COMPARISON OF SEVOFLURANE AND HALOTHANE FOR INDUCTION AND INTUBATION IN PEDIATRIC CARDIAC SURGICAL PATIENTS

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Introduction: Sevoflurane (S) provides rapid induction due to its low blood gas solubility. Its non-irritant and non pungent characteristics provide easy acceptability in children for inhalational induction. Halothane (H) also provides smooth inhalational induction and good intubating conditions in children but may produce myocardial depression and cardiac arrhythmias [1]. Sevoflurane and halothane have been compared for induction and tracheal intubation in children undergoing noncardiac surgery [2,3]. We compared induction and intubation characteristics of sevoflurane and halothane in children undergoing repair of congenital cardiac defects. Methods: 46 children aged 3 months to 6 years (mean 25 months) scheduled for repair of congenital cardiac defects were prospectively and randomly allocated to two groups. Premedication was with chloral hydrate 75 mg/kg orally 1 hour before induction. Patients were induced with O2 and N2 O (1:1) and either 8% S (23 patients) or 4% H (23 patients). Nasal tracheal intubation was performed after insertion of I V cannula, without the use of myorelaxants or opioids. Characteristics of induction and intubating conditions (Golberg's criteria) were recorded by an independent observer. Induction time was noted from application of face mask to loss of eyelash reflex. Intubation was undertaken when there was central miosis. Time to intubation was also noted. Hemodynamic parameters (HR, SpO2, SBP) were recorded when the eylash reflex was lost, immediately after intubation and at 1 and 3 min after intubation. Statistical analysis used students t test or chi-square test when appropriate. Results: Both the groups were comparable for age, weight, induction time, intubation time and intubating conditions (Table 1). There was no increase in airway secretions, coughing or laryngospasm in any patient. Hemodynamic parameters were comparable in both the groups except that SBP decreased by 25% in H group and by 16% in S group immediately after intubation (p<0.05) and by 26% in H group and 15% in S group at 1 min after intubation (p<0.05). There was no change in cardiac rhythm in S group but in H group 60% of the children had arrhythmias (p<0.001).Table 1Discussion: Sevoflurane and halothane are equally comparable in children undergoing repair of congenital cardiac defects. Both the agents provide quick and smooth induction with excellent intubating conditions. Better hemodynamic stability with sevoflurane makes it an attractive alternative for inhalational induction and intubation in paediatric cardiac surgical patients.