title: Awakening arterial blood and end-tidal concentrations of isoflurane in female surgical patients.
abstract: Delayed extubation occurs after isoflurane anesthesia, especially following prolonged surgical duration. We aimed to determine the arterial blood concentrations of isoflurane and the correlation with end-tidal concentrations for predicting emergence from general anesthesia.Thirty-four American Society of Anesthesiologists physical status class I-II gynecologic patients were included. General anesthesia was maintained with a fixed 2% inspiratory isoflurane in 6 L/minute oxygen, which was discontinued after surgery. One milliliter of arterial blood was obtained for the determination of isoflurane concentration by gas chromatography at 20 and 10 minutes before and 0, 5, 10, 15, and 20 minutes after discontinuation, in addition to the time of eye opening to verbal command, defined as awakening. Inspiratory and end-tidal concentrations were simultaneously detected by an infrared analyzer.The mean awakening arterial blood concentration of isoflurane was 0.20%, which was lower than the simultaneous end-tidal concentration 0.23%. The differences between arterial and end-tidal concentrations during emergence fell into an acceptable range (±1.96 standard deviation). After receiving a mean time of 108-minute general anesthesia, the time to eye opening after discontinuing isoflurane was 18.5 minutes (range 11-30, median 18 minutes), without statistical significance with anesthesia duration (P = 0.078) and body mass index (P = 0.170).We demonstrated the awakening arterial blood concentration of isoflurane in female patients as 0.20%. With well-assisted ventilation, the end-tidal concentration could be an indicator for the arterial blood concentration to predict emergence from shorter duration of isoflurane anesthesia.
authors.affiliation: Department of Anesthesiology, Tri-Service General Hospital Department of Anesthesiology, Taipei Veterans General Hospital, National Defense Medical Center, Taipei Department of Anesthesiology, Tungs' Taichung MetroHarbor Hospital, Taichung, Taiwan Department of Medicine, School of Medicine, Johns Hopkins University, Baltimore, MD Department of Pharmacology, School of Medicine, Temple University, Philadelphia, PA Department of Obstetrics and Gynecology, Tri-Service General Hospital School of Public Health, National Defense Medical Center, Taipei, Taiwan.
authors.forename: Tso-Chou
authors.initials: TC
authors.lastname: Lin
authors.forename: Chih-Cherng
authors.initials: CC
authors.lastname: Lu
authors.forename: Che-Hao
authors.initials: CH
authors.lastname: Hsu
authors.forename: Joseph V
authors.initials: JV
authors.lastname: Pergolizz
authors.forename: Cheng-Chang
authors.initials: CC
authors.lastname: Chang
authors.forename: Meei-Shyuan
authors.initials: MS
authors.lastname: Lee
authors.forename: Shung-Tai
authors.initials: ST
authors.lastname: Ho
mesh_terms: D000328:Adult; D060666:Airway Extubation; D000762:Anesthesia Recovery Period; D000768:Anesthesia, General; D000769:Anesthesia, Inhalation; D015992:Body Mass Index; D005260:Female; D013509:Gynecologic Surgical Procedures; D006801:Humans; D007530:Isoflurane / Q000493:pharmacokinetics*; D008657:Metabolic Clearance Rate / Q000502:physiology; D008875:Middle Aged; D013990:Tidal Volume; D014851:Wakefulness / Q000187:drug effects* / Q000502:physiology*
chemical_list: D007530:Isoflurane