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Isoflurane anesthesia in children aged 1-10 preserved hemodynamic parameters better than halothane. Isoflurane also provided faster, deeper, and longer muscle relaxation, though it depressed spontaneous respiration.
Area of Science:
- Pediatric Anesthesiology
- Pharmacology
Background:
- Halothane has been a standard anesthetic agent for pediatric patients.
- Isoflurane offers potential advantages in hemodynamic stability and muscle relaxation.
Purpose of the Study:
- To compare the effects of isoflurane (I) versus halothane (H) anesthesia on hemodynamic parameters, spontaneous respiration, and neuromuscular blockade in children.
- To evaluate the dose-dependent effects of vecuronium bromide on muscle relaxation under isoflurane and halothane anesthesia.
Main Methods:
- Seventy pediatric patients (1-10 years) received isoflurane or halothane anesthesia (O2:N2O = 1:3).
- Hemodynamic parameters, respiratory function (respiratory rate, minute volume, end-tidal CO2, pCO2), and airway pressures were monitored.
- Neuromuscular blockade was assessed using the train-of-four (TOF) method with varying doses of vecuronium bromide.
Main Results:
- Isoflurane maintained hemodynamic parameters well, with increased pulse rate and decreased diastolic pressure due to vasodilation. Baroreceptor reflexes appeared more functional under isoflurane.
- Spontaneous respiration was depressed by isoflurane, leading to CO2 accumulation. Younger children experienced more airway issues with isoflurane compared to halothane.
- Isoflurane resulted in a faster onset, more profound, and longer duration of muscle relaxation with vecuronium bromide compared to halothane, with statistically significant differences.
Conclusions:
- Isoflurane is a viable anesthetic agent for pediatric patients, offering stable hemodynamics and effective muscle relaxation.
- Careful monitoring of spontaneous respiration and airway pressures is crucial when using isoflurane in younger children.
- Isoflurane enhances the effects of neuromuscular blocking agents like vecuronium bromide in pediatric anesthesia.
Abstract:
Seventy patients 1-10 years of age were submitted to isoflurane (I) or halothane (H) anaesthesia (O2:N2O = 1:3); H was used as a reference substance. Under I anaesthesia, haemodynamic parameters proved to be well preserved. While the pulse rate under I increased significantly, the diastolic pressure decreased as a result of peripheral vascular dilatation. Baroceptor reflexes seemed to function more properly under the effect of I. Spontaneous respiration was definitely depressed by I. Respiratory rate, minute volume, end-expiratory CO2 and pCO2 values indicated CO2 accumulation. Younger children breathing spontaneously were subject to airway problems in I more than in H anaesthesia by decreasing negative occlusion pressures. Increasing doses of vecuronium bromide (5, 10, 15 and 70 micrograms/kg body wt.) accomplished muscular relaxation of various degrees, as tested by the train-of-four (TOF) method. The use of I in two age groups resulted in faster onset, more profound muscular relaxation, and longer duration in comparison with H; these results were statistically significant.