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Immediate 8% sevoflurane induction in children: a comparison with incremental sevoflurane and incremental halothane

V C Baum1, T A Yemen, L D Baum

  • 1Department of Anesthesiology, University of Virginia, Charlottesville 22908, USA.

Anesthesia and Analgesia
|August 1, 1997
PubMed

Insights

Immediate 8% sevoflurane in nitrous oxide offers faster pediatric anesthesia induction than gradual sevoflurane or halothane. This method was well-tolerated, though not a single-breath induction in children.

Area of Science:

  • Anesthesiology
  • Pediatric Medicine
  • Pharmacology

Background:

  • Pediatric anesthesia induction requires careful consideration of efficacy and patient tolerance.
  • Sevoflurane and halothane are common inhalation agents used in pediatric anesthesia.
  • Optimizing induction techniques is crucial for minimizing patient distress and improving safety.

Purpose of the Study:

  • To compare the efficacy and tolerance of pediatric anesthesia induction using immediate high-concentration sevoflurane versus incremental sevoflurane or halothane.
  • To evaluate the speed of induction and patient distress levels associated with different sevoflurane and halothane administration methods.

Main Methods:

  • Forty-six unpremedicated children received anesthesia induction via three methods: immediate 8% sevoflurane/70% nitrous oxide (HS), gradual sevoflurane/70% nitrous oxide (GS), or gradual halothane/70% nitrous oxide (HAL).
  • Anesthesia induction was video-recorded, and behavioral distress was assessed using a validated rating scale.
  • Times to complete quietness and eye closure were measured as primary efficacy endpoints.

Main Results:

  • Immediate high sevoflurane (HS) resulted in significantly faster times to quietness (19.8 s) compared to gradual sevoflurane (GS; 52 s) and halothane (HAL; 43 s) (P = 0.001).
  • Times to eye closure were also significantly shorter with HS (37 s) versus GS (70 s) and HAL (81 s) (P < 0.001).
  • Distress scores indicated a more rapid decrease in distress with HS, and the method was well-tolerated in ASA class I and II patients.

Conclusions:

  • Immediate 8% sevoflurane in 70% nitrous oxide provides a significantly faster and well-tolerated anesthesia induction in children compared to gradual sevoflurane or halothane.
  • While faster, immediate high sevoflurane did not achieve a single-breath induction under the study conditions.
  • The findings support the use of immediate high sevoflurane for efficient and safe pediatric anesthesia induction.

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