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Respiratory mechanics during sevoflurane anesthesia in children with and without asthma
1Division of Anaesthesia, Geneva Children's Hospital, Geneva, Switzerland. Walid.Habre@hcuge.ch
Insights
Sevoflurane anesthesia with tracheal intubation increased respiratory system resistance (Rrs) in children with asthma, but not in healthy children. This finding is important for managing pediatric anesthesia.
Area of Science:
- Pediatric Anesthesiology
- Respiratory Mechanics
- Asthma Management
Background:
- Sevoflurane is increasingly used for tracheal intubation in children.
- Understanding its effects on respiratory mechanics in asthmatic children is crucial.
Purpose of the Study:
- To investigate the impact of sevoflurane anesthesia and endotracheal intubation on lung function in children with and without asthma.
- To compare respiratory system resistance (Rrs) and compliance between asthmatic and non-asthmatic children.
Main Methods:
- Lung function was assessed in 44 children (22 asthmatics, 22 controls) under sevoflurane anesthesia.
- Measurements included airway pressure and flow before and after endotracheal intubation.
- Respiratory system resistance (Rrs) and compliance were calculated.
Main Results:
- Endotracheal intubation significantly increased Rrs in asthmatic children (17% +/- 49%) but decreased it slightly in normal children (-4% +/- 39%).
- Higher sevoflurane concentrations (4.2%) led to a slight Rrs decrease in both groups.
- No significant changes in compliance were observed, and no adverse events occurred.
Conclusions:
- Tracheal intubation with sevoflurane anesthesia increases Rrs in children with mild to moderate asthma.
- Sevoflurane appears safe for intubation in this population, but careful monitoring of respiratory mechanics is advised for asthmatic children.
Unlabelled:
We studied lung function in children with and without asthma receiving anesthesia with sevoflurane. Fifty-two children had anesthesia induced with sevoflurane (up to 8%) in a mixture of 50% nitrous oxide in oxygen and then maintained at 3% with children breathing spontaneously via face mask and Jackson-Rees modification of the T-piece. Airway opening pressure and flow were then measured. After insertion of an oral endotracheal tube under 5% sevoflurane, measurements were repeated at 3%, as well as after increasing to 4.2%. Respiratory system resistance (Rrs) and compliance during expiration were calculated using multilinear regression analysis of airway opening pressure and flow, assuming a single-compartment model. Data from 44 children were analyzed (22 asthmatics and 22 normal children). The two groups were comparable with respect to age, weight, ventilation variables, and baseline respiratory mechanics. Intubation was associated with a significant increase in Rrs in asthmatics (17% +/- 49%), whereas in normal children, Rrs slightly decreased (-4% +/- 39%). At 4.2%, Rrs decreased slightly in both groups with almost no change in compliance system resistance. We concluded that in children with mild to moderate asthma, endotracheal intubation during sevoflurane anesthesia was associated with increase in Rrs that was not seen in nonasthmatic children.
Implications:
Tracheal intubation using sevoflurane as sole anesthetic is possible and its frequency is increasing. When comparing children with and without asthma, tracheal intubation under sevoflurane was associated with an increase in respiratory system resistance in asthmatic children. However, no apparent clinical adverse event was observed.