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Impact of high concentrations of sevoflurane on laryngeal reflex responses

Thomas O Erb1, Britta S von Ungern-Sternberg2,3, Jens Moll1

  • 1Department of Anesthesia, University of Basel Children's Hospital, Basel, Switzerland.

Paediatric Anaesthesia
|February 10, 2017
PubMed

Insights

High sevoflurane concentrations did not fully suppress laryngospasm in children. Laryngeal reflex responses, including laryngospasm, were still observed in 18% of children under 4.7% sevoflurane anesthesia.

Area of Science:

  • Anesthesiology
  • Pediatric Anesthesia
  • Airway Reflexes

Background:

  • Exaggerated upper airway reflexes, like laryngospasm, can cause hypoxemic damage in children.
  • Laryngeal reflex responses are typically reduced with deeper anesthesia, but this is less clear with sevoflurane.
  • High sevoflurane concentrations may impact these reflexes in pediatric patients.

Purpose of the Study:

  • To assess the effect of high sevoflurane concentrations on laryngeal and respiratory reflexes in spontaneously breathing children.
  • To test the hypothesis that high-dose sevoflurane (4.7%) completely suppresses laryngeal reflexes compared to a lower dose (2.5%).

Main Methods:

  • Prospective observational study involving 40 children (3-7 years) undergoing elective surgery.
  • Sevoflurane was administered at 2.5% (1 MAC) and 4.7% (ED95Intubation) in random order, with 5-minute equilibration.
  • Laryngeal stimulation with distilled water under bronchoscopic view assessed reflex responses by a blinded reviewer.

Main Results:

  • Laryngospasm (>10s episodes) occurred in 32% of patients at 2.5% sevoflurane versus 18% at 4.7% sevoflurane (OR 3.5, P=0.18).
  • Other reflex responses (coughing, expiration, panting) were infrequent and similar between concentrations.
  • The incidence of laryngospasm was not statistically significantly reduced at the higher sevoflurane concentration.

Conclusions:

  • Contrary to the hypothesis, laryngospasm was still observed in 18% of children at the higher sevoflurane concentration (4.7%).
  • High concentrations of sevoflurane may not completely abolish laryngeal reflex responses in pediatric patients.
  • Further research is needed to fully understand sevoflurane's effect on airway reflexes in children.
Abstract

Keywords:
anesthesiachildlaryngeal reflexeslaryngospasmrespiratory adverse eventssevoflurane

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