Hostname: page-component-586b7cd67f-rdxmf Total loading time: 0 Render date: 2024-11-23T04:16:26.888Z Has data issue: false hasContentIssue false
  • English
  • Français

Inhalational induction of anaesthesia with 8% sevoflurane in children: conditions for endotracheal intubation and side-effects

Published online by Cambridge University Press:  11 July 2005

F. Wappler ,
D. P. Frings ,
J. Scholz ,
V. Mann ,
C. Koch  and
J. Schulte am Esch
F. Wappler
Affiliation:
University Hospital Hamburg-Eppendorf, Department of Anaesthesiology, Hamburg, Germany
D. P. Frings
Affiliation:
University Hospital Hamburg-Eppendorf, Department of Anaesthesiology, Hamburg, Germany
J. Scholz
Affiliation:
University Hospital Hamburg-Eppendorf, Department of Anaesthesiology, Hamburg, Germany University Hospital, Department of Anaesthesiology, Kiel, Germany
V. Mann
Affiliation:
University Hospital Hamburg-Eppendorf, Department of Anaesthesiology, Hamburg, Germany
C. Koch
Affiliation:
University Hospital Hamburg-Eppendorf, Department of Anaesthesiology, Hamburg, Germany
J. Schulte am Esch
Affiliation:
University Hospital Hamburg-Eppendorf, Department of Anaesthesiology, Hamburg, Germany
Get access

Extract

Summary

Background and objective: This study was designed to assess the conditions for endotracheal intubation or insertion of a laryngeal mask airway following an inhalational induction using 8% sevoflurane and nitrous oxide without the use of muscle relaxants or opioids.

Methods: There were two groups: 30 children had endotracheal intubation and 30 children had a laryngeal mask airway inserted. Induction of anaesthesia was accomplished using an inspiratory concentration of sevoflurane 8% in a nitrous oxide and oxygen mixture. After an end-expiratory concentration of sevoflurane of at least 4% had been reached, when the pupils were miotic and centred, the trachea was intubated or a laryngeal mask inserted. The time to loss of consciousness and successful airway management was recorded. Jaw relaxation, movements, visibility, and position of the vocal cords and vital parameters were monitored.

Results: Jaw relaxation was complete in all children. The vocal cords were completely visible in all patients of the tracheal intubation group, whereas vocal cord relaxation was incomplete in five children. Nevertheless, all children had an atraumatic intubation or insertion of the laryngeal mask without the use of a muscle relaxant. Vital signs were stable in both groups. There were no cases of restlessness and/or postoperative shivering. Four patients in the endotracheal group (13.3%) were nauseous and three (10%) vomited, while two children (6.6%) in the laryngeal mask group experienced nausea and vomiting.

Conclusions: Induction with sevoflurane in nitrous oxide and oxygen leads to fast loss of consciousness and provides ideal conditions for managing the airway without supplemental opioids or muscle relaxants. Furthermore, sevoflurane using this technique was very well tolerated, indicated by high haemodynamic stability and a reduced rate of postoperative restlessness, shivering, nausea and vomiting.

Keywords

AGE GROUPS, childANAESTHETICS, INHALATION, sevofluraneINTUBATION, INTRATRACHEAL, laryngeal masksNEUROMUSCULAR DEPOLARIZING AGENTS, succinylcholine
Type
Original Article
Information
European Journal of Anaesthesiology , Volume 20 , Issue 7 , September 2003 , pp. 548 - 554
Copyright
© 2003 European Society of Anaesthesiology

Access options

Get access to the full version of this content by using one of the access options below. (Log in options will check for institutional or personal access. Content may require purchase if you do not have access.)

References

Magorian T, Flannery KB, Miller RD. Comparison of rocuronium, succinylcholine, and vecuronium, for rapid-sequence induction in adult patients. Anesthesiology 1993; 79: 913–918.Google Scholar
Epstein RH, Mendel HG, Guarnieri KM, Staudt SR, Lessin JB, Marr AT. Sevoflurane versus halothane for general anesthesia in pediatric patients: a comparative study of vital signs, induction, and emergence. J Clin Anesth 1995; 7: 237–244.Google Scholar
Kataria B, Epstein R, Bailey A, et al. A comparison of sevoflurane to halothane in pediatric surgical patients: results of a multicentre study. Paediatr Anaesth 1996; 6: 283–292.Google Scholar
Naito Y, Tamai S, Shingu K, Fujimori R, Mori K. Comparison between sevoflurane and halothane for pediatric ambulatory anaesthesia. Br J Anaesth 1991; 67: 387–389.Google Scholar
Landais A, Saint-Maurice C, Hamza J, Robichon J, McGee K. Sevoflurane elimination kinetics in children. Paediatr Anaesth 1995; 5: 297–301.Google Scholar
Johannesson GP, Floren M, Lindahl SG. Sevoflurane for ENT-surgery in children. A comparison with halothane. Acta Anaesthesiol Scand 1995; 39: 546–550.Google Scholar
Greenspun JC, Hannallah RS, Welborn LG, Norden JM. Comparison of sevoflurane and halothane anesthesia in children undergoing outpatient ear, nose ant throat surgery. J Clin Anesth 1995; 7: 398–402.Google Scholar
Gronert GA. Cardiac arrest after succinylcholine: mortality greater with rhabdomyolysis than receptor upregulation. Anesthesiology 2001; 94: 523–529.Google Scholar
Helbo-Hansen S, Ravlo O, Trap-Anderson S. The influence of alfentanil on the intubation conditions after priming with vecuronium. Acta Anaesth Scand 1988; 32: 41–44.Google Scholar
Epstein RH, Stein AL, Marr AT, Lessin JB. High concentration versus incremental induction of anesthesia with sevoflurane in children: a comparison of induction times, vital signs and complications. J Clin Anesth 1998; 10: 41–45.Google Scholar
O'Brien K, Kumar R, Morton NS. Sevoflurane compared with halothane for tracheal intubation in children. Br J Anaesth 1998; 80: 452–455.Google Scholar
Piat V, Dubois MC, Johanet S, Murat I. Induction and recovery characteristics and hemodynamic responses to sevoflurane and halothane in children. Anesth Analg 1994; 79: 840–844.Google Scholar
Yurino M, Kimura H. Vital capacity rapid inhalation induction technique: comparison of sevoflurane and halothane. Can J Anaesth 1993; 40: 440–443.Google Scholar
Haga S, Shima T, Momose K, Andoh K, Hashimoto Y. Anesthetic induction of children with high concentrations of sevoflurane. Masui 1992; 41: 1951–1955.Google Scholar
Inomata S, Nishikawa T. Determination of endtidal sevoflurane concentration for tracheal intubation in children with the rapid method. Can J Anesth 1996; 43: 806–811.Google Scholar
Baum VC, Yemen TA, Baum LD. Immediate 8% sevoflurane induction in children: a comparison with incremental sevoflurane and incremental halothane. Anesth Analg 1997; 85: 313–316.Google Scholar
Aldrete JA, Kroulik D. A postanesthetic recovery score. Anesth Analg 1970; 49: 924–934.Google Scholar
Sarner JB, Levine M, Davis PJ, Lerman J, Cook DR, Motoyama EK. Clinical characteristics of sevoflurane in children. A comparison with halothane. Anesthesiology 1995; 82: 38–46.Google Scholar
Green DH, Townsend P, Bagshaw O, Stokes MA. Nodal rhythm and bradycardia during inhalation induction with sevoflurane in infants: a comparison of incremental and high-concentration techniques. Br J Anaesth 2000; 85: 368–370.Google Scholar
Uezono S, Goto T, Terui K, et al. Emergence agitation after sevoflurane versus propofol in pediatric patients. Anesth Analg 2000; 91: 563–566.Google Scholar
Wells LT, Rasch DK. Emergence ‘delirium’ after sevoflurane anesthesia: a paranoid delusion? Anesth Analg 1999; 88: 1308–1310.Google Scholar
Shirato M, Uezono S, Terui K, Goto T, Morita S. A randomized crossover comparison of sevoflurane and propofol on recovery characteristics in children. Anesthesiology 1999; 91 (Suppl): A1298.Google Scholar
Aono J, Mamiya K, Manabe M. Preoperative anxiety is associated with a high incidence of problematic behavior on emergence after halothane anaesthesia in boys. Acta Anaesthesiol Scand 1999; 43: 542–544.Google Scholar
Scholz J. Sevoflurane in child anaesthesia. Anaesthesist 1998; 47 (Suppl): S43–S48.Google Scholar
Sury MR, Black A, Hemington L, Howard R, Hatch DJ, Mackersie A. A comparison of the recovery characteristics of sevoflurane and halothane in children. Anaesthesia 1996; 51: 543–546.Google Scholar
Beskow A, Westrin P. Sevoflurane causes more postoperative agitation in children than does halothane. Acta Anaesthesiol Scand 1999; 43: 536–541.Google Scholar
Davis PJ, Greenberg JA, Gendelman M, Fertal K. Recovery characteristics of sevoflurane and halothane in preschool-aged children undergoing bilateral myringotomy and pressure equalization insertion. Anesth Analg 1999; 88: 34–38.Google Scholar
Motsch J, Bock M, Kunz P, Böttiger BW, Martin E. Clonidine prevents delirs after sevoflurane. Anesthesiology 1999; 91 (Suppl): A1261.Google Scholar