title: Anesthesia maintenance with 'induction dose only' sevoflurane during pediatric ophthalmic examination: comparison with standard low-flow technique through a randomized controlled trial.
abstract: BACKGROUND
  Sevoflurane is preferred for pediatric day care procedures. However, financial and environmental costs remain major limitations. Induction dose of sevoflurane could itself be sufficient for maintaining anesthesia with low fresh gas flow during short noninvasive procedures.
  
  
  METHODS
  Fifty children, aged 1-5 years, scheduled for ophthalmic examination under anesthesia, were randomized into two groups. All children were induced with 8% sevoflurane in O2: N2O (40 : 60). In the Group S, anesthesia was maintained with 2% sevoflurane at 1 l·min-1fresh gas flow [O2: N2O = 50 : 50]. In Group L, the sevoflurane vaporizer was turned off and fresh gas flow was reduced to 0.5 l·min-1[O2: N2O = 50 : 50]. HR, BP, MAC, BIS, total sevoflurane consumption, ocular deviation, body movement, time to laryngeal mask airway removal (TWO), and airway complications were compared between the groups. Rescue propofol bolus was used, if needed.
  
  
  RESULTS
  Median duration of examination was 14 min (IQR = 9-17) in Group S and 15 min (IQR = 10-17) in Group L. Sevoflurane consumption was lower in the Group L (7 ml) compared to Group S (9 ml) [median difference = 2 ml, P < 0.001, 95% CI = 0.96-3.04]. TWOwas lower in Group L (86 s) compared to Group S (131 s) [median difference = 45 s, P = 0.002, 95% CI = 19.85-70.15]. There was no difference in hemodynamic parameters, incidence of ocular deviation, movement or airway complications, and need for rescue propofol.
  
  
  CONCLUSIONS
  Induction dose of sevoflurane is, in itself, adequate for maintaining anesthesia for short noninvasive ophthalmic examinations lasting approximately 15 min. This method significantly reduces sevoflurane consumption and cost.
authors.affiliation: Department of Anaesthesiology & Intensive Care, All India Institute of Medical Sciences, New Delhi, India.
authors.forename: Priyankar K
authors.initials: PK
authors.lastname: Datta
authors.affiliation: Department of Anaesthesiology & Intensive Care, All India Institute of Medical Sciences, New Delhi, India.
authors.forename: Renu
authors.initials: R
authors.lastname: Sinha
authors.affiliation: Department of Anaesthesiology & Intensive Care, All India Institute of Medical Sciences, New Delhi, India.
authors.forename: Bikash Ranjan
authors.initials: BR
authors.lastname: Ray
authors.affiliation: Department of Anaesthesiology & Intensive Care, All India Institute of Medical Sciences, New Delhi, India.
authors.forename: Venkateswaran
authors.initials: V
authors.lastname: Jambunathan
authors.affiliation: Department of Anaesthesiology & Intensive Care, All India Institute of Medical Sciences, New Delhi, India.
authors.forename: Riddhi
authors.initials: R
authors.lastname: Kundu
mesh_terms: D000758:Anesthesia / Q000379:methods*; D018685:Anesthetics, Inhalation / Q000008:administration & dosage*; D002675:Child, Preschool; D004311:Double-Blind Method; D005260:Female; D006801:Humans; D007223:Infant; D008297:Male; D008738:Methyl Ethers / Q000008:administration & dosage*; D009885:Ophthalmology / Q000379:methods*; D000077149:Sevoflurane
chemical_list: D018685:Anesthetics, Inhalation; D008738:Methyl Ethers; D000077149:Sevoflurane
keywords: 
  EEG
  ; child; clinical trials; depth of anesthesia; sevoflurane