title: The ED(95) of end-tidal sevoflurane concentration for the smooth exchange of the tracheal tube for a laryngeal mask airway is 2.97%.
abstract: OBJECTIVE
  Exchanging the tracheal tube for the laryngeal mask airway (the TT/LMA exchange) while the patient is still anesthetized avoids coughing associated with tracheal extubation. This study was conducted to determine the end-tidal concentration of sevoflurane that prevented response to this exchange in 50% patients (MAC(TT/LMA)).
  
  
  METHODS
  We studied 21 adult male patients, ASA I, aged 21-54 yr. Anesthesia was induced with thiamylal and sevoflurane, and the trachea was intubated following vecuronium neuromuscular blockade. Anesthesia was maintained with sevoflurane and nitrous oxide in oxygen. After surgery, a predetermined end-tidal sevoflurane concentration was achieved and a steady state was maintained for at least 20 min. The concentration at which the TT/LMA exchange was attempted was determined by a modification of Dixon's up-and-down method with 0.25% as the step size. At the time of the TT/LMA exchange, no residual nitrous oxide > 3% was detected, and the return to normal neuromuscular function was confirmed. When the TT/LMA exchange was accomplished without coughing, movement, or airway obstruction, it was considered a smooth exchange.
  
  
  RESULTS
  Sevoflurane MAC(TT/LMA) determined using the up-and-down method was 2.63% +/- 0.14%. The 50% effective dose obtained using a probit analysis was similar [2.53% (95% confidence limits, 2.13-2.82%)].
  
  
  CONCLUSIONS
  Sevoflurane MAC(TT/LMA) in adult male patients was 2.63% (1.54 MAC) and may be useful for the smooth exchange of the tracheal tube for the LMA in a clinical setting.
authors.affiliation: Department of Anesthesiology Critical Care Medicine Hokkaido University Graduate School of Medicine Sapporo Japan. ktakita@med.hokudai.ac.jp
authors.forename: Koichi
authors.initials: K
authors.lastname: Takita
authors.forename: Masahiro
authors.initials: M
authors.lastname: Yamane
authors.forename: Yuji
authors.initials: Y
authors.lastname: Morimoto
authors.forename: Osamu
authors.initials: O
authors.lastname: Kemmotsu
mesh_terms: D000328:Adult; D018685:Anesthetics, Inhalation / Q000008:administration & dosage; D004305:Dose-Response Relationship, Drug; D006801:Humans; D007442:Intubation, Intratracheal / Q000009:adverse effects / Q000379:methods*; D017214:Laryngeal Masks / Q000009:adverse effects; D008297:Male; D008738:Methyl Ethers / Q000008:administration & dosage; D008875:Middle Aged; D019148:Neuromuscular Blockade; D003473:Neuromuscular Nondepolarizing Agents; D000077149:Sevoflurane; D014673:Vecuronium Bromide
chemical_list: D018685:Anesthetics, Inhalation; D008738:Methyl Ethers; D003473:Neuromuscular Nondepolarizing Agents; D000077149:Sevoflurane; D014673:Vecuronium Bromide