The present study was designed to compare induction and recovery characteristics of sevoflurane and halothane anesthesia in children, and to assess the hemodynamic profile of both anesthetics during induction and maintenance of anesthesia. Thirty-four children (aged 9 mo-9 yr) scheduled for ambulatory surgery were allocated randomly to groups to receive either halothane (HALO, n = 17) or sevoflurane (SEVO, n = 17) in a mixture of O2 and N2O (40:60) for mask induction and maintenance of anesthesia. The inspired concentrations used for inhalation via a mask were increased every five breaths and were successively 1%, 2%, 3%, and 3.5% for HALO and 2%, 4%, 6%, and 7% for SEVO. After tracheal intubation, expired concentration was maintained at 1 minimum alveolar anesthetic concentration (MAC) corrected for age until skin closure. Analgesia was provided by epidural anesthesia using a mixture of plain 1% lidocaine and 0.25% bupivacaine. Induction and recovery characteristics as well as hemodynamic data were recorded. The two groups were identical in age, weight, and duration of anesthesia and surgery. Time to intubation was the same between groups. In the SEVO group, five children exhibited mild excitement, while in the HALO group, one mild laryngospasm and one transient cardiovascular deterioration were observed. In the SEVO group, a significant increase in heart rate (HR) was observed before tracheal intubation, but during maintenance of anesthesia HR and systolic arterial pressure (SAP) did not change compared to control values. In the HALO group, HR did not change throughout the study, whereas SAP remained significantly below control values throughout both induction and maintenance of anesthesia.(ABSTRACT TRUNCATED AT 250 WORDS)

Pour mesurer l’impact d’une amélioration de la synchronisation des temps médicaux et non médicaux autour du patient hospitalisé, les auteurs ont accompagné onze établissements de santé. Dans ces derniers, des actions de synchronisation des temps des professionnels ont été mises en œuvre dans les structures les plus sensibles : blocs opératoires, hospitalisation conventionnelle et ambulatoire, consultations externes, etc. Les auteurs analysent les effets induits sur ces sites de production de soins par une meilleure synchronisation des temps médicaux et non médicaux. Le soin réalisé par une équipe hospitalière est l’aboutissement d’une intervention collective. Mais collectif ne veut pas dire coordonné… Pour autant si de nombreuses publications font état d’une relation entre la sécurité des soins et la qualité de la communication au sein de l’équipe hospitalière (1), le sujet des impacts de la synergie temporelle des soignants autour du patient parait encore très peu exploré. Le projet d’accompagnement au développement de la synchronisation des temps médicaux et non médicaux a concerné onze établissements de santé essentiellement publics.

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