End-Tidal Sevoflurane Concentration for Tracheal Extubation and Skin Incision in Children

Inomata, Shinichi; Suwa, Tomohide; Toyooka, Hidenori; Suto, Yoshiko

doi:10.1097/00000539-199812000-00010

Cited by 11 publications

(7 citation statements)

References 13 publications

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“…Loss of eyelash reflex test became negative with 5% sevoflurane in 132.6 ± 9.32 sec in our study while it was 147 seconds in another study in children without opioids 11 . This was due to the difference in the flow rate of oxygen gas, age, and opioids are given.…”

Section: Methodcontrasting

confidence: 40%

Untitled

2019

IJPSR

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Introduction: Tracheal intubation is commonly facilitated by the use of muscle relaxants. Sevoflurane fulfills the criteria for successful rapid & smooth inhalational induction when muscle relaxants are contra-indicated. Aim: To compare the success rate of intubation characteristics, hemodynamic changes, the effectiveness of the trapezius squeezing test for an adequate condition for intubation. Method: A total of 150 patients of ASA grade I and II undergoing elective surgical procedures of aged 20-60 years were included in our study. Patients on MAOinhibitors, antidepressants, and B-blockers were excluded. 50 patients in each group; were randomized to groups A, B, and C with sevoflurane dial concentration of 3%, 5%, and 8% respectively. Before induction, priming of the circuit with allotted group done with 3 times bag full and empty cycles. Once the trapezius squeeze test is negative, IPPV (intermittent positive pressure ventilation) was continued for another one minute. Mean arterial pressure (MAP) and heart rate (HR), jaw relaxation, body movements vocal cord position; complications were recorded for all patients. Results: The incidence of successful intubation in the first attempt was 72%, 94%, 100% in groups A, B, and group C respectively (P≤0.0001). 14/50 patients in group A and 3/50 patients in group B required a second attempt for intubation due to the stiff jaw or moderate to severe body movement. In all groups, induction time is maximum in group A p-value <0.0001. Significant increase in mean blood pressure and pulse was present from laryngoscopy to 4 min after intubation in groups A, and group B. Cardiovascular stability is seen in group C. Conclusion: Higher concentration 8% sevoflurane (group C) has a faster and more successful induction with cardiovascular stability and lesser incidence of body movements, cough compare to 5% sevoflurane (group B). TST is used as an indicator of anesthesia depth, which also seems adequate and simple to perform. INTRODUCTION: Tracheal intubation is commonly facilitated by the use of muscle relaxants. Intubation without muscle relaxants required in situations like hyperkalemia, burns, plasma cholinesterase deficiency, penetrating eye injury and myopathies.

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Section: Methodcontrasting

confidence: 40%

Untitled

2019

IJPSR

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“…Both Dexmedetomidine and Clonidine mainly are α 2 adrenergic receptor agonists with weak action on α 1 receptors. But, the ratio of selectivity to α 2 receptors for Dexmedetomidine is eight to ten times greater than that of clonidine [ 14 ] leading to better sedative effect and less side effect of dexmedetomidine.…”

Section: Discussionmentioning

confidence: 99%

“…Inomata et al reported that the MAC EX value of sevoflurane in children was 1.64% with the administration of N 2 O but without systematic analgesics [ 14 ]. In this present study, we found the MAC EX value of sevoflurane for smooth extubation to be 1.40% in Group D 0 .…”

Section: Discussionmentioning

confidence: 99%

Intravenous dexmedetomidine pre-medication reduces the required minimum alveolar concentration of sevoflurane for smooth tracheal extubation in anesthetized children: a randomized clinical trial

Yang

et al. 2018

BMC Anesthesiol

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BackgroundIt has been known that Dexmedetomidine pre-medication enhances the effects of volatile anesthetics, reduces the need of sevoflurane, and facilitates smooth extubation in anesthetized children. This present study was designed to determine the effects of different doses of intravenous dexmedetomidine pre-medication on minimum alveolar concentration of sevoflurane for smooth tracheal extubation (MACEX) in anesthetized children.MethodsA total of seventy-five pediatric patients, aged 3–7 years, ASA physical status I and II, and undergoing tonsillectomy were randomized to receive intravenous saline (Group D0), dexmedetomidine 1 μg∙kg−1 (Group D1), or dexmedetomidine 2 μg∙kg−1 (Group D2) approximately 10 min before anesthesia start. Sevoflurane was used for anesthesia induction and anesthesia maintenance. At the end of surgery, the initial concentration of sevoflurane for smooth tracheal extubation was determined according to the modified Dixon’s “up-and-down” method. The starting sevoflurane for the first patient was 1.5% in Group D0, 1.0% in Group D1, and 0.8% in Group D2, with subsequent 0.1% up or down in next patient based on whether smooth extubation had been achieved or not in current patient. The endotreacheal tube was removed after the predetermined concentration had been maintained constant for ten minutes. All responses (“smooth” or “not smooth”) to tracheal extubation and respiratory complications were assessed.ResultsMACEX values of sevoflurane in Group D2 (0.51 ± 0.13%) was significantly lower than in Group D1 (0.83 ± 0.10%; P < 0.001), the latter being significantly lower than in Group D0 (1.40 ± 0.12%; P < 0.001). EC95 values of sevoflurane were 0.83%, 1.07%, and 1.73% in Group D2, Group D1, and Group D0, respectively. No patient in the current study had laryngospasm.ConclusionDexmedetomidine decreased the required MACEX values of sevoflurane to achieve smooth extubation in a dose-dependent manner. Intravenous dexmedetomidine 1 μg∙kg−1 and 2 μg∙kg−1 pre-medication decreased MACEX by 41% and 64%, respectively.Trial registrationChinese Clinical Trial Registry (ChiCTR): ChiCTR-IOD-17011601, date of registration: 09 Jun 2017, retrospectively registered.

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“…In our study, we found that adequate ventilation was maintained and smooth extubation was safely performed at 1.3 MAC of sevoflurane with 2 lgAEkg )1 fentanyl. Importantly, Inomata et al (12) found that the 95% effective dose of sevoflurane for a smooth extubation was 1.87% in children aged 2-8 years; however, the authors could not exclude the effects of nitrous oxide.…”

Section: Discussionmentioning

confidence: 99%

“…Importantly, Inomata et al. (12) found that the 95% effective dose of sevoflurane for a smooth extubation was 1.87% in children aged 2–8 years; however, the authors could not exclude the effects of nitrous oxide.…”

Section: Discussionmentioning

confidence: 99%