Airway responses to desflurane during maintenance of anesthesia and recovery in children with laryngeal mask airways

Lerman, Jerrold; Hammer, Gregory B.; Verghese, Susan T.; Ehlers, Melissa; Khalil, Sara; Betts, Eugene K.; Trillo-Nouche, Ramiro; Deutsch, Jonathan S.

doi:10.1111/j.1460-9592.2010.03305.x

Cited by 29 publications

(24 citation statements)

References 31 publications

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“…Use of desflurane incurred a hazard rate of desaturation and laryngospasm 5- and 10-fold higher, respectively, compared to the use of other inhalation agents, a result supported by a study by Lerman et al [18]. The mechanism of desflurane inducing airway contraction by activating transient receptor potential-A1 during spontaneous breathing with assisted ventilation via facemask or LMA makes laryngospasm more likely than when using airway protection with ETT [19].…”

Section: Discussionmentioning

confidence: 99%

Risk over time and risk factors of intraoperative respiratory events: a historical cohort study of 14,153 children

et al. 2014

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BackgroundThe variation in the rate of intraoperative respiratory events (IRE) over time under anesthesia and the influence of anesthesia-related factors have not yet been described. The objectives of this study were to describe the risk over time and the risk factors for IRE in children at a tertiary care hospital in southern Thailand.MethodsThe surveillance anesthetic database and chart review of IRE of 14,153 children who received surgery at Songklanagarind Hospital during January 2005 to December 2011 were used to obtain demographic, surgical and anesthesia-related data. Incidence density of IRE per person-time was determined by a Poisson modelling. Risk of IRE over time was displayed using Kaplan Meier survival and Nelson-Aalen curves. Multivariate Cox regression was employed to identify independent predictors for IRE. Adjusted hazard ratios (HR) and their 95% confidence intervals (CI) were obtained from the final Cox model.ResultsOverall, IRE occurred in 315 out of 14,153 children. The number (%) of desaturation, wheezing or bronchospasm, laryngospasm, reintubation and upper airway obstruction were 235 (54%), 101 (23%), 75 (17%), 21 (5%) and 4 (1%) out of 315 IRE, respectively. The incidence density per 100,000 person-minutes of IRE at the induction period (61.3) was higher than that in the maintenance (13.7) and emergence periods (16.5) (p < 0.001). The risk of desaturation, wheezing and laryngospasm was highest during the first 15, 20 and 30 minutes of anesthesia, respectively. After adjusting for age, history of respiratory disease and American Society of Anesthesiologist (ASA) classification, anesthesia-related risk factors for laryngospasm were assisted ventilation via facemask (HR: 18.1, 95% CI: 6.4-51.4) or laryngeal mask airway (HR: 12.5, 95% CI: 4.6-33.9) compared to controlled ventilation via endotracheal tube (p < 0.001), and desflurane (HR: 11.0, 95% CI: 5.1-23.9) compared to sevoflurane anesthesia (p < 0.001).ConclusionsIRE risk was highest in the induction and early maintenance period. Assisted ventilation via facemask or LMA and desflurane anesthesia were anesthesia-related risk factors for laryngospasm. Therefore, anesthesiologists should pay more attention during the induction and early maintenance period especially when certain airway devices incorporated with assisted ventilation or desflurane are used.

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Section: Discussionmentioning

confidence: 99%

Risk over time and risk factors of intraoperative respiratory events: a historical cohort study of 14,153 children

et al. 2014

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“…Due to a high incidence of restlessness during emergence from anesthesia [45] and the difficulty in using it for mask induction, have kept many pediatric anesthesiologists from using it. However, airway events after desflurane anesthesia can be reduced considerably when children are extubated when they are awake [46]. …”

Section: Inhalational Anesthesiamentioning

confidence: 99%

Recent advances in pediatric anesthesia

Holzki

2011

Korean J Anesthesiol

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Writing about advances in a field of medicine normally includes some pride about progress which one was witness to or even a participant in. The younger one is, the more enthusiastically every advance is lauded and welcomed. This is human nature and nothing to be complained about. However, when anesthesiologists, having worked and struggled in the field of pediatric anesthesia for about 40 years, look back to past advances, a more realistic, even painful picture comes to mind. There was a price which a considerable number of patients had to pay for progress, ruined health or even death. This experience of decades of practice is rarely presented in the literature but should not be forgotten when we proudly remember advances in pediatric anesthesia.

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“…Dr. Hannallah raises several interesting questions regarding our study (1). With respect to the investigators’ previous experience with desflurane, accurate data would have been difficult to obtain and were not collected.…”

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confidence: 97%

Response to: Airway responses to desflurane during maintenance of anesthesia and recovery in children with laryngeal mask airways

Lerman

Hammer

2010

Pediatric Anesthesia

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Airway responses to desflurane during maintenance of anesthesia and recovery in children with laryngeal mask airways

Cited by 29 publications

References 31 publications

Risk over time and risk factors of intraoperative respiratory events: a historical cohort study of 14,153 children

Risk over time and risk factors of intraoperative respiratory events: a historical cohort study of 14,153 children

Recent advances in pediatric anesthesia

Response to: Airway responses to desflurane during maintenance of anesthesia and recovery in children with laryngeal mask airways

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