Caudal anesthesia reduces the minimum alveolar concentration of enflurane for laryngeal mask airway removal in boys.
OBJECTIVE
To investigate the effects of caudal analgesia on the minimal alveolar concentration of enflurane for laryngeal mask airway (LMA) smooth extubation (MACex).


METHODS
We studied 50 nonpremedicated children, aged three to ten years, ASA physical status I, undergoing surgery for hypospadias repair. After a sevoflurane inhalation induction, children were randomized to receive LMA insertion with or without ropivacaine caudal analgesia. At the end of surgery, a predetermined end-tidal enflurane concentration was achieved, and the LMA was removed by an anesthesiologist blinded to group allocation. Each concentration at which LMA extubation was attempted was predetermined by the up-and-down method (with 0.1% as the step size). When LMA removal was accomplished without coughing, clenching teeth or gross purposeful muscular movements during or within one minute after removal, it was considered successful.


RESULTS
MACex of enflurane for LMA removal in the group without caudal anesthesia was 1.04% (95% confidence interval, 1.00-1.10) and the LMA MACex of enflurane in the group with caudal anesthesia was 0.74% (95% confidence interval, 0.63-0.81). Caudal analgesia significantly reduced enflurane requirements by 29% (95% confidence interval, 22-36%).


CONCLUSIONS
In conclusion, caudal analgesia significantly reduced the LMA MACex of enflurane by approximately 29%. Possible mechanisms may be related to the analgesic effect of caudal blockade or to the sedative properties of neuraxial anesthesia.
Xiao
Wen-Jing
WJ
Department of Anesthesiology, Plastic Surgery Hospital, Chinese Academy of Medical Sciences, Peking Union Medical College, Beijing, China. wenjingxiao@sina.com
Deng
Xiao-Ming
XM
Tang
Geng-Zhi
GZ
Lu
Mao-Ping
MP
Xu
Kun-Ling
KL
D000763:Anesthesia, Caudal; D018685:Anesthetics, Inhalation / Q000494:pharmacology*; D002648:Child; D002675:Child, Preschool; D004737:Enflurane / Q000493:pharmacokinetics / Q000494:pharmacology*; D006801:Humans; D017214:Laryngeal Masks; D008297:Male; D011650:Pulmonary Alveoli / Q000378:metabolism*
D018685:Anesthetics, Inhalation; D004737:Enflurane