Clinical research Clinical effects of sevoflurane anesthesia induction with a portable inhalational anesthetic circuit in pediatric patients

Abstract

IntroductionPediatric anesthesia induction with sevoflurane usually needs a special vaporizer and gas source, which limits its use to the operating room (OR). Many children feel anxious and cry when entering the OR because of being separated from their parents, which impairs anesthesia safety and their physical and mental health. In this study, we used a portable circuit to perform sevoflurane anesthesia induction outside the OR, assessed its effects and compared them with those of ketamine anesthesia in pediatric patients.Material and methodsOne hundred children had anesthesia induced with either sevoflurane (sevoflurane group) through the portable inhalational anesthetic circuit, or ketamine by intramuscular injection (ketamine group), then were transferred to the OR. Peak inspired concentration (Cp) and steady state concentration (Cs) of sevoflurane were measured. Heart rate (HR) and saturation of peripheral oxygen (SpO2) were monitored. Time for anesthesia induction, awakening, leaving the OR and duration of the operation were recorded. The patients’ reaction during anesthesia was also analyzed.ResultsThe Cp and Cs of sevoflurane were correlated with bodyweight. Compared with the ketamine group, the sevoflurane group showed shorter time for anesthesia induction (28 ±7 s vs. 195 ±34 s, p < 0.0001), awakening (11.2 ±3.6 s vs. 63.5 ±6.7 s, p < 0.0001) and leaving the OR (20.5 ±5.6 s vs. 43.4 ±10.6, p < 0.0001), less noncooperation during anesthesia induction (10% vs. 80%, p < 0.0001), lower HR (130 ±16 beats/min vs. 143 ±19 beats/min, p = 0.0004) and higher SpO2 (98.9 ±0.9% vs. 96.1 ±2.5%, p < 0.0001) on arrival at the OR.ConclusionsPediatric anesthesia induction by sevoflurane with the portable inhalational anesthetic circuit is convenient, safe and effective outside the OR.

Repeated exposure to sevoflurane in neonatal rats impairs cognition in adulthood via the PKA‑CREB‑BDNF signaling pathway

“…Sev is a commonly used inhalational anesthetic in pediatric surgery and exhibits minimal airway reactivity and a low blood/gas partition coefficient (2). Although Sev has various advantages, it is crucial to elucidate its effects on brain development, particularly on safety issues arising from the use of anesthesia in children (20). The current study evaluated the effect of Sev on cognition in rats.…”

“…It has been hypothesized that the activation of PKA/CREB/BDNF signaling pathways may improve cognition (36). Therefore, rats were treated with Buc, a selective PKA agonist (20), and the results demonstrated that the activation of PKA significantly improved cognition in Sev-treated rats. Furthermore, when Buc was administered to rats, the expression of PKA, p-CREB and BDNF in the hippocampus was increased compared with rats treated only with Sev.…”

Assessment of Preoperative Risk in Children

“…predlažu prijeoperacijsku primjenu inhalacije salbutamola, uvod u anesteziju propofolom in-travenski, uz održavanje anestezije sevofl uranom, manje invazivnom tehnikom održavanja dišnog puta te iskusnog anesteziologa. [36][37][38][39][40][41][42] Osim aktivne respiratorne infekcije, astma ovisna o terapiji kortikosteroidima, bronhalna hiperreaktivnost, ali i KOPB koji se danas počinje shvaćati kao bolest što se razvija od rane dječje dobi te restriktivna plućna bolest smatraju se visokorizičnim čimbenicima u procjeni prema NARCO-SS-u. 24,43,44 Preporučuje se dijete koje ima astmu procijeniti dva tjedna prije zahvata da bi se omogućila eventualna modifi kacija uobičajene terapije.…”