title: Immediate 8% sevoflurane induction in children: a comparison with incremental sevoflurane and incremental halothane.
abstract: We compared the efficacy and tolerance of pediatric inductions with immediate 8% sevoflurane in 70% nitrous oxide with either incremental sevoflurane or incremental halothane in 70% nitrous oxide. Forty-six unpremedicated children had anesthesia induced by immediate 8% sevoflurane (high sevoflurane [HS]; circuit primed with 70% N2O and 8% sevoflurane before application of the face mask), gradual sevoflurane (GS; primed with 70% N2O with increments of sevoflurane), and gradual halothane (HAL; 70% N2O with incremental halothane). Blind video recordings were made, and each child's distress was rated prior to mask application, during mask application, and every 10 s thereafter using a behavioral rating scale. There were no complications. Of those subjects not quiet and cooperative throughout, times to complete quiet were significantly different (P = 0.001): HS 19.8 +/- 8 s (range 9-34); GS 52 +/- 17 s (range 8-73); HAL 43 +/- 22 s (range 13-73). Times to eye closure were also significantly different (P < 0.001): HS 37 +/- 10 s (range 15-56); GS 70 +/- 18 s (range 35-114); HAL 81 +/- 34 s (range 55-140). Distress scale scores showed more rapid decrement with HS than with GS or HAL. We conclude that 1) immediate 8% sevoflurane/N2O results in a significantly faster induction than GS or HAL;2) in children, HS in N2O will not result in a single-breath induction under the conditions of this study; 3) in this small group, HS was extremely well tolerated in ASA class I and II patients.
authors.affiliation: Department of Anesthesiology, University of Virginia, Charlottesville 22908, USA.
authors.forename: V C
authors.initials: VC
authors.lastname: Baum
authors.forename: T A
authors.initials: TA
authors.lastname: Yemen
authors.forename: L D
authors.initials: LD
authors.lastname: Baum
mesh_terms: D000764:Anesthesia, Closed-Circuit; D000769:Anesthesia, Inhalation; D018685:Anesthetics, Inhalation / Q000008:administration & dosage*; D002648:Child; D002652:Child Behavior / Q000187:drug effects; D002675:Child, Preschool; D003299:Cooperative Behavior; D004987:Ethers / Q000008:administration & dosage*; D005260:Female; D006221:Halothane / Q000009:adverse effects*; D006801:Humans; D007223:Infant; D008297:Male; D008397:Masks; D008738:Methyl Ethers; D009609:Nitrous Oxide / Q000008:administration & dosage; D000077149:Sevoflurane; D016037:Single-Blind Method; D013312:Stress, Physiological / Q000503:physiopathology; D013997:Time Factors; D014741:Video Recording
chemical_list: D018685:Anesthetics, Inhalation; D004987:Ethers; D008738:Methyl Ethers; D000077149:Sevoflurane; D009609:Nitrous Oxide; D006221:Halothane