title: Larger tidal volume increases sevoflurane uptake in blood: a randomized clinical study.
abstract: BACKGROUND
  The rate of uptake of volatile anesthetics is dependent on alveolar concentration and ventilation, blood solubility and cardiac output. We wanted to determine whether increased tidal volume (V(T)), with unchanged end-tidal carbon dioxide partial pressure (P(ET)CO(2)), could affect the arterial concentration of sevoflurane.
  
  
  METHODS
  Prospective, randomized, clinical study. ASA physical status (2) and II patients scheduled for elective surgery of the lower abdomen were randomly assigned to one of the two groups with 10 patients in each: one group with normal V(T) (NV(T)) and one group with increased V(T) (IV(T)) achieved by increasing the inspired plateau pressure 0.04 cmH(2)O/kg above the initial plateau pressure. A corrugated tube added extra apparatus dead space to maintain P(ET)CO(2) at 4.5 kPa. The respiratory rate was set at 15 min(-1), and sevoflurane was delivered to the fresh gas by a vaporizer set at 3%. Arterial sevoflurane tensions (P(a)sevo), F(i)sevo, P(ET)sevo, P(ET)CO(2), P(a)CO(2), V(T) and airway pressure were measured.
  
  
  RESULTS
  The two groups of patients were similar with regard to gender, age, weight, height and body mass index. The mean P(ET)sevo did not differ between the groups. Throughout the observation time, arterial sevoflurane tension (mean ± SE) was significantly higher in the IV(T) group compared with the NV(T) group, e.g. 1.9 ± 0.23 vs. 1.6 ± 0.25 kPa after 60 min of anesthesia (P<0.05).
  
  
  CONCLUSIONS
  Ventilation with larger tidal volumes with isocapnia maintained with added dead-space volume increases the tension of sevoflurane in arterial blood.
authors.affiliation: Section of Anaesthesiology and Intensive Care, Department of Clinical Sciences, Lund University, Lund, Sweden. bruno.enekvist@skane.se
authors.forename: B
authors.initials: B
authors.lastname: Enekvist
authors.forename: M
authors.initials: M
authors.lastname: Bodelsson
authors.forename: L W
authors.initials: LW
authors.lastname: Sturesson
authors.forename: A
authors.initials: A
authors.lastname: Johansson
mesh_terms: D000328:Adult; D000368:Aged; D000369:Aged, 80 and over; D018685:Anesthetics, Inhalation / Q000097:blood*; D005260:Female; D005652:Functional Residual Capacity; D006801:Humans; D008297:Male; D008738:Methyl Ethers / Q000097:blood*; D008875:Middle Aged; D011175:Positive-Pressure Respiration; D011446:Prospective Studies; D000077149:Sevoflurane; D013990:Tidal Volume
chemical_list: D018685:Anesthetics, Inhalation; D008738:Methyl Ethers; D000077149:Sevoflurane