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Optimum end-tidal concentration of sevoflurane to facilitate supraglottic airway device insertion with propofol at induction allowing spontaneous respiration in obese patients: A prospective observational study.

Abstract Obese patients are more likely to encounter with difficult airway management, and supraglottic airway device has been adopted to facilitate tracheal intubation. The optimum anesthetic concentration for obese patients to insert a supraglottic airway device with spontaneous respiration has not been investigated. This study was designed to determine the end-tidal concentration of sevoflurane that would provide acceptable condition for supraglottic airway device insertion with propofol at induction in obese patients without using neuromuscular blockade.Thirty elective obese patients [body mass index (BMI) 30-50 kg/m] scheduled for bariatric surgery were enrolled in this study. Sevoflurane was inhaled at a concentration of 5% after infusion of 1 mg/kg propofol (within 1 minute) according to lean body weight. The target concentration of sevoflurane was initiated at 2.5% with 0.5% as a step size using a modified Dixon up-and-down method. Five minutes after target concentration achieved, the insertion of supraglottic airway device was attempted.The minimum alveolar concentration of sevoflurane for successful insertion of supraglottic airway device calculated using up-and-down method were 2.25 (0.53) % for obese patients. The values of the effective concentration of sevoflurane for successful supraglottic airway device insertion in 50% (EC50) and 95% (EC95) of the obese patients obtained by probit regression analysis were 2.09% (95% confidence interval 1.48-2.68) and 3.31% (95% confidence interval 2.70-8.12), respectively.We conclude that sevoflurane at a minimum alveolar concentration of 2.25% can provide optimal conditions for insertion of supraglottic airway device with spontaneous respiration in obese patients with 1 mg/kg propofol at induction.
PMID
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Authors

Mayor MeshTerms
Keywords
Journal Title medicine
Publication Year Start




PMID- 29382022
OWN - NLM
STAT- MEDLINE
DCOM- 20180207
LR  - 20180207
IS  - 1536-5964 (Electronic)
IS  - 0025-7974 (Linking)
VI  - 96
IP  - 47
DP  - 2017 Nov
TI  - Optimum end-tidal concentration of sevoflurane to facilitate supraglottic airway 
      device insertion with propofol at induction allowing spontaneous respiration in
      obese patients: A prospective observational study.
PG  - e8902
LID - 10.1097/MD.0000000000008902 [doi]
AB  - Obese patients are more likely to encounter with difficult airway management, and
      supraglottic airway device has been adopted to facilitate tracheal intubation.
      The optimum anesthetic concentration for obese patients to insert a supraglottic 
      airway device with spontaneous respiration has not been investigated. This study 
      was designed to determine the end-tidal concentration of sevoflurane that would
      provide acceptable condition for supraglottic airway device insertion with
      propofol at induction in obese patients without using neuromuscular
      blockade.Thirty elective obese patients [body mass index (BMI) 30-50 kg/m]
      scheduled for bariatric surgery were enrolled in this study. Sevoflurane was
      inhaled at a concentration of 5% after infusion of 1 mg/kg propofol (within 1
      minute) according to lean body weight. The target concentration of sevoflurane
      was initiated at 2.5% with 0.5% as a step size using a modified Dixon up-and-down
      method. Five minutes after target concentration achieved, the insertion of
      supraglottic airway device was attempted.The minimum alveolar concentration of
      sevoflurane for successful insertion of supraglottic airway device calculated
      using up-and-down method were 2.25 (0.53) % for obese patients. The values of the
      effective concentration of sevoflurane for successful supraglottic airway device 
      insertion in 50% (EC50) and 95% (EC95) of the obese patients obtained by probit
      regression analysis were 2.09% (95% confidence interval 1.48-2.68) and 3.31% (95%
      confidence interval 2.70-8.12), respectively.We conclude that sevoflurane at a
      minimum alveolar concentration of 2.25% can provide optimal conditions for
      insertion of supraglottic airway device with spontaneous respiration in obese
      patients with 1 mg/kg propofol at induction.
CI  - Copyright (c) 2017 The Authors. Published by Wolters Kluwer Health, Inc. All
      rights reserved.
FAU - Wang, Hai-Xia
AU  - Wang HX
AD  - Department of Anesthesiology, Beijing Friendship Hospital, Capital Medical
      University, Beijing, China.
FAU - Miao, Hui-Hui
AU  - Miao HH
FAU - Gao, Xue
AU  - Gao X
FAU - Wei, Wei
AU  - Wei W
FAU - Ding, Guan-Nan
AU  - Ding GN
FAU - Zhang, Ye
AU  - Zhang Y
FAU - Tian, Ming
AU  - Tian M
LA  - eng
PT  - Journal Article
PT  - Observational Study
PL  - United States
TA  - Medicine (Baltimore)
JT  - Medicine
JID - 2985248R
RN  - 0 (Anesthetics, Inhalation)
RN  - 0 (Anesthetics, Intravenous)
RN  - 0 (Methyl Ethers)
RN  - 38LVP0K73A (sevoflurane)
RN  - YI7VU623SF (Propofol)
SB  - AIM
SB  - IM
MH  - Adult
MH  - Airway Management/*methods
MH  - Anesthetics, Inhalation/*administration & dosage/analysis
MH  - Anesthetics, Intravenous/administration & dosage
MH  - Bariatric Surgery
MH  - Dose-Response Relationship, Drug
MH  - Female
MH  - Humans
MH  - Intubation, Intratracheal/*methods
MH  - Male
MH  - Methyl Ethers/*administration & dosage/analysis
MH  - Obesity/*surgery
MH  - Propofol/administration & dosage
MH  - Prospective Studies
MH  - Pulmonary Alveoli/metabolism
PMC - PMC5709021
EDAT- 2018/02/01 06:00
MHDA- 2018/02/08 06:00
CRDT- 2018/02/01 06:00
PHST- 2018/02/01 06:00 [entrez]
PHST- 2018/02/01 06:00 [pubmed]
PHST- 2018/02/08 06:00 [medline]
AID - 10.1097/MD.0000000000008902 [doi]
AID - 00005792-201711270-00113 [pii]
PST - ppublish
SO  - Medicine (Baltimore). 2017 Nov;96(47):e8902. doi: 10.1097/MD.0000000000008902.