Changing aspects of sevoflurane in paediatric anaesthesia: 1975–99

Holzki, Josef; Kretz, F.-J.

doi:10.1046/j.1460-9592.1999.00415.x

Cited by 57 publications

(35 citation statements)

References 36 publications

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“…Although usually self-limiting, it causes distress to patients, parents and staff, and may result in physical harm to the child, particularly at the site of surgery, dressings and intravenous cannulae. Agitation and regressive behaviour lasting up to two days has been described [4] and long-term psychological effects remain unknown. The term 'emergence agitation' is often used interchangeably with 'emergence delirium' but agitation is excessive motor activity, is more common than emergence delirium in the postoperative period and is associated with discomfort, pain or anxiety.…”

Section: Editorialmentioning

confidence: 99%

Emergence delirium in children

Wong

Bailey

2015

Anaesthesia

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Section: Editorialmentioning

confidence: 99%

Emergence delirium in children

Wong

Bailey

2015

Anaesthesia

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“…Epileptiform potentials are observed under deep sevoflurane anaesthesia, sometimes accompanied by tonic-clonic movements [10], but most often without clinical signs [11]. Hyperventilation [4], speed of induction [7], high alveolar concentrations of sevoflurane [4], [8], [12], and female gender [2] are discussed in the literature as factors which may activate seizure-like motor activity as well as EEG abnormalities [13] during sevoflurane administration. As it is still not clear whether these EEG changes are of clinical relevance, some authors recommend to avoid them [14].…”

Section: Introductionmentioning

confidence: 99%

Influence of the Sevoflurane Concentration on the Occurrence of Epileptiform EEG Patterns

et al. 2014

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Objectives and AimThis study was performed to analyse the effects of different sevoflurane concentrations on the incidence of epileptiform EEG activity during induction of anaesthesia in children in the clinical routine.BackgroundIt was suggested in the literature to use sevoflurane concentrations lower than 8% to avoid epileptiform activity during induction of anaesthesia in children.Methods100 children (age: 4.6±3.0 years, ASA I–III, premedication with midazolam) were anaesthetized with 8% sevoflurane for 3 min or 6% sevoflurane for 5 min in 100% O2 via face mask followed by 4% sevoflurane until propofol and remifentanil were given for intubation. EEGs were recorded continuously and were analysed visually with regard to epileptiform EEG patterns.ResultsFrom start of sevoflurane until propofol/remifentanil administration, 38 patients (76%) with 8% sevoflurane had epileptiform EEG patterns compared to 26 patients (52%) with 6% (p = 0.0106). Epileptiform potentials tended to appear later in the course of the induction with 6% than with 8%. Up to an endtidal concentration of 6% sevoflurane, the number of children with epileptiform potentials was similar in both groups (p = 0.3708). The cumulative number of children with epileptiform activity increased with increasing endtidal sevoflurane concentrations. The time from start of sevoflurane until loss of consciousness was similar in patients with 8% and 6% sevoflurane (42.2±17.5 s vs. 44.9 s ±14.0 s; p = 0.4073). An EEG stage of deep anaesthesia with continuous delta waves <2.0 Hz appeared significantly earlier in the 8% than in the 6% group (64.0±22.2 s vs. 77.9±20.0 s, p = 0.0022).ConclusionThe own analysis and data from the literature show that lower endtidal concentrations of sevoflurane and shorter administration times can be used to reduce epileptiform activity during induction of sevoflurane anaesthesia in children.

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“…Human trials began in 1981, and the Food and Drug Administration (FDA) approved its use in 1995. 6 Sevoflurane is a volatile ether inhalation anesthetic with a low blood/gas solubility. 7 This allows for a rapid induction and emergence.…”

Section: Sevofluranementioning

confidence: 99%

“…Sevoflurane has several side effects, which include seizures during induction and maintenance, elevations in plasma inorganic fluoride and compound A concentrations, and an increased incidence of emergence delirium. 6 Halothane is not an "ideal pediatric inhaled agent" because of its potential to cause hypotension, bradycardia, and ventricular ectopy. 9…”

Section: Sevofluranementioning

confidence: 99%