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[Comparison of airway complications on tracheal extubation in deeply sevoflurane anesthetized versus awake children]
T Goyagi1, S Kihara, I Harukuni
1Department of Anesthesia, Oyama Citizen's Hospital.
Insights
Extubating children deeply anesthetized with sevoflurane showed similar respiratory complications compared to awake extubation. However, the anesthetized group had more airway obstruction but less coughing and breath-holding.
Area of Science:
- Pediatric Anesthesiology
- Respiratory Medicine
Background:
- Emergence from sevoflurane anesthesia involves risks of respiratory complications.
- Tracheal extubation timing (anesthetized vs. awake) may influence these risks in children.
Purpose of the Study:
- To compare respiratory complications and oxygen saturation during sevoflurane emergence between deeply anesthetized and awake tracheal extubation in children.
Main Methods:
- Thirty children (1-10 years) undergoing sevoflurane anesthesia were randomized into deeply anesthetized or awake extubation groups.
- Respiratory complications and oxygen saturation were monitored during emergence.
Main Results:
- No significant differences in overall respiratory complications (apnea, laryngospasm, bronchospasm, arrhythmias) between groups.
- The deeply anesthetized group had higher incidence of airway obstruction but lower incidence of cough and breath-holding.
- Oxygen saturation levels remained comparable before and after extubation in both groups.
Conclusions:
- Deep sevoflurane anesthesia extubation in children is feasible with comparable respiratory complication rates to awake extubation.
- Careful monitoring for airway obstruction is crucial when extubating deeply anesthetized children.
Abstract:
We investigated the incidence of respiratory complications and oxygen saturation level during emergence from sevoflurane anesthesia in children whose tracheas were extubated while they were anesthetized or after they became awake. Thirty children, aged 1-10 years, were studied. Anesthesia was induced with sevoflurane or thiopental and maintained with nitrous oxide, oxygen and sevoflurane. After nitrous oxide was discontinued at the end of surgery, the patients were randomly assigned to two groups: deeply anesthetized extubation group (anesthetized group) and awake extubation group (awake group). In anesthetized group, the patients were extubated while they were administered 1.5% or higher sevoflurane in 100% oxygen. In awake group, extubation was performed while the patients were awake. The incidence of respiratory complications such as apnea, laryngospasm, bronchospasm and arrythmias was not significantly different between the two groups. There was a significantly higher incidence of the airway obstruction but less incidence of cough and breath-holding in anesthetized group. Oxygen saturation level before and after tracheal extubation was not different between the two groups. In conclusion, with proper attention to airway obstruction, it may be possible to extubate while children are deeply anesthetized with sevoflurane.