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1-1-12 one-step wash-in scheme for desflurane-nitrous oxide low-flow anesthesia: rapid and predictable induction
Thepakorn Sathitkarnmanee1, Sirirat Tribuddharat1, Chakthip Suttinarakorn1
1Department of Anesthesiology, Faculty of Medicine, Khon Kaen University, Khon Kaen 40002, Thailand.
Background:
We propose a 1-1-12 wash-in scheme for desflurane-nitrous oxide (N2O) low-flow anesthesia. The objective of our study was to determine the time to achieve alveolar concentration of desflurane (FAD) at 1, 2, 3, 4, 5, and 6%.
Methods:
We enrolled 106 patients scheduled for elective surgery under general anesthesia. After induction and intubation, wash-in was started with a fresh gas flow (FGF) of N2O : O2 1 : 1 L min(-1) and vaporizer concentration of desflurane (FD) of 12%. Ventilation was controlled to maintain PACO2 at 30-35 mmHg.
Results:
The FAD rose rapidly from 0 to 4% in 2 min in a linear manner in 0.5 min increments. An FAD of 6% was achieved in 4 min in a linear fashion from FAD of 4% but in 1 min increments. An FAD of 1 to 6% occurred at 0.6, 1, 1.5, 2, 3, and 4 min. Heart rate during wash-in showed a statistically, albeit not clinically, significant pattern of increase. By contrast, blood pressure slightly decreased during this period.
Conclusions:
We developed a 1-1-12 wash-in scheme using a FGF of N2O : O2 1 : 1 L min(-1) and FD of 12% for desflurane-nitrous oxide low-flow anesthesia. A respective FAD of 1, 2, 3, 4, 5, and 6% can be expected at 0.6, 1, 1.5, 2, 3, and 4 min.
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