Comparison of low-fresh gas flow technique to standard technique of sevoflurane induction in children-A randomized controlled trial.

Abstract

Although sevoflurane is preferred for inhalational induction in children, financial and environmental costs remain major limitations. The aim of this study was to determine if the use of low-fresh gas flow during inhalational induction with sevoflurane could significantly reduce agent consumption, without adversely affecting induction conditions. After institutional ethical committee approval, 50 children, aged 1-5years, undergoing ophthalmic procedures under general anesthesia, were randomized into two groups-standard induction (Group S) and low-flow induction (Group L). A pediatric circle system with 1L reservoir bag was primed with 8% sevoflurane in oxygen at 6Lmin-1 for 30seconds before beginning induction. In Group S, fresh gas flow was maintained at 6Lmin-1 until the end of induction. In Group L, fresh gas flow was reduced to 1Lmin-1 after applying facemask (time=T0). In both groups, sevoflurane was reduced to 5% after loss of eyelash reflex (T1). Once adequate depth of anesthesia was achieved (regular respiration, loss of muscle tone, and absence of movement to trapezius squeeze), intravenous access was secured (T2), followed by insertion of an appropriately sized LMA-Classic™ (T3). Heart rate and endtidal sevoflurane concentration were measured at each of the above time points, and at 15seconds following laryngeal mask airway insertion (T4). The total amount of sevoflurane consumed during induction was recorded. Sevoflurane consumption was significantly lower in Group L (4.17±0.70mL) compared to Group S (8.96±1.11mL) (mean difference 4.79 [95% CI=4.25-5.33] mL; P<0.001). Time to successful laryngeal mask airway insertion was similar in both groups. There were no significant differences in heart rate, incidence of reflex tachycardia, or need for rescue propofol. Induction of anesthesia with sevoflurane using low-fresh gas flow is effective in reducing sevoflurane consumption, without compromising induction time and conditions.