Sevoflurane In Pediatric Patients Research Articles

Comparative study: evaluation of the effect of sevoflurane versus isoflurane in general anesthesia for pediatric patients undergoing cardiac catheterization

ABSTRACT Background Anesthesiologists have had a difficult time managing infants with congenital heart disease, particularly at cardiac catheterization. Aim and objectives The investigation goal was to examine hemodynamic parameters and recovery profiles using Sevoflurane or isoflurane for anaesthesia in children scheduled for elective cardiac catheterization. Setting University educational hospital. Design A single-center, prospective clinical trial Materials and Methods Sixty juvenile patients having optional cardiac catheterization were randomised and assigned to one of two groups: isoflurane (group I) or sevoflurane (group S). Midazolam 0.5 mg/kg was given orally to all patients, 30 minutes prior to the surgical procedure. The initiation of anaesthesia was initiated with 5 mg/kg intramuscular ketamine in both groups. Maintenance of anaesthesia throughout the procedure was either by One MAC 2 ug/kg was given to all patients to provide analgesia and 1% xylocaine infiltration at the site of catheter insertion. Isoflurane (1.2%) (Group I) or sevoflurane (2%) (Group S) in an oxygen-air mixture of 1:1. All drugs were given by anaesthesiologists not involved in the study. Results Hemodynamic changes at and after the procedure: Mean arterial blood pressure (MAP), O2 saturation, ejection fraction (EF), and fraction shortening (FS) showed statistically substantial differences (P 0.05). The S group had a considerably greater steward score (recovery score) than the I group. Conclusion Sevoflurane in paediatric patients having cardiac catheterization provides good preservation of hemodynamic stability, rapid recovery, better sedation, and minimal side effects.

Intraoperative clonidine to prevent delirium following sevoflurane in pediatric patients

Intraoperative clonidine to prevent delirium following sevoflurane in pediatric patients

Anesthesia affects excitatory/inhibitory synapses during the critical synaptogenic period in the hippocampus of young mice: Importance of sex as a biological variable

BackgroundSex plays an important yet often underexplored role in neurodevelopment and neurotoxicity. While several studies report the importance of sex regarding anesthesia-induced neurotoxicity in neonatal mice, only few have focused on the late postnatal period. Here, to further understand the importance of sex regarding the neurobiological changes after early anesthesia during the critical synaptogenic period, we exposed postnatal day 16, 17 (PND 16, 17) mice to sevoflurane in pediatric patients and performed detailed evaluations in the hippocampus. MethodsPND 16, 17 mice received a single exposure of oxygen with or without sevoflurane (2.5%) for 2 h. Changes of the hippocampus were analyzed in male and female mice 6 h after exposure: excitatory/inhibitory synaptic transmission, protein/mRNA expression levels of excitatory/inhibitory synaptic molecules (GluR1, GluR2, PSD95, gephyrin, GAD65), and number of excitatory synapses. ResultsSevoflurane exposure increased the frequency of miniature excitatory postsynaptic currents specifically in male mice (control: 0.07 ± 0.04 [Hz]; sevoflurane: 14.72 ± 0.08 [Hz]), while miniature inhibitory postsynaptic currents were affected specifically in female mice. The protein/mRNA expression levels of excitatory synaptic molecules were also increased specifically in male mice. Unexpectedly, protein/mRNA expression levels of inhibitory synaptic molecules were increased in both sexes, and there was no male-specific increase of excitatory synapse number. ConclusionsExposure of mice to sevoflurane during the critical, late postnatal period induces sex-dependent changes in the hippocampus. Although often disregarded, our results confirm the importance of sex as a biological variable when studying the changes triggered by early anesthesia.

Comparative Study of Induction Time and Heart Rate Changes During Induction with Halothane and Sevoflurane in Paediatric Patients

Comparative Study of Induction Time and Heart Rate Changes During Induction with Halothane and Sevoflurane in Paediatric Patients

Effect of dexmedetomidine on emergence agitation in children undergoing adenotonsillectomy under sevoflurane anesthesia: A randomized controlled study

BackgroundEmergence agitation is a frequent postoperative problem in pediatric patients undergoing adenotonsillectomy. The incidence of EA is wide ranging in the literature from 10% to 80%.ObjectiveThe aim of this study was to assess the effect of dexmedetomidine in decreasing emergence agitation associated with sevoflurane in children after adenotonsillectomy.DesignA prospective randomized study.SettingKing Fahad military hospital, Saudi Arabia.MethodsThe study included 150 patients, classified randomly into two groups and received either sevoflurane or sevoflurane with dexmedetomidine. The Pediatric Anesthesia Emergence Delirium Scale (PAED) was used to assess the emergence agitation. If the PAED scale was ⩾16, the patient was considered agitated.ResultsThe incidence of emergence agitation was 29 patients in group A (38.66%) and 6 patients (8%) in group B (P < 0.001). Also the comparison of incidence time of agitation, nausea and vomiting and time of discharge from post-anesthesia care unit between the two groups was significant (P < 0.05).ConclusionDexmedetomidine decreased significantly the incidence of agitation with sevoflurane in pediatric patients undergoing adenotonsillectomy and it was associated with a shorter time to extubation, lower incidence of postoperative nausea and vomiting and shorter post-anesthesia care unit length of stay.

Establishment of pharmacodynamic model of sevoflurane in pediatric patients: bispectral index

Objective To establish the pharmacodynamic model of sevoflurane with bispectral index (BIS) as the effective index in pediatric patients.Methods Thirteen ASA physical status Ⅰ or Ⅱ pediatric patients,aged 4-9 yr,weighing 12-39 kg,undergoing non-cardiac surgery,were selected in the study.The pediatric patients sequentially inhaled 1％,5 ％ and 1％ sevoflurane via a face mask and each concentration was inhaled for 15 min.BIS value,HR,BP and SpO2 were automatically recorded every 10 s.Based on nonlinear mixed effect modeling,the population pharmacodynamic model of sevoflurane was established using NONMEM software.The effect of age on the pharmacodynamic parameters was evaluated using a stepwise forward addition then backward elimination modeling approach.The standard for model improvement was defined as a decrease in the value of the objective function by more than 3.84.Results Twelve pediatric patients,aged 4.0-8.5 yr,weighing 12.8-38.0 kg,with body height of 92-135 cm,were enrolled in this study and the data which were enrolled comprised 2964 effective concentration-time-BIS points.The model was not improved significantly with any covariates (age,body height,and body weight) introduced (P ＞ 0.05).The estimated parameters of the final pharmacodynamic model of sevoflurane were as follows:ke0 =O.516/min ; EC50 (BIS50) =2.11％ ; γ =2.46 ; E0 =74.6 ; EMAx =11.2.Conclusion The pharmacodynamic model of sevoflurane is successfully established with BIS as the effective index in pediatric patients,and the analysis for each parameter of the model indicates that the sensitivity to sevoflurane is lower,but the blood-brain equilibration time of the drug is shorter and the onset and recovery are faster in children than in adults. Key words: Anesthetics, inhalation; Pharmacology, clinical; Electroencephalography

Nitrous oxide administration during washout of sevoflurane improves postanesthetic agitation in children

The use of sevoflurane in pediatric patients, which could enable a more rapid emergence and recovery, is complicated by a high incidence of postanesthetic agitation, probably due to residual sevoflurane during washout. The present study was designed to investigate whether administration of nitrous oxide (N2O) reduces sevoflurane concentration at awakening and suppresses postanesthetic agitation. The study enrolled 20 children classified as ASA physical status I. Anesthesia was induced with 5% sevoflurane and maintained with 2.5% end-tidal sevoflurane and N2O in oxygen. In the control group, sevoflurane and N2O were discontinued immediately after completion of surgery. In the N2O group, inspired N2O was replaced with oxygen after the bispectral index (BIS) had reached 80. The end-tidal concentrations of sevoflurane at awakening were significantly lower (P < 0.05) in the N2O group than in the control group. The BIS at awakening was higher (P < 0.01) in the N2O group than in the control group. The point scores of postanesthetic agitation were significantly lower (P < 0.01) in the N2O group than in the control group. Using N2O during washing out of sevoflurane may improve postanesthetic agitation at awakening in children.

Nausea and Vomiting after VIMA with Sevoflurane in Pediatric Patients

Background: Postoperative nausea and vomiting (PONV) is one of the most common complications after general anesthesia. Sevoflurane is a newer inhalational anesthetic agent and is commonly used in general anesthesia, especially in pediatric patients and outpatients. However, the incidence of PONY after volatile induction and maintenance of anesthesia (VIMA) with sevoflurane in pediatric patients has not been reported in Korea. In this study, the incidence of PONY after VIMA with sevoflurane in pediatric patients was evaluated. Methods: A total of 251 pediatric patients, scheduled for inguinal surgery, extremity operation and perianal surgery, were selected for the study. None of the pediatric patients was given premedicants, opioids or reversal agents during VIMA. Results: The incidence of PONY after VIMA with sevoflurane in pediatric patients was 9.2%. There were no significant differences in PONY incidence according to the sex or age. PONV commonly occurred immediately after anesthesia, with the incidence of 4.9% in the operating room and 3.2% in the recovery room, respectively. Conclusions: The VIMA technique with sevoflurane for brief operations could reduce the incidence of PONV but not to zero incidence. Therefore, anesthesiologists should pay attention to the possibility of PONY, and should consider not only the anesthetic methods and agents but also the use of antiemetics, especially in high risk patients.

Clinical Characteristics and Biotransformation of Sevoflurane in Pediatric Patients During Antiepileptic Drug Therapy

KOMATSU, HISAO; UEKI, MASAAKI; MORITA, JUNKO; CHUJO, KOUSUKE; OGLI, KENJI; Joseph, Michele M.B. B.S., F.A.N.Z.CA. Author Information

Clinical characteristics and biotransformation of sevoflurane in paediatric patients during antiepileptic drug therapy

Patients with epilepsy on long term antiepileptic drug (AED) therapy deserve special consideration not only concerning seizure control but also the effect on anaesthetic metabolism and hepatorenal functions. In the present study, we examined the effects of sevoflurane anaesthesia on plasma inorganic fluoride (F-) level and hepatorenal function in patients with and without AED therapy. Twenty-two patients (12 with AEDs = AED group, and ten without AEDs = control group = C group), ASA I, who were free of hepatorenal disease, received approximately 2-3 h sevoflurane anaesthesia. Plasma F- analysis was performed at the stages of: 1) induction of anaesthesia, 2) conclusion of anaesthesia, 3) 15 h after the conclusion of anaesthesia, using an ion-selective electrode calibrated with a standard solution of sodium fluoride. Pre- and postoperative hepatic (aspartate aminotransferase, alanine aminotransferase, alkaline phosphatase, total bilirubin) and renal (blood urea nitrogen, creatinine) function was tested. There were no significant differences between the two groups in the average age (AED group = 9.4 and control group = 10.1 y.o.), body weight, duration of anesthesia, and MAC hours (2.6 and 2.4). The mean peak F- levels were 15.5 and 13.6 microM, in AED and C groups (not significant), respectively. No patient exhibited F- values greater than 50 microM, the hypothetical nephrotoxic threshold. The patients showed no abnormal values either in hepatic or renal function tests postoperatively. These results suggest approximately 2-3 h sevoflurane anaesthesia to be safe in patients taking AEDs.