Sevoflurane and isoflurane reduce oxygen saturation in infants

Volatile anesthetics are generally known to exert several influences on the respiratory system, but their direct effect on oxygen saturation as measured by pulse oximetry (SpO2) in infants remains unknown. In this study, 70 infants under 2 years of age who received general anesthesia were examined to determine the effects of several volatile anesthetics and nitrous oxide on SpO2. After endotracheal intubation, the subjects were ventilated using a Jackson-Rees circuit with oxygen, nitrous oxide, and either sevoflurane, enflurane, or isoflurane adjusted to twice the adult minimum alveolar concentration (MAC) for the agents when used in combination with 67% nitrous oxide. In all cases, the end-tidal carbon dioxide tension (PetCO2) was maintained within the same range (28-35 mm Hg). Significantly lower SpO2 values (paired t test, P < .05) were observed when the subjects were ventilated with oxygen, 67% nitrous oxide, and sevoflurane or isoflurane--but not with oxygen, 67% nitrous oxide, and enflurane--than when they were administered oxygen, 50% nitrous oxide, and the original concentration of each volatile anesthetic. These results suggest that sevoflurane and isoflurane have different effects from enflurane on gas exchange systems.