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Propofol or halothane anaesthesia for children with asthma: effects on respiratory mechanics
W Habre1, I Matsumoto, P D Sly
1Division of Clinical Sciences, Princess Margaret Hospital for Children, Perth, Australia.
Insights
Propofol anesthesia is safe for children with asthma, showing comparable respiratory mechanics to healthy children. Lung function remains stable, indicating propofol
Area of Science:
- Anesthesiology
- Pediatric Pulmonology
Background:
- Propofol may affect airway tone and reactivity, but its safety in pediatric asthmatics is not well-documented.
- Limited data exists on propofol's impact on lung function in children with asthma.
Purpose of the Study:
- To compare respiratory mechanics in asthmatic and non-asthmatic children under propofol anesthesia.
- To evaluate the effects of propofol and subsequent halothane administration on lung function in pediatric patients.
Main Methods:
- Sixty children (aged 2-12 years) with or without asthma underwent anesthesia induced with propofol, fentanyl, and atracurium.
- Respiratory mechanics, including dynamic compliance (Crs,dyn) and respiratory system resistance (Rrs), were measured using a single-compartment model.
- Halothane was administered at 1 MAC, and its effects on respiratory parameters were assessed.
Main Results:
- Respiratory mechanics (Rrs and Crs,dyn) were comparable between normal and asthmatic children during propofol anesthesia.
- Halothane administration resulted in minimal, clinically insignificant changes in respiratory system resistance and tidal volume in both groups.
- No significant changes in dynamic compliance were observed after halothane administration.
Conclusions:
- Propofol anesthesia demonstrates comparable respiratory mechanics in children with and without asthma.
- The use of propofol appears safe for maintaining lung function in pediatric asthmatic patients.
- Subsequent halothane administration causes minimal, non-clinically relevant alterations in respiratory mechanics.
Abstract:
Propofol may cause histamine release and alter airway tone and reactivity. Although its use has been reported to be safe in asthmatics, there is a lack of information on its effect on lung function in children with asthma. We measured respiratory mechanics after i.v. or inhalation anaesthesia in 60 children, aged 2-12 yr, with or without asthma. Anaesthesia was induced with propofol 3 mg kg-1, fentanyl 1 microgram kg-1 and atracurium 0.5 mg kg-1 and maintained with an infusion of propofol 10 mg kg-1h-1 and 50% nitrous oxide in oxygen. Halothane was administered subsequently at a concentration of 1 MAC. Respiratory mechanics were measured by applying a single-compartment model using multi-linear regression analysis to calculate dynamic compliance (Crs,dyn) and respiratory system resistance (Rrs), based on: Pao = V/Crs,dyn + V Rrs + PA,EE, where Pao = airway opening pressure, PA,EE = alveolar pressure, V = volume and V = flow. The two groups were comparable in age, weight and ventilation variables (tidal volume and peak pressure). Respiratory mechanics during propofol anaesthesia were comparable in normal and asthmatic children (Rrs = 20.5 X 10(-4) (SD 5.2 X 10(-4)) vs 21.5 X 10(-4) (5.7 X 10(-4)) kPa ml-1 S-1 (ns) and Crs,dyn = 247.5 (76.51 vs 235.1 (63.8) ml kPa-1 (ns)). Halothane produced a minimal decrease in Rrs and a minimal increase in tidal volume in both groups without changes in Crs,dyn. In conclusion, respiratory mechanics were comparable after propofol anaesthesia in both children with and without asthma. Changes in Rrs after halothane administration were not clinically relevant.