title: End-tidal desflurane concentration for tracheal extubation in adults.
abstract: OBJECTIVE
  To determine the end-tidal desflurane concentration required for tracheal extubation in anaesthetised adults.
  
  
  METHODS
  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-1, fentanyl 2μg.kg-1, and rocuronium 0.6mg.kg-1for intubation. Maintenance of anaesthesia was provided by desflurane in oxygen and air (40:60), and remifentanil at 0.05-0.25μg.kg-1.min1. 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-1in 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.
  
  
  RESULTS
  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.
  
  
  CONCLUSIONS
  Extubation in patients receiving desflurane may be feasible at 0.62 minimum alveolar concentration.
authors.affiliation: Servicio de Anestesiología-Reanimación y Terapéutica del Dolor, Hospital Universitario Gregorio Marañón, Madrid, España.
authors.forename: A
authors.initials: A
authors.lastname: Reyes
authors.affiliation: Servicio de Anestesiología-Reanimación y Terapéutica del Dolor, Hospital Universitario Gregorio Marañón, Madrid, España.
authors.forename: M
authors.initials: M
authors.lastname: López
authors.affiliation: Servicio de Anestesiología-Reanimación y Terapéutica del Dolor, Hospital Universitario Gregorio Marañón, Madrid, España.
authors.forename: F
authors.initials: F
authors.lastname: de la Gala
authors.affiliation: Servicio de Anestesiología-Reanimación y Terapéutica del Dolor, Hospital Universitario Gregorio Marañón, Madrid, España; Universidad Complutense de Madrid, Madrid, España.
authors.forename: M I
authors.initials: MI
authors.lastname: Canal Alonso
authors.affiliation: Servicio de Anestesiología-Reanimación y Terapéutica del Dolor, Hospital Universitario Gregorio Marañón, Madrid, España.
authors.forename: S
authors.initials: S
authors.lastname: Agustí
authors.affiliation: Servicio de Anestesiología-Reanimación y Terapéutica del Dolor, Hospital Universitario Gregorio Marañón, Madrid, España; Universidad Complutense de Madrid, Madrid, España. Electronic address: mati@plagaro.net.
authors.forename: M
authors.initials: M
authors.lastname: Zaballos
mesh_terms: D000328:Adult; D000368:Aged; D060666:Airway Extubation / Q000009:adverse effects; D000556:Ambulatory Surgical Procedures; D018685:Anesthetics, Inhalation / Q000032:analysis*; D001944:Breath Tests; D003371:Cough / Q000517:prevention & control; D018592:Cross-Over Studies; D000077335:Desflurane; D005260:Female; D006439:Hemodynamics; D006801:Humans; D007530:Isoflurane / Q000031:analogs & derivatives* / Q000032:analysis; D007826:Laryngismus / Q000517:prevention & control; D008297:Male; D008875:Middle Aged; D061886:Neuromuscular Monitoring; D010880:Piperidines; D011183:Postoperative Complications / Q000517:prevention & control; D000077208:Remifentanil; D055815:Young Adult
chemical_list: D018685:Anesthetics, Inhalation; D010880:Piperidines; D000077335:Desflurane; D007530:Isoflurane; D000077208:Remifentanil
keywords: Airway extubation; Concentración al final de la espiración; Desflurane; Desflurano; End-tidal concentration; Extubación vía aérea