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Humidification reduces coughing and breath-holding during inhalation induction with isoflurane in children
1Department of Anaesthesia, Children's Research Centre, Our Lady's Hospital for Sick Children, Crumlin, Ireland.
Insights
Humidifying isoflurane inhalation during anesthesia induction in children reduces coughing and breath-holding severity. This method also decreases the need for increased oxygen, though it does not impact laryngospasm or oxygen desaturation rates.
Area of Science:
- Anesthesiology
- Pediatric Anesthesia
- Respiratory Care
Background:
- Inhalation induction with isoflurane can cause airway irritation, coughing, and breath-holding, particularly in pediatric patients.
- These respiratory complications can lead to adverse events during anesthesia induction.
Purpose of the Study:
- To investigate whether humidifying isoflurane in oxygen/nitrous oxide mixtures reduces respiratory complications during inhalation induction in children.
- To assess the impact of humidification on hypoxic episodes at induction.
Main Methods:
- A randomized study involving 59 children (3 months to 12 years) undergoing anesthesia induction.
- Participants received either humidified isoflurane (Group A, n=27) or non-humidified isoflurane (Group B, n=32) with 4% isoflurane in 50% oxygen/nitrous oxide.
- Complications like coughing, breath-holding, and laryngospasm were observed and graded for severity.
Main Results:
- Humidified isoflurane significantly reduced the frequency and severity of coughing compared to non-humidified isoflurane (33% vs 53%).
- Severity scores for coughing and breath-holding were lower in the humidified group.
- The need for increased supplemental oxygen (FIO2) was less frequent with humidified isoflurane (4% vs 16%).
Conclusions:
- Humidification of inspired isoflurane effectively mitigates coughing and breath-holding during pediatric anesthesia induction.
- It also reduces the requirement for supplemental oxygen adjustments.
- Humidification did not significantly affect the incidence or severity of laryngospasm or arterial oxygen desaturation.
Purpose:
Inhalation induction using isoflurane is associated with airway irritability, coughing, breath-holding and laryngospasm. These complications are more common in children. This study was designed to determine if humidification of isoflurane in oxygen/nitrous oxide would reduce respiratory complications and hypoxic episodes at induction.
Methods:
Fifty-nine unpremedicated children, aged three months to 12 yr, were enrolled in the study and randomised to receive either humidified isoflurane (n = 27, Group A), or non-humidified isoflurane (n = 32, Group B). All inductions of anaesthesia were with isoflurane 4% in 50% oxygen/nitrous oxide. Subjects were observed for the occurrence of breath-holding, coughing, laryngospasm, bronchospasm, secretions, and hiccoughs. The severity of each complication was graded on a scale of 0-3. The need to administer 100% oxygen and/or succinylcholine was also identified.
Results:
Coughing (33% vs 53%) was more frequent in Group B (P < 0.05). Coughing severity scores (13 vs 36) and breath-holding severity scores (8 vs 19) were also greater in Group B (P < 0.05). A change in FIO2 was required more frequently in Group B (4% vs 16%). Although there was a high incidence of laryngospasm in both groups (52% vs 59%), no other differences were identified, breath-holding (26% vs 31%), secretions (30% vs 31%), hiccough (11% vs 12.5%) (P > 0.05).
Conclusion:
Humidification of inspired isoflurane reduces the frequency and severity of coughing, the severity of breath-holding, and the need to increase supplemental inspired oxygen concentration, when isoflurane is used for inhalation induction of anaesthesia in children. Humidification has no effect, however, on the frequency and severity of laryngospasm, or on the frequency of occurrence of arterial oxygen desaturation.