediatric patients. Patients and Methods In this clinical trial, pediatric subjects of either sex aged 2-5 years, weighing 10-20 kg were included. Results Showed that an end tidal sevoflurane of 1.46% has 50% probability for successful intravenous cannulation without movement in children. Conclusion We conclude that an end tidal sevoflurane of 1.46% has 50% probability for successful intravenous cannulation in un- premedicated children aged between 2 and 5 years.


Medicina ◽  
2021 ◽  
Vol 57 (10) ◽  
pp. 1034
Author(s):  
Kyung-Mi Kim ◽  
Ki-Hwa Lee ◽  
Jae-Hong Park

Background and Objectives: Phase lag entropy, an electroencephalographic monitor, evaluates the variety in temporal patterns of phase relationship between frontal and prefrontal brain region. Phase lag entropy can reflect the depth of anesthesia induced by propofol, but the association between sevoflurane and phase lag entropy has not been elucidated. This study examined the effect of sevoflurane on phase lag entropy during induction of general anesthesia. We also explored the pharmacodynamic model between end-tidal anesthetic concentration and electroencephalographic monitor. Materials and Methods: A total of 20 patients were enrolled. General anesthesia was produced by escalating the sevoflurane (1 vol% up to 8 vol%). The relationship between phase lag entropy and end-tidal anesthetic concentration was analyzed. A non-linear mixed-effects model was used to get the relationship of pharmacodynamics between the end-tidal sevoflurane concentration and phase lag entropy. Mean blood pressure, heart rate, and the modified observer’s assessment of alertness/sedation scale were also recorded during sevoflurane anesthesia. Results: As level of sedation increased, phase lag entropy decreased. A significant correlation was showed between phase lag entropy and end-tidal sevoflurane concentration (r = −0.759, p < 0.001). The correlation coefficient between the modified observer’s assessment of alertness/sedation scale and phase lag entropy was 0.731 (p < 0.001). The pharmacodynamic factors assessed by the sigmoid Emax model were E0 = 84.9, Emax = 42, Ce50 = 1.81, γ = 4.78, and ke0 = 0.692. The prediction probability of phase-lag entropy for measuring the modified observer’s assessment of alertness/sedation scale and end-tidal sevoflurane concentration were 0.764 and 0.789, respectively. With the increasing concentration of sevoflurane, mean blood pressure decreased, but heart rate did not change. Conclusions: The continuing escalation in end-tidal sevoflurane concentration caused a decline in phase lag entropy. Phase lag entropy can serve as an indicator of hypnotic depth in patients receiving sevoflurane anesthesia.


2021 ◽  
Vol 49 (2) ◽  
pp. 030006052098776
Author(s):  
Jian-wen Zhang ◽  
Zhi-gan Lv ◽  
Wei-wei Zhang ◽  
Zhe Wang ◽  
Bao-guo Wang

Objective To investigate the correlation between the pain rating index (PRi), which is an index derived from processed electroencephalography signals, and the end-tidal sevoflurane concentration (ETsevo). Methods This study involved 50 adults with a body mass index of 18 to 25 kg/m2 who were undergoing elective surgery under general anesthesia. Thyrocricocentesis was performed with 2.5 mL of 2% tetracaine for endotracheal surface anesthesia, and intravenous injections of midazolam, etomidate, and rocuronium were then administered. The patients’ tracheas were intubated and their ventilatory rate was adjusted to maintain the partial pressure of end-tidal carbon dioxide at 30 to 35 mmHg. Anesthesia was maintained with sevoflurane. The ETsevo was adjusted to maintain anesthesia at 0.6, 0.8, 1.0, and 1.2 minimum alveolar concentration for 15 minutes each, and the PRi, mean arterial pressure (MAP), and heart rate were recorded at each concentration. Results A negative correlation was found between the PRi and ETsevo (−0.882) and between the MAP and ETsevo (−0.571). A low positive correlation was found between the PRi and MAP (0.484). Conclusions The PRi showed a high negative correlation with the ETsevo. Therefore, the PRi can be used to guide the depth regulation of sevoflurane anesthesia. Clinical trial registration number: ChiCTR-IPR-17012092


2020 ◽  
Vol 20 (1) ◽  
Author(s):  
Yanxia Guo ◽  
Dan Wang ◽  
Xiaolin Yang ◽  
Pingping Jiang ◽  
Juan Xu ◽  
...  

Abstract Background This study aims to observe the effects of different target controlled plasma sufentanil concentrations on the minimum alveolar concentration (MAC) of sevoflurane for blocking adrenergic response (BAR) in patients undergoing laparoscopic cholecystectomy with carbon dioxide pneumoperitoneum stimulation. Methods Eighty-five patients undergoing laparoscopic cholecystectomy, aged 30–65 years, with American Society of Anesthesiologists physical status I-II, were enrolled in this study. All the patients were randomly divided into 5 groups (S0, S1, S2, S3, S4) with different sufentanil plasma target concentration (0.0, 0.1, 0.3, 0.5, 0.7 ng ml− 1). Anesthesia was induced by inhalation of 8% sevoflurane in 100% oxygen, and 0.6 mg kg− 1 of rocuronium was intravenously injected to facilitate the insertion of a laryngeal mask airway. The end-tidal sevoflurane concentration and sufentanil plasma target concentration were adjusted according to respective preset value in each group. The hemodynamic response to pneumoperitoneum stimulus was observed after the end-tidal sevoflurane concentration had been maintained stable at least for 15 min. The MACBAR of sevoflurane was measured by a sequential method. Meanwhile, epinephrine (E) and norepinephrine (NE) concentrations in the blood were also determined before and after pneumoperitoneum stimulus in each group. Results When the method of independent paired reversals was used, the MACBAR of sevoflurane in groups S0, S1, S2, S3, S4 was 5.333% (confidence interval [CI] 95%: 5.197–5.469%), 4.533% (95% CI: 4.451–4.616%), 2.861% (95% CI: 2.752–2.981%), 2.233% (95% CI: 2.142–2.324%) and 2.139% (95% CI: 2.057–2.219%), respectively. Meanwhile, when the isotonic regression analysis was used, the MACBAR of sevoflurane in groups S0, S1, S2, S3, S4 was 5.329% (95% CI: 5.321–5.343%), 4.557% (95% CI: 4.552–4.568%), 2.900% (95% CI: 2.894–2.911%), 2.216% (95% CI: 2.173–2.223%) and 2.171% (95% CI: 2.165–2.183%), respectively. The MACBAR was not significantly different between groups S3 and S4 when using 0.5 and 0.7 ng ml− 1 of sufentanil plasma target concentrations. No significant difference was found in the change of E or NE concentration between before and after pneumoperitoneum stimulation in each group. Conclusions The MACBAR of sevoflurane can be decreased with increasing sufentanil plasma target concentrations. A ceiling effect of the decrease occurred at a sufentanil plasma target concentration of 0.5 ng ml− 1. When the sympathetic adrenergic response was inhibited in half of the patients to pneumoperitoneum stimulation in each group, the changes of E and NE concentrations showed no significant differences. Trial registration The study was registered at http://www.chictr.org.cn (ChiCTR1800015819, 23, April, 2018).


2020 ◽  
Author(s):  
Yanxia Guo ◽  
Dan Wang ◽  
Xiao-lin Yang ◽  
Pingping Jiang ◽  
Juan Xu ◽  
...  

Abstract Background: This study aims to observe the effects of different target controlled plasma sufentanil concentrations on the minimum alveolar concentration (MAC) of sevoflurane for blocking adrenergic response (BAR) in patients undergoing laparoscopic cholecystectomy with carbon dioxide pneumoperitoneum stimulation.Methods: Eighty-five patients undergoing laparoscopic cholecystectomy, aged 30-65 years, with American Society of Anesthesiologists physical status Ⅰ-Ⅱ, were enrolled in this study. All the patients were randomly divided into 5 groups (S0, S1, S2, S3, S4) with different sufentanil plasma target concentration (0.0, 0.1, 0.3, 0.5, 0.7 ng ml-1). Anesthesia was induced by inhalation of 8% sevoflurane in 100% oxygen, and 0.6 mg kg-1 of rocuronium was intravenously injected to facilitate the insertion of a laryngeal mask airway. The end-tidal sevoflurane concentration and sufentanil plasma target concentration were adjusted according to respective preset value in each group. The hemodynamic response to pneumoperitoneum stimulus was observed after the end-tidal sevoflurane concentration had been maintained stable at least for 15 min. The MACBAR of sevoflurane was measured by a sequential method. Meanwhile, epinephrine (E) and norepinephrine (NE) concentrations in the blood were also determined before and after pneumoperitoneum stimulus in each group.Results: When the method of independent paired reversals was used, the MACBAR of sevoflurane in groups S0, S1, S2, S3, S4 was 5.333% (confidence interval [CI] 95%: 5.197-5.469%), 4.533% (95% CI: 4.451-4.616%), 2.861% (95% CI: 2.752-2.981%), 2.233% (95% CI: 2.142-2.324%) and 2.139% (95% CI: 2.057-2.219%), respectively. Meanwhile, when the isotonic regression analysis was used, the MACBAR of sevoflurane in groups S0, S1, S2, S3, S4 was 5.329% (95% CI: 5.321-5.343%), 4.557% (95% CI: 4.552-4.568%), 2.900% (95% CI: 2.894-2.911%), 2.216% (95% CI: 2.173-2.223%) and 2.171% (95% CI: 2.165-2.183%), respectively. The MACBAR was not significantly different between groups S3 and S4 when using 0.5 and 0.7 ng ml-1 of sufentanil plasma target concentrations. No significant difference was found in the change of E or NE concentration between before and after pneumoperitoneum stimulation in each group.Conclusions: The MACBAR of sevoflurane can be decreased with increasing sufentanil plasma target concentrations. A ceiling effect of the decrease occurred at a sufentanil plasma target concentration of 0.5 ng ml-1. When the sympathetic adrenergic response was inhibited in half of the patients to pneumoperitoneum stimulation in each group, the changes of E and NE concentrations showed no significant differences.Trial registration: The study was registered at http://www.chictr.org.cn (ChiCTR1800015819, 23, April, 2018).


2020 ◽  
Author(s):  
Yanxia Guo ◽  
Dan Wang ◽  
Xiao-lin Yang ◽  
Pingping Jiang ◽  
Juan Xu ◽  
...  

Abstract Background: This study aims to observe the effects of different target controlled plasma sufentanil concentrations on the minimum alveolar concentration (MAC) of sevoflurane for blocking adrenergic response (BAR) in patients undergoing laparoscopic cholecystectomy with carbon dioxide pneumoperitoneum stimulation.Methods: Eighty-five patients undergoing laparoscopic cholecystectomy, aged 30-65 years, with American Society of Anesthesiologists physical status Ⅰ-Ⅱ, were enrolled in this study. All the patients were randomly divided into 5 groups (S0, S1, S2, S3, S4) with different sufentanil plasma target concentration (0.0, 0.1, 0.3, 0.5, 0.7 ng ml-1). Anesthesia was induced by inhalation of 8% sevoflurane in 100% oxygen, and 0.6 mg kg-1 of rocuronium was intravenously injected to facilitate the insertion of laryngeal mask airway. The end-tidal sevoflurane concentration and sufentanil plasma target concentration were adjusted according to respective preset value in each group. The hemodynamic response to pneumoperitoneum stimulus was observed after the end-tidal sevoflurane concentration had been maintained stable at least for 15 min. The MACBAR of sevoflurane was measured by a sequential method. Meanwhile, epinephrine (E) and norepinephrine (NE) concentrations in the blood were also determined before and after pneumoperitoneum stimulus in each group.Results: When the method of independent paired reversals was used, the MACBAR of sevoflurane in groups S0, S1, S2, S3, S4 was 5.333% (confidence interval [CI] 95%: 5.197-5.469%), 4.533% (95% CI:4.451-4.616%), 2.861% (95% CI:2.752-2.981%), 2.233% (95% CI:2.142-2.324%) and 2.139% (95% CI:2.057-2.219%), respectively. Meanwhile, when the isotonic regression analysis was used, the MACBAR of sevoflurane in groups S0, S1, S2, S3, S4 was 5.329% (95% CI:5.321-5.343%), 4.557% (95% CI:4.552-4.568%), 2.900% (95% CI:2.894-2.911%), 2.216% (95% CI:2.173-2.223%) and 2.171% (95%CI:2.165-2.183%), respectively. The MACBAR had no significant difference between group S3 and group S4 when using 0.5 and 0.7 ng ml-1 of sufentanil plasma target concentrations. No significant difference was found in the change of E or NE concentration between before and after pneumoperitoneum stimulation in each group.Conclusions: The MACBAR of sevoflurane can be decreased with increasing sufentanil plasma target concentrations. A capping effect of the decrease occurred at a sufentanil plasma target concentration of 0.5 ng ml-1. When the sympathetic adrenergic response was inhibited in half patients to pneumoperitoneum stimulation in each group, the changes of E and NE concentrations showed no significant differences.Trial registration: The study was registered at http://www.chictr.org.cn (ChiCTR1800015819, 23, April, 2018).


2020 ◽  
Author(s):  
Yanxia Guo ◽  
Dan Wang ◽  
Xiao-lin Yang ◽  
Pingping Jiang ◽  
Juan Xu ◽  
...  

Abstract Background:The objective of this study is to observe the effects of different target controlled plasma sufentanil concentrations on the minimum alveolar concentration (MAC) of sevoflurane for blocking adrenergic response (BAR) in patients undergoing laparoscopic cholecystectomy with carbon dioxide pneumoperitoneum stimulation.Methods: Eighty-five patients undergoing laparoscopic cholecystectomy, aged 18-65 years, with American Society of Anaesthesiologists physical status Ⅰ-Ⅱ, were enrolled in this study. All the patients were randomly divided into 5 groups (S0, S1, S2, S3, S4) with different sufentanil plasma target concentration (0.0, 0.1, 0.3, 0.5, 0.7 ng ml-1). Anaesthesia was induced by inhalation of 8% sevoflurane in 100% oxygen, and 0.6 mg kg-1 of rocuronium was intravenously injected to facilitate the insertion of laryngeal mask airway. The end-tidal sevoflurane concentration and sufentanil plasma target concentration were adjusted according to respective preset value in each group. The hemodynamic response to pneumoperitoneum stimulus was observed after the end-tidal sevoflurane concentration had been maintained stable at least for 15 min. The MACBAR of sevoflurane was measured by a sequential method. Meanwhile, epinephrine and norepinephrine concentrations in the blood were also determined before and after pneumoperitoneum stimulus in each group.Results:The basic MACBAR of sevoflurane in group S0 was 5.33% (confidence interval[CI] 95%: 5.19-5.47%), which was decreased 15%, 46%, 58% and 60% by the infusion of sufentanil with 0.1, 0.3, 0.5 and 0.7 ng ml-1 plasma target concentration, respectively. But the decreased degree had no significant difference between 0.5 and 0.7 ng ml-1 of sufentanil plasma target concentrations. No significant difference was found in the change of epinephrine or norepinephrine concentration between before and after pneumoperitoneum stimulation in each group.Conclusions: The MACBAR of sevoflurane can be decreased with increasing sufentanil plasma target concentrations. A capping effect of the decrease occurred at a sufentanil plasma target concentration of 0.5 ng ml-1. When the sympathetic adrenergic response was inhibited in half patients to pneumoperitoneum stimulation in each group, the changes of epinephrine and norepinephrine concentrations showed no significant differences.Trial registration: The study was registered at http://www.chictr.org.cn (ChiCTR1800015819, 23, April, 2018) .


2020 ◽  
Vol 20 (1) ◽  
Author(s):  
Cristina Monteserín-Matesanz ◽  
Tatiana González ◽  
María José Anadón-Baselga ◽  
Matilde Zaballos

Abstract Background ProSeal (PLMA) and Supreme (SLMA) laryngeal mask airways are effective ventilator devices with distinctive designs that may require different anaesthetics for insertion. Sevoflurane induction provides acceptable conditions for laryngeal mask insertion, and remifentanil significantly decreases the minimum alveolar concentration of sevoflurane required for that insertion. The study aimed to evaluate the optimal end-tidal (ET) sevoflurane concentration for successful insertion of PLMA versus SLMA in patients receiving a remifentanil infusion without a neuromuscular blocking agent. Methods Altogether, 45 patients ASA (American Society Anaesthesiologists) physical status I–II, aged 18–60 years were scheduled for elective ambulatory surgery. Exclusion criteria were a difficult airway, recent respiratory infection, reactive airway, obstructive sleep apnoea syndrome, gastric aspiration’s risk factors, pregnancy, and lactation. Patients were randomly allocated to receive the SLMA or the PLMA. Sevoflurane induction with co-administration of remifentanil was performed at an effect-site concentration of 4 ng mL− 1. ET50 was calculated with a modified Dixon’s up-and-down method (starting at 2.5% in steps of 0.5%). Predetermined sevoflurane concentration was kept constant during the 10 min before LMA insertion. Patient’s response to LMA insertion was classified as “movement” or “no movement”. Sevoflurane ET50 was determined as the midpoint concentration of all the independent pairs that manifested crossover from “movement” to “no movement”. Results The ET50 sevoflurane concentration co-administered with remifentanil required for PLMA insertion was 1.20 ± 0.41% (95% confidence interval 0.76 to 1.63%). For SLMA insertion, it was 0.55 ± 0.38% (95% confidence interval 0.14 to 0.95%) (p = 0.019). Conclusions The end-tidal sevoflurane concentration with co-administered remifentanil required to allow insertion of the SLMA was 54% lower than that needed for inserting the PLMA. Trial registration Clinicaltrials.gov identifier: NCT03003377. Retrospectively registered. Date of registration: December 28, 2016.


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