title: Inhalational induction with "vasoparalytic" sevoflurane: are we "hyperoxygenating" while anesthetizing developing brains? A case series discussion.
abstract: BACKGROUND
  The concerns for hyperoxia-related brain tissue injury are well known to the medical community. The cerebro-vasodilatory properties of sevoflurane may create relative cerebral tissue "hyperoxia" during inhalational induction as compared to a propofol-based intravenous induction of anesthesia.
  
  
  OBJECTIVE
  The objective for this case series discussion was to identify any differences in cerebral tissue oxygenation secondary to induction of anesthesia with sevoflurane versus propofol. METHODS/STUDY PROCEDURES: After institutional review board approval, the computer data of tissue cerebral oximetry of pediatric patients (1-18 years age group) undergoing non-cardiac surgeries was comparatively analyzed for changes over time between the groups of children who received sevoflurane induction versus propofol induction of anesthesia. "Hyperoxia" ("hyperoxygenation") was defined as significant percent changes from the baseline values as recorded in tissue cerebral oximetry.
  
  
  RESULTS
  In this case series, seven patients underwent inhalational (INH) induction with high concentrations (8%) sevoflurane with nitrous oxide in 33% oxygen and four patients underwent intravenous (i.v.) induction with 2 mg/kg propofol and nitrous oxide in 33% oxygen. As compared to propofol, significant cerebral tissue "hyperoxia" occurred with sevoflurane induction (p = 0.003). This did not resolve over time.
  
  
  CONCLUSIONS
  As compared to intravenous induction with propofol, inhalational induction with "vasoparalytic" sevoflurane "hyperoxygenates" developing brains. This observation requires validation in larger trials to conclude appropriate effect on our practice of pediatric anesthesia and pediatric patient safety under anesthesia.
authors: Department of Anesthesiology, Childrens Hospital of Michigan, Wayne State University/Detroit Medical Center, Detroit, MI 48201, USA.
authors: Deepak
authors: D
authors: Gupta
authors: Jaspreet
authors: J
authors: Sangha
authors: Edward
authors: E
authors: Kaminski
mesh_terms: D000293:Adolescent; D018685:Anesthetics, Inhalation / Q000009:adverse effects*; D018686:Anesthetics, Intravenous / Q000494:pharmacology; D001921:Brain / Q000187:drug effects* / Q000378:metabolism; D002648:Child; D002675:Child, Preschool; D006801:Humans; D018496:Hyperoxia / Q000139:chemically induced*; D007223:Infant; D008738:Methyl Ethers / Q000009:adverse effects*; D015742:Propofol / Q000494:pharmacology; D000077149:Sevoflurane
chemical_list: D018685:Anesthetics, Inhalation; D018686:Anesthetics, Intravenous; D008738:Methyl Ethers; D000077149:Sevoflurane; D015742:Propofol