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Single-breath vital capacity rapid inhalation induction in children: 8% sevoflurane versus 5% halothane
R C Agnor1, N Sikich, J Lerman
1Department of Anaesthesia and Research Institute, The Hospital for Sick Children, University of Toronto, Ontario, Canada.
Insights
Sevoflurane anesthesia induction in children is faster and safer than halothane. Single-breath vital capacity induction with sevoflurane, with or without nitrous oxide, offers improved speed and fewer adverse events compared to halothane.
Area of Science:
- Anesthesiology
- Pediatric Anesthesia
- Pharmacology
Background:
- Comparing anesthetic induction speeds is crucial for pediatric patient care.
- Single-breath vital capacity induction offers a rapid method for administering inhaled anesthetics.
- Sevoflurane and halothane are commonly used inhaled anesthetics in pediatric populations.
Purpose of the Study:
- To compare the speed of anesthesia induction using sevoflurane versus halothane in children.
- To evaluate the safety profile, including movement and dysrhythmias, of sevoflurane compared to halothane during induction.
- To assess the efficacy of single-breath vital capacity induction with sevoflurane in a pediatric cohort.
Main Methods:
- 51 healthy children aged 5-12 years were randomized into three groups.
- Participants inhaled a single breath of either sevoflurane with nitrous oxide, sevoflurane with oxygen, or halothane with nitrous oxide.
- An independent observer recorded times to loss of eyelash reflex, return of gaze, airway reflexes, movement, and hemodynamic responses.
Main Results:
- Induction was significantly faster with sevoflurane (34-38 seconds) compared to halothane (58 seconds) (P < 0.01).
- Fewer instances of involuntary movement occurred with sevoflurane anesthesia (P < 0.05).
- The incidence of dysrhythmias was lower in the sevoflurane groups compared to the halothane group (P < 0.01).
Conclusions:
- Single-breath vital capacity induction with sevoflurane is more rapid than with halothane in children.
- Sevoflurane induction is associated with a lower incidence of movement and dysrhythmias compared to halothane.
- Sevoflurane represents a potentially safer and more efficient anesthetic option for pediatric induction.
Background:
The authors compared the speed of induction of anesthesia with sevoflurane with and without nitrous oxide with the speed of halothane and nitrous oxide using a single-breath vital capacity induction.
Methods:
With informed parental consent, 51 healthy unpremedicated children aged 5-12 yr were randomized to inhale a single breath of one of three gas mixtures: 8% sevoflurane in 66% nitrous oxide, 8% sevoflurane in oxygen, or 5% halothane in 66% nitrous oxide. A blinded observer recorded the times to loss of the eyelash reflex, return of conjugate gaze, the presence of airway reflex responses, involuntary movement, and hemodynamic responses.
Results:
Forty-two children completed the study. The times (mean +/- SD) to loss of the eyelash reflex with sevoflurane/nitrous oxide, 38+/-8 s, and for sevoflurane-oxygen, 34+/-12 s, were less than that with halothane-nitrous oxide, 58+/-17 s (P < 0.01). Movement occurred less frequently during sevoflurane than during halothane anesthesia (P < 0.05). The times to return of conjugate gaze and the incidence of airway reflex responses were similar among the groups. The incidence of dysrhythmias in the sevoflurane groups was less than that in the halothane group (P < 0.01).
Conclusions:
Induction of anesthesia with a single breath of 8% sevoflurane with or without 66% nitrous oxide is more rapid than with 5% inspired halothane with 66% nitrous oxide in children. The incidence of movement and dysrhythmias during a single-breath induction with sevoflurane are less than they are with halothane.