title: Inhalation induction with sevoflurane in adult cardiac surgery patients. A case series.
abstract: BACKGROUND
  Anesthesia induction through volatile agents is a well-established technique in several fields but not in adult patients undergoing cardiac surgery. Successful inhalation induction requires a poorly soluble, reasonably potent and minimally irritant agent, and the benefits associated to this technique include reduced incidence of hypothermia and hypotension and lower costs when compared to some intravenous anesthetics agents.
  
  
  METHODS
  Fifty-six patients undergoing coronary artery bypass grafting were observed at the induction of general anesthesia with sevoflurane in oxygen by facial mask. All patients received 2% sevoflurane in 100% oxygen initially for 30 seconds. The inspired concentration of sevoflurane was increased to 7% until loss of consciousness and then reduced back to 2%. Next, intravenous 0.5 µg/kg sufentanil and 0.1 mg/kg pancuronium were administered. Volume-controlled ventilation was started before tracheal intubation.
  
  
  RESULTS
  All 56 patients tolerated the inhalational induction. No patient presented signs of airway irritation. Hypotension occurred in 30 patients and was managed with low dose phenylephrine.
  
  
  CONCLUSIONS
  This case series showed that inhalation induction is feasible and safe even in adult patients undergoing cardiac surgery.
authors.affiliation: Dante Pazzanese Institute of Cardiology, São Paulo, Brazil.
authors.forename: C
authors.initials: C
authors.lastname: Nigro Neto
authors.affiliation: Dante Pazzanese Institute of Cardiology, São Paulo, Brazil.
authors.forename: E
authors.initials: E
authors.lastname: Costa
authors.affiliation: Dante Pazzanese Institute of Cardiology, São Paulo, Brazil.
authors.forename: R
authors.initials: R
authors.lastname: Rossi
authors.affiliation: Anaesthesia and Intensive Care Department, Federal University of São Paulo, São Paulo, Brazil.
authors.forename: M A
authors.initials: MA
authors.lastname: Tardelli
keywords: anesthetics technique; cardiac surgery; induction; sevoflurane; volatile anesthetics