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jsmc-10115


ENDOTRACHEAL INTUBATION WITH SEVOFLURANE IN SURGICAL PEDIATRIC PATIENTS: INCREMENTAL VERSUS HIGH CONCENTRATION INHALATION INDUCTION 

Amir Murad Khudadad Boujan a and Dara Ahmed Hassan b 


a  Department of Surgery, College of Medicine, University of Sulaimani. 
b Teaching Hospital, Sulaimani City. 


Submitted: 13/2/2017; Accepted: 1/8/2017; Published: 15/8/2017

ABSTRACT

Background

Sevoflurane is a preferred anesthetic agent for induction and maintenance of pediatric anesthesia. Many studies have been undertaken to show the optimal technique of induction with sevoflurane. In this study we compare the optimal time needed for successful tracheal intubation with immediate high concentration sevoflurane and incremental sevoflurane induction in surgical pediatric patients.

Patients and Methods

With the approval of the Research Scientific and Ethic Committee of the School of Medicine at Sulaimani University at 18th of May 2011, and the informed written consent from the parents, we studied 100 patients of ASA (American Society of Anesthesiologists) physical status І and II elective pediatric surgical patients aged 2-7 years, patients admitted to Sulaimani Teaching Hospital at the Otorhinolaryngology, Head and Neck Surgical Department, from the first of June 2011 to the first of September 2011. Sevoflurane has been used for induction in children who were scheduled for elective adenotonsillectomy operations. Patients were randomly divided into two equal groups, group 1 (G1) 50 patients, using incremental induction with sevoflurane (1-8 %) in 100% O2, the vapor concentration is increased by 1% every few breaths, and group 2 (G2) 50 patients, using high concentration of sevoflurane for induction, (8%) in 100% O2 from the beginning of induction. Intubation is done when the pupils are miotic and centered, after establishing a good muscle relaxation with no movements in response to laryngoscopy and tracheal intubation. The time from induction to successful tracheal intubation is recorded.

Results

We have found that the mean time for tracheal tube insertion was shorter in (G2) 208.4 seconds ± 44.5 (SD), than (G1) 265.8 seconds ± 44.4 (SD), and this was statistically significant with a P value of less than 0.001, Vital signs were stable in both groups.

Conclusion

In healthy pediatric patients undergoing mask induction of general anesthesia with sevoflurane, the induction time can be significantly shortened using a high concentration compared with a conventional, incremental induction method.
KEYWORDS

Induction, Intubation time, Sevoflurane, Pediatrics.
References

1. James Duke, Pediatric Anesthesia, Anesthesia Secrets, Philadelphia 2011, Fourth Edition, Chapter 57, Page 396.

2. J K Aronson, General Anesthetics, Meyler’s Side Effects of Drugs Used in Anesthesia, Oxford Elsevier B.V, 2009, Page 4.

3. Barash, PG, Cullen BF, Stoeling RK, Inhalation Anesthesia, Pediatric Anesthesia, Clinical Anesthesia, Connecticut, Lippincott Williams & Wilkins, 2006, 5th Edition Chapter 15, Page 385, Chapter 44, Page1210, Chapter 15, Page 386-387, Page 389-391.

4. Morgan GE, Mikhail MS, Murray MJ, Chapter 44, Pediatric Anesthesia; Clinical Anesthesiology, Medical Publishing Division, New York 2006, 4th Edition, Page 934-935.

5. Aitkenhead AR, Rowbotham DJ, Smith G, The practical conduct of anesthesia, D.Fell, Pediatric Anesthesia and Intensive Care Unit, E. de Melo, Textbook of Anesthesia, Harcourt publication, Philadelphia, 2002, 4th Edition, Chapter 37; Page 460-461, Chapter 53, Page 659.

6. Martin Johr, Anaesthesia for tonsillectomy, Current Opinion in Anaesthesiology, 2006, 19:260–261.

7. Chawathe M, Zatman T, Hall JE, Gildersleve C, Jones RM, Wilkes AR et al, Sevoflurane (12% and 8%) Inhalational Induction In Children, Paediatric Anesthesia, 2006 May; 16(5):601-2.

8. Inomata S, Yamashita S, Toyooka H, Yaghuchi Y, Taghuchi M, Sato S, Anaesthetic induction time for tracheal intubation using sevoflurane or halothane in children. Anesthesia, 1998; 53:440–5.

9.Politis GD, Tobin JR, Morell RC, James RL, Cantwellet MF, Tracheal intubation of healthy pediatric patients without muscle relaxant: a survey of technique utilization and perceptions of safety. Anesthesia Analgesia, 1999; 88:737–41.

10. Shruti R, Jalwal GK, Saxena M, Shrivastava OP, A comparative study of induction, maintenance and recovery characteristics of sevoflurane and halothane anaesthesia in pediatric patients (6 months to 6 years), Anaesthesiology Clinical Pharmacology, 2010 Oct-Dec; 26(4): 484–487.

11. Blair JM, Hill DA, Wilson CM, Fee JP, Tracheal intubating conditions after induction with sevoflurane 8% in children, Anaesthesia 2000; 55: 774–8.

12. Fenlon S, Pearce A, Sevoflurane induction and difficult airway management, Anaesthesia 1997; 52: 285–6.

13. Epstein RH, Stein AL, Marr AT, Lessin JB, High concentration versus incremental induction of anesthesia with sevoflurane in children: a comparison of induction times, vital signs, and complications, clinical Anethesia, 1998 Feb; 10(1):41-5.

14. Victor C. Baum, Terrence A. Yemen, Lora D. Baum, Immediate 8% Sevoflurane Induction in Children: A Comparison with Incremental Sevoflurane and Incremental Halothane, Anesthesia Analgesia, 1997; 85:313)

15.Dubois MC, Piat V, Constant I, Lamblin O, Murat I, Comparison of three techniques for induction of Anaesthesia with sevoflurane in children, Paediatric Anaesthesia, 1999; 9(1):19-23.


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