Halothane In Paediatric Patients Research Articles

A RANDOMIZED CONTROL STUDY COMPARING EMERGENCE CHARACTERS OF DESFLURANE WITH HALOTHANE IN PAEDIATRIC PATIENTS UNDERGOING GENERAL ANAESTHESIA.

Background: Emergence agitation (EA) was described at rst by Eckenhoff et al in the early 1960s. EA has been described as a dissociated state of consciousness in which the child is inconsolable, irritable, uncooperative, typically thrashing, crying, moaning or incoherent. Although EA is usually self-limited and occurs within the rst 30-minutes of recovery in PACU, but it can last up to 2 days and lead to physical damage, disconnection of intravenous catheters, removing of dressing or drainage tube and monitoring devices. Although, numerous medications have been studied to prevent or reduce EA in children, no special preventive method has been shown to be highly superior. Aims and objectives: The aim of this study is to compare the emergence characters of Desurane with Halothane. The primary objective is to compare the Emergence characters using PAED (Pediatric Anaesthesia Emergence Delirium) score. The secondary objective is : 1) To compare the recovery characters(Time to recover) using Steward Recovery Scores. 2) To compare the PACU discharge criteria meeting time with Modied Aldrete Score. 3) To assess post operative Pain, nausea, vomiting, shivering. Materials and Methods: This Randomized interventional study (single blinded) was conducted in Institute of child health and hospital for children, egmore from October 2019 to December 2019. 70 Pediatric patients based on the parent article, Comparison of Emergence and Recovery characteristics of Sevourane, Desurane, and Halothane in Pediatric Patients undergoing General Anaesthesia, authored by Welborn ,Hannallallah Published AnesthAnalg. 1996 Nov;83(5):917-20. Result: Recovery time, Emergence Agitation, Time to reach discharge criteria and post operative complications were compared. Post anaesthesia Emergence Agitation was higher in Desurane group compared to Halothane group which was statistically signicant. Desurane resulted in faster recovery, early Emergence than Halothane which was statistically signicant. This is due the fact that Desurane has very low Blood Gas Solubility index which results in rapid emergence and thus Emergence Agitation. Though time to reach discharge criteria was not much prolonged in Halothane group, study showed statistically signicant difference between two groups. Post operative complications is not statistically signicant between two groups. Conclusion: In our study Post anaesthesia Emergence Agitation was signicantly higher in Desurane group compared to Halothane group. Desurane anaesthesia resulted in rapid Emergence, early recovery compared to Halothane anaesthesia .

English

AIM: This study was conducted to compare the speed of induction, intubation, and speed of emergence with sevoflurane and halothane in pediatric patients. METHODOLOGY: All the patients had full preanesthetic check-up and the routine investigation (complete blood count, urine albumin) was done. Patients were kept fasting for 6 hrs. for solid food, 4hours for semisolid and 2 hours for liquid. They were randomly divided into Gr S and Gr H each comprising of 30 patients each to receive sevoflurane and halothane with 60% nitrous and 40% oxygen respectively by inhalation. On arrival in the operation theatre, the standard monitors were applied including an electrocardiogram, pulse oximeter, non-invasive blood pressure and precordial stethoscope and the baseline readings of respective parameters were taken. Anesthetic induction was done with face mask application using incremental dosing of 0.5% for halothane and 1% for sevoflurane every three to five breath to deliver maximum inspired concentration of upto 5% halothane(maximum inspired concentration) or 8% sevoflurane (maximum inspired concentration). Spontaneous ventilation was maintained till loss of eye lash reflex. Following the loss of the eyelash reflex, the vaporizer concentration was decreased to 4% for sevoflurane and 0.86 % for halothane (approximately 2 MAC). Intravenous catheter was inserted. Inhalational agent at the same concentration was given until the loss of corneal reflex. After the intravenous line was secured, inj pentazocine 0.3 mg/kg was given. The patients were intubated with appropriate size endotracheal tube only after the loss of corneal reflex. After successful intubation, intravenous vecuronium 0.1 mg/kg was administered for muscle paralysis and the anesthetic concentrations was adjusted at 1.3 MAC with N2O (0.56% halothane and 2.6% sevoflurane). Time intervals measured: (induction time, intubation time, emergence time) were measured. Vitals recorded: Heart rate, systolic, diastolic blood pressures, and SpO2. The depth of anesthesia was assessed clinically by evaluation of changes in heart rate, and blood pressure during surgery and these were maintained within 20% of baseline values. RESULTS: Induction time was significantly shorter with Gr S(mean(SD) 136.0(19.343)secs) than with Gr H (mean (SD) 156.09(10.651)) secs) (P=0.0001). Intubation time was significantly shorter with Gr S (mean (SD) 242.400(9.940) secs) than with Gr H(mean(SD) 265.769(12.039) secs) (P<0.0001). Time to emergence was significantly shorter in Gr S (mean(SD) 217.667(22.831)secs) than with Gr H(mean(SD) 450.5(18.407) secs) (P<0.0001). CONCLUSIONS: We found that sevoflurane is an excellent agent for inhalational induction of anesthesia in pediatric patients. It facilitates a rapid induction of anesthesia, found to be 20 seconds faster than halothane in our study. Emergence time is

Emergence Characteristics of Sevoflurane Compared to Halothane in Pediatric Patients Undergoing Bilateral Pressure Equalization Tube Insertion

Emergence Characteristics of Sevoflurane Compared to Halothane in Pediatric Patients Undergoing Bilateral Pressure Equalization Tube Insertion

Emergence characteristics of sevoflurane compared to halothane in pediatric patients undergoing bilateral pressure equalization tube insertion

Study Objective: To compare the emergence characteristics of sevoflurane with halothane in pediatric patients having bilateral myringotomy and pressure equalization tube insertion using a highly standardized and common anesthetic technique. Design: Prospective, randomized, double-blind study. Setting: University hospital. Patients: 43 ASA physical status I and II healthy pediatric outpatients scheduled for initial ear tube placement by one surgeon. Interventions: Patients were randomized to receive either halothane or sevoflurane as their sole anesthetic drug for ear tube insertion. All patients as well as the research nurse grading emergence agitation were blinded to group assignment. No premedication was administered, and all patients received a standard dose of rectal acetaminophen for postoperative pain control. Measurement and Main Results: The primary outcome was the percentage of patients with emergence agitation, defined as thrashing behavior requiring physical restraint for greater than three minutes. Time to discharge from the postanesthesia care unit (PACU) and from the hospital were also compared. Sevoflurane patients had a greater incidence of emergence delirium: 57% versus 27% [95% CI (1.7%–58.1%) p = 0.047]. Time to discharge from the PACU and the hospital were longer for patients who received sevoflurane: 62 versus 50 min [95% CI (1.4–23.6) p = 0.02] and 102 versus 79 mins [95% CI (9.6–37.1) p = 0.003]. Conclusion: In our institution there is a trend toward greater emergence agitation in ear tube placement patients given sevoflurane versus halothane anesthesia. Further, (with our discharge criteria) patients are actually discharged from the PACU and the hospital faster when given halothane as a sole anesthetic when compared to sevoflurane.

Emergence Characteristics of Sevoflurane Compared to Halothane in Pediatric Patients

Emergence Characteristics of Sevoflurane Compared to Halothane in Pediatric Patients

Sevoflurane

Sevoflurane is an ether inhalation general anaesthetic agent with lower solubility in blood than isoflurane or halothane but not desflurane. The low solubility and the absence of pungency facilitate rapid mask induction; the low blood solubility also expedites "wash-out' and therefore recovery from anaesthesia. Sevoflurane produces dose-dependent CNS, cardiovascular and respiratory depressant effects that generally parallel those of isoflurane. Sevoflurane is degraded by carbon dioxide absorbents to nephrontoxic (in rats) haloalkenes, although renal toxicity has not been observed in humans. Compared with other inhalation anaesthetics, negligible quantities of carbon monoxide are generated from degradation of sevoflurane by carbon dioxide absorbents. Sevoflurane has negligible airway irritant effects, which facilitates a "smooth' induction, even in comparison with halothane in paediatric patients, and makes sevoflurane especially amenable to rapid induction of anaesthesia in adults and children. Emergence, orientation an postoperative cognitive and psychomotor function recovery of paediatric outpatients is singnificantly more rapid from sevoflurane than from halothane anaesthesia. In adult inpatients and outpatients, emergence and orientation are significantly faster after sevoflurane than after isoflurane but not desflurane anaesthesia. Other recovery parameters (e.g. times to sitting, ambulation) occur at similar times after either sevoflurane or desflurane anaesthesia. Recovery of psychomotor function occurs at generally similar times after sevoflurane, isoflurane or desflurane. Compared with propofol, sevoflurane facilitates more predictable extubation times and significantly better postoperative modified Aldrete scores in outpatients, although cognitive and psychomotor recovery occurs at similar times for both agents. As a supplement to opioid anaesthesia during coronary bypass graft surgery or in those at risk for myocardial ischaemia, sevoflurane is comparable to isoflurane. Limited data suggest that it is also as useful as isoflurane for the maintenance of anaesthesia during neurosurgical or obstetric procedures. Sevoflurane is well tolerated by adult and paediatric patients during induction of anaesthesia, with a low incidence of mild airway complications (breath-holding, coughing, excitement and laryngospasm). During rapid induction, it is particularly better tolerated than isoflurane or halothane. Sevoflurane has a lower potential for hepatic injury than halothane. Unlike methoxyflurane, sevoflurane undergoes minimal intrarenal defluorination, which may account for the lack of fluoride ion-induced nephrotoxicity in humans, despite elevated plasma fluoride levels after its use. In summary, sevoflurane provides for a rapid and smooth induction of, and recovery from, anaesthesia. These features combined with its favourable cardiovascular profile should make sevoflurane the agent of choice for inhalation induction in adult and paediatric anaesthesia. Although further clinical evaluation will define the role of this agent relative to that of propofol and desflurane, sevoflurane should also prove to be a valuable alternative anaesthetic agent for adults in both outpatient and inpatient surgery.

Sevoflurane versus halothane for general anesthesia in pediatric patients: A comparative study of vital signs, induction, and emergence

Study Objective: To compare vital signs and the speed of induction and emergence with sevoflurane versus halothane in pediatric patients. Design: Prospective, randomized, open study. Setting: Thomas Jefferson University Hospital. Patients: 40 unpremedicated ASA Physical Status I and II children age 9 months to 16 years undergoing elective inpatient otorhinolaryngologic or orthopedic surgery. Interventions: Standardized induction of anesthesia with sevoflurane (start: 1%, maximum: 7%) or halothane (start: 0.5%, maximum: 5%) in nitrous oxide/oxygen ( N 2O O 2 ). Intubation following vecuronium and 4 minutes of controlled ventilation with 2 minimum alveolar concentration (MAC) drug in O 2; 1.5 MAC drug in N 2O O 2 delivered for 20 minutes; then 0.75 MAC until the end of surgery. Fentanyl 1 mcg/kg was administered 15 minutes before the anticipated end of surgery, at which time anesthetics were stopped and mechanical ventilation continued until eye opening (emergence). Measurements and Main Results: Blood pressure, heart rate (HR), oxygen saturation, end-tidal gas concentrations, and temperature were recorded. Induction and emergence times were measured to the nearest second. Induction (loss of eyelash reflex) was faster with sevoflurane (97 ± 31 sec) than halothane (120 ± 36 sec; p < 0.05), despite a lower inspired sevoflurane MAC. Emergence was faster with sevoflurane (9.9 ± 2.9 min vs. 12.5 ± 4.7 min; p < 0.05), despite a higher MAC multiple of end-tidal sevoflurane concentration at the end of surgery. Following intubation, HR (compared with the preinduction value in the operating room) was significantly higher in the halothane group (136.8% ± 16.3% vs. 115.0% ± 25.6%), as was mean arterial pressure (113.2% ± 25.5% vs. 87.8% ± 22.6%). This finding corresponded with a higher MAC multiple of end-tidal concentration in the sevoflurane group than in the halothane group. Conclusion: Induction of and emergence from anesthesia was faster with sevoflurane than halothane. Airway complications were low in both groups. Vital signs were stable with sevoflurane during maintenance. Sevoflurane is an excellent drug for inhalation induction in pediatric patients.

Safety and efficacy of alfentanil and halothane in paediatric surgical patients

Alfentanil, a congener of the opioid fentanyl, possesses properties that make it an attractive choice for use during short operative procedures. Since the pharmacodynamic aspects of alfentanil have not been well documented in children, this study was undertaken to evaluate the safety, efficacy, and dose requirements of alfentanil when used with nitrous oxide or halothane in paediatric patients. Eighty unpremedicated patients, ASA physical status I or II and aged 2-12 yr were studied. Patients were randomly assigned to one of four groups. After induction of anaesthesia with nitrous oxide, oxygen, and halothane, the groups were treated as follows. In Group 1 (n = 19), after halothane was discontinued, alfentanil 50 micrograms.kg-1 was infused over 30 sec. In Group 2 (n = 20), the end-tidal halothan was maintained at 0.5% and alfentanil 25 micrograms.kg-1 was infused. In Group 3 (n = 20), the end-tidal halothane concentration was maintained at 1% and alfentanil 12.5 micrograms.kg-1 was infused. In Group 4 (n = 21), the end-tidal halothane concentration was maintained at 1.5% and no alfentanil was administered. Patients in Groups 1, 2, and 3 received bolus doses of alfentanil 12.5 micrograms.kg-1 as needed to maintain haemodynamic stability. After alfentanil administration, there were transient decreases in systolic blood pressure in Groups 1 and 2, and in heart rate in Group 2. With surgical stimulation, haemodynamic stability was well maintained except in patients in Group 1, who had an increase in systolic blood pressure. Children Group 1 were alert sooner and their tracheas were extubated earlier than those in Groups 2, 3, and 4.(ABSTRACT TRUNCATED AT 250 WORDS)