Intubating conditions and adverse events during sevoflurane induction in infants

Devys, Jean‐Michel; Mourissoux, G.; Donnette, F.X.; Plat, R; Schauvliege, Franck; Bigot, P. Le; Dureau, P.; Plaud, Benoît

doi:10.1093/bja/aeq346

Cited by 39 publications

(33 citation statements)

References 27 publications

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“…The age range of children enrolled in the studies using sevoflurane induction of anesthesia was 12–120 months; one study included children aged 1–24 months (10) (Table 1). The age range of children enrolled in the studies using propofol induction of anesthesia was 12–180 months (Table 2).…”

Section: Resultsmentioning

confidence: 99%

“…(10), who reported respiratory or hemodynamic events in 11 of 27 (40.1%) patients in the saline group and in 12 of 23 (52.2%) patients in the alfentanil group. Failed intubations at first attempt were reported in three of the nine studies (9–11) (Table 1), which represent a total of 16 failed intubations at first attempt and an incidence of 2.3%.…”

Section: Resultsmentioning

confidence: 99%

“…Four studies evaluated sevoflurane alone for intubation (Table 1) (10,(12)(13)(14)(15). The weighted average of excellent intubating conditions was 41% (range, 14.3-71.7%, n = 107).…”

Section: Sevoflurane Alonementioning

confidence: 99%

See 2 more Smart Citations

The effect of adjuvant drugs on the quality of tracheal intubation without muscle relaxants in children: a systematic review of randomized trials

Aouad

Yazbeck‐Karam

Mallat

et al. 2012

Pediatric Anesthesia

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Intubation without prior administration of muscle relaxants is a common practice in children. However, succinylcholine may be considered as the golden standard for optimizing intubating conditions. We conducted a systematic review of the literature to identify drug combinations that included induction of anesthesia with sevoflurane or propofol. Our aim was to select drug combinations that yield excellent intubating conditions ≥80%; we identified six combinations in children aged 1-9 years. Sevoflurane with remifentanil (1 or 2 μg·kg(-1) ), lidocaine (2 mg·kg(-1) ), or propofol (2 mg·kg(-1) ) as the adjuvant shared the following characteristics: premedication with midazolam and/or ketamine, long sevoflurane exposure time, high inspired and endtidal sevoflurane concentration, and assisted ventilation. One combination using sevoflurane with propofol (3 mg·kg(-1) ) without premedication, with shorter sevoflurane exposure time, and spontaneous breathing indicated that propofol may be the adjuvant of choice for a rapid sevoflurane induction. The only adjuvant identified in propofol induction was remifentanil (4 μg·kg(-1) ). No serious adverse events were reported with these combinations.

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Section: Resultsmentioning

confidence: 99%

Section: Resultsmentioning

confidence: 99%

See 1 more Smart Citation

The effect of adjuvant drugs on the quality of tracheal intubation without muscle relaxants in children: a systematic review of randomized trials

Aouad

Yazbeck‐Karam

Mallat

et al. 2012

Pediatric Anesthesia

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“…While NMBA can reduce the risk of laryngospasm at the time of tracheal intubation [62], a large observational cohort study demonstrated a greater incidence of laryngospasm in the postoperative period [8]. Maintenance of anesthesia with sevoflurane, propofol, or isoflurane is associated with a significantly smaller incidence of laryngospasm compared with desflurane, which should be avoided in children (see also under bronchospasm) [8,63].…”

Section: Anesthetic Agentsmentioning

confidence: 99%

Diagnosis and Management of Respiratory Adverse Events in the Operating Room

Regli

Ungern‐Sternberg

2015

Curr Anesthesiol Rep

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Perioperative respiratory adverse events cause more than three-quarters of all perioperative critical incidents in pediatric anesthesia and approximately half of anesthesia-related cardiac arrests. We can define seven main clinical types of perioperative respiratory adverse events: upper airway obstruction, laryngospasm, bronchospasm, severe persistent cough, apnea, stridor, and oxygen desaturation. Depending on the definitions used for preoperative respiratory adverse events and the cohort of children examined, the incidence varies between 8 and 21 %. This review discusses the recognition and treatment of perioperative respiratory adverse events. Furthermore, it provides guidance on how to identify children who are at increased risk for developing perioperative respiratory adverse events and how to tailor the perioperative anesthetic management for the individual child in order to minimize the risk of perioperative respiratory adverse events.

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“…A controversial and perhaps more appropriate question is the use of muscle relaxants in the management of the difficult pediatric airway vs maintenance of spontaneous respiration. The use of muscle relaxant to facilitate intubations in infants and children in conjunction with Sevoflurane anesthetic was associated with fewer adverse respiratory events . The decision to administer muscle relaxant is contingent on the underlying airway pathology and expected ability to perform mask ventilation.…”

Section: Anesthetic Management For Difficult Pediatric Airwaymentioning

confidence: 99%

Pediatric airway management: current practices and future directions

Sunder

Haile

Farrell

et al. 2012

Pediatric Anesthesia

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Management of a pediatric airway can be a challenge, especially for the non-pediatric anesthesiologists. Structured algorithms for an unexpected difficult pediatric airway have been missing so far. A recent step wise algorithm, based on the Difficult Airway society (DAS) adult protocol, is a step in the right direction. There have been some exciting advances in development of pediatric extra-glottic devices for maintaining ventilation, and introduction of pediatric versions of new 'non line of sight' laryngoscopes and optical stylets. The exact role of these devices in routine and emergent situations is still evolving. Recent advances in simulation technology has become a valuable tool in imparting psychomotor and procedural skills to trainees and allied healthcare workers. Moving toward the goal of eliminating serious adverse events during the management of routine and difficult pediatric airway, authors propose that institutions develop a dedicated Difficult Airway Service comprising of a team of experts in advanced airway management.

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Intubating conditions and adverse events during sevoflurane induction in infants

Abstract: In 1- to 24-month-old infants, the addition of 0.3 mg kg⁻¹ rocuronium to 8% sevoflurane improved intubating conditions and decreased the frequency of respiratory adverse events. Alfentanil provided no additional benefit in this study.

Cited by 39 publications

References 27 publications

The effect of adjuvant drugs on the quality of tracheal intubation without muscle relaxants in children: a systematic review of randomized trials

The effect of adjuvant drugs on the quality of tracheal intubation without muscle relaxants in children: a systematic review of randomized trials

Diagnosis and Management of Respiratory Adverse Events in the Operating Room

Pediatric airway management: current practices and future directions

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