Abstract
In 48 randomly assigned ASA I adult patients undergoing elective orthopaedic procedures, we compared the pharmacodynamics of desflurane (DF) and isoflurane (IF), and their pharmacokinetics during rapid induction of deep anaesthesia (via face mask, to 1.5–2 MAC, after thiopentone), maintenance of anaesthesia at 1.25 MAC, and emergence therefrom. During induction, laryngeal reactions ranging from mild crowing to laryngospasm occurred more frequently with DF than with IF (15/24 DF, 5/24 IF; P < 0.05) and was more severe (9/ 24 DF, 1/24 IF, excluding the mildest form, P < 0.05). As a result, induction of anaesthesia was not accomplished faster with DF, in spite of a faster equilibration between exhaled and inhaled concentrations. Emergence from DF was more rapid and less complicated by delirium. Pharmacokinetically, the exhaled concentration of DF reached 90% of the inhaled concentration within five minutes of induction, whereas that of IF lagged behind and remained 25% below the inhaled concentration (1 vs 1.34 ± 0.05) even one hour after induction. Premature ventricular contractions did not occur in any patient even during periods of difficulty with the airway and oxygen desaturation. It is concluded that DF is a safe anaesthetic, pharmacokinetically superior to IF but clinically inferior for induction of anaesthesia via a face mask. Because of the fast equilibration, the exhaled concentration of DF can be controlled more precisely by the dial setting of the vaporiser.
Résumé
Quarante-huit adultes ASA I soumis à une chirurgie orthopédique programmée ont été aleatoirement choisis pour comparer la pharmacodynamique du desflurane (DF) en de l’isoflurane (IF), et leur pharmacocinétique au cours de l’induction rapide d’une anesthésie profonde (par un masque facial, à 1,5–2 MAC, après thiopental), au cours de l’entretien de l’anesthésie à 1,25 MAC, et ensuite au cours du réveil. Pendant l’induction, des réactions laryngées allant du léger stridor au laryngospasme se sont manifestées plus fréquemment avec DF qu’avec IF (15/ 24 DF, 5/24 IF, P < 0,05). L’induction de l’anesthésie n’a pas été réalisée plus vite avec DF, malgré l’équilibration plus rapide entre les concentrations expirées et inspirées. Le réveil après DF a été plus rapide et a présenté moins de confusion. Pharmacocinétiquement, la concentration expirée du DF a atteint 90% de la concentration inspirée dans les cinq minutes de l’induction, tandis que celle de l’IFest restée plus stationnaire et s’est maintenue à 25% sous la concentration inspirée (1 versus 1,34 ± 0,05) même heure après l’induction. Aucune extrasystole ventriculaire ne s’est produite chez les patients, même pendant des épisodes difficiles de maintien de l’airway et de désaturation artérielle. On en conclut que DF et un agent anesthésique sûr, pharmacocinétiquement supérieur à l’IF mais cliniquement inférieur pour l’induction de l’anesthésie par un masque facial. Grâce à une équilibration rapide, la concentration expirée de DF peutêtre contrôlée plus précisément par l’ajustement du contrôle du vaporisateur.
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Lee, C., Kwan, WF., Tsai, SK. et al. A clinical assessment of desflurane anaesthesia and comparison with isoflurane. Can J Anaesth 40, 487–494 (1993). https://doi.org/10.1007/BF03009728
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DOI: https://doi.org/10.1007/BF03009728