Mask induction and one-lung ventilation with sevoflurane

Abstract

The low blood/gas solubility, the rapid uptake and nonpungent odor permits mask induction with sevoflurane in adults. Depending on the induction techniques (tidal breathing, deep breaths or single-breath induction), the use of nitrous oxide and the concentration of inspired sevoflurane anesthesia can rapidly be induced within 41-178 s. Adverse effects like coughing, breath-holding or increased secretions occur with a low incidence of 2%-20%. Some 88 to 100% of the volunteers or patients would accept a mask induction again. Clinical experience shows that sevoflurane is well indicated for mask induction in adults. Acute severe bronchospasm is a feared complication of anesthesia with an incidence of 1.7%. Although halothane is often recommended as the agent of choice in patients with reactive airways, there is little evidence in humans that it is more effective than other volatile agents. The bronchodilating effects of sevoflurane are comparable to those of other volatile anesthetics, it produces minimal airway irritation and allows rapid adjustment of anesthetic depth. These properties and our clinical experience suggest that sevoflurane is a useful choice for patients with reactive airways. Hypoxemia during one-lung ventilation (OLV) occurs in 9-27% of patients and remains a clinical problem. Although hypoxic pulmonary vasoconstriction is directly inhibited by volatile anesthetics in in vitro studies, this effect is usually of minor clinical consequence. The use of volatile anesthetics may be advocated because of their salutory effects on bronchomotor tone, high potency (allowing high inspired concentration of oxygen while avoiding awareness) and rapid adjustment of anesthetic depth. Sevoflurane possesses these attributes and may be useful for OLV.