ENDOTRACHEAL INTUBATION WITH SEVOFLURANE IN SURGICAL PEDIATRIC PATIENTS: INCREMENTAL VERSUS HIGH CONCENTRATION INHALATION INDUCTION
Keywords:Induction, Intubation time, Sevoflurane, Pediatrics
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.
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.
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.
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