Optimum sevoflurane concentration for I-gel insertion in unpremedicated children

Ghai, Babita; Sethi, Sameer; Bansal, Deepika; Ram, Jagat

doi:10.1016/j.jclinane.2015.05.024

Cited by 6 publications

(7 citation statements)

References 23 publications

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“…Supraglottic airway devices, as viable tools for airway management, have been recommended to provide oxygenation in the way of both routine use and rescue airway management [ 4 , 31 ]. Previous studies have reported the anesthetic techniques for supraglottic airway device insertion in children and lean patients [ 16 , 32 , 33 ]. However, the dose of anesthetic agents required to insert supraglottic airway devices is much less fully investigated in obese patients.…”

Section: Discussionmentioning

confidence: 99%

“…Meanwhile, sevoflurane provides better hemodynamic stability and lower incidence of apnea as compared with intravenous agents, such as propofol. The ED 50 and ED 95 of sevoflurane required for supraglottic airway device insertion in lean patients and children are now known [ 14 – 16 ]. However, no study has explored optimum end-tidal concentration of sevoflurane for supraglottic airway device insertion allowing spontaneous breathing in 50% of obese patients.…”

Section: Introductionmentioning

confidence: 99%

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The optimum sevoflurane concentration for supraglottic airway device Blockbuster™ insertion with spontaneous breathing in obese patients: a prospective observational study

et al. 2017

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BackgroundAirway management of the obese patient presenting for surgery is more likely to be a challenging problem. Supraglottic airway device has been adopted as a bridge to connect ventilation and tracheal intubation in obese patients who would be suffered with difficult intubation. The optimum sevoflurane concentration for supraglottic airway device insertion allowing spontaneous breathing in 50% of obese patients (ED50) is not known. The purpose of this study was to determine the ED50 of sevoflurane for supraglottic airway device Blockbuster™ insertion with spontaneous breathing in obese patients requiring general anesthesia.MethodsThirty elective obese patients (body mass index 30-50 kg/m2) undergoing bariatric surgery were recruited in this study. The predetermined target sevoflurane concentration (initiating at 2.5% with 0.5% as a step size) was sustained for >5 min using a modified Dixon’s up-and-down method, and then the supraglottic airway device Blockbuster™ was inserted. The patient’s response to supraglottic airway device insertion was classified as either ‘movement’ or ‘no-movement’. The ED50 of sevoflurane were determined by calculating the midpoint concentration of crossover point from ‘movement’ or ‘no-movement’ response.ResultsThe ED50 of sevoflurane for supraglottic airway device Blockbuster™ insertion in obese patients calculated using up-and-down method were 2.50 ± 0.60%. The ED50 and ED95 (95% confidence interval) obtained by probit regression analysis were 2.35 (1.28–3.42) % and 4.03 (3.16–17.83) % for supraglottic airway device Blockbuster™ insertion, respectively.ConclusionWe conclude that the optimum end-tidal sevoflurane concentration required for the supraglottic airway device Blockbuster™ insertion allowing spontaneous breathing in 50% of obese patients (ED50) is 2.5 ± 0.6%.Trial registrationChinese Clinical Trial Registry, ChiCTR-IPR-16009071, Registered on 24 August 2016.

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Section: Discussionmentioning

confidence: 99%

Section: Introductionmentioning

confidence: 99%

The optimum sevoflurane concentration for supraglottic airway device Blockbuster™ insertion with spontaneous breathing in obese patients: a prospective observational study

et al. 2017

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“…There have been many studies calculating and comparing the EC50 for classic laryngeal mask airway (LMA) insertion, I gel insertion, laryngoscopy and endotracheal intubation in both children and adults . The EC50 documented for I gel insertion is far too less than end tidal sevoflurane value documented by abovementioned studies for intravenous cannulation.…”

Section: Discussionmentioning

confidence: 99%

“…After establishing intravenous access, injection fentanyl 0.5 µg/kg was administered and appropriate sized I‐Gel was inserted for maintenance of airway after achieving adequate effective concentration required for I‐Gel insertion . Anaesthesia was maintained with 2%–3% sevoflurane in oxygen and nitrous oxide.…”

Section: Methodsmentioning

confidence: 99%

Sevoflurane EC50 for intravenous cannulation attempt and movement in children

Goel

Jain

Ghai

2019

Acta Anaesthesiol Scand

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Background: Intravenous cannulation at lighter planes of anaesthesia can lead to adverse respiratory and haemodynamic events. So far, there is no consensus on optimum end tidal sevoflurane concentration required for intravenous cannulation in children. We aimed to evaluate the optimum end tidal concentration at which an intravenous cannulation can be successfully attempted without movements in paediatric patients after inhalational induction of general anaesthesia. Material and Methods:In this clinical trial, paediatric subjects of either sex aged 1-3 years, weighing 7-15 kg having American Society of Anaesthesiologists physical status I/II of undergoing elective cataract surgery were included. After inhalational induction of general anaesthesia with 8% sevoflurane and 100% oxygen, end tidal sevoflurane concentration was maintained at 2% for 4 minutes for the first child. This was followed by intravenous cannulation attempted by an experienced anesthesiologist. The intravenous cannulation was considered to be unsuccessful if there was "movement" and successful if there was "no movement" in response to the stimuli of cannulation. End-tidal concentration was increased/decreased (step-size 0.2% for sevoflurane) using Dixon and Massey up and down method in the next patient depending upon previous patient's response. Results:The sevoflurane EC50 for successful intravenous cannulation is 1.32% ± 1.0%.Pearson correlation (r) between weight of the child and response to intravenous cannulation was found to be 0.40 with P value of 0.008. Conclusion:Intravenous cannulation can be accomplished without movements at end tidal sevoflurane of 1.3% in children aged 1-3 years in 50% of children.

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“…Recent pediatric anesthesia examples of Dixon‐like UDM include investigating the optimal dose of propofol for pediatric tracheal intubation during sevoflurane induction , the effect of age on the dose of remifentanil for tracheal intubation , the size of a rapid bolus dose of dexmedetomidine with acceptable hemodynamic outcomes in children , MAC‐awake of sevoflurane in children , the median effective concentration of propofol during oesophagogastroduodenoscopy , the dose range of levobupivacaine or ropivacaine spinal anesthesia in neonates , the MAC of desflurane with fentanyl for laryngeal mask airway removal , the effect of epidural clonidine on MAC of levobupivacaine for caudal block , the MAC of desflurane with caudal analgesia for laryngeal mask airway removal , the optimum sevoflurane concentration for I‐gel insertion in unpremedicated children , the optimal dose of sevoflurane or desflurane for laryngeal mask airway removal in anesthetized children following cataract surgeries using subtenon block , the dose of caudal dexmedetomidine needed to decrease required concentrations of levobupivacaine for caudal block , or identifying the ropivacaine concentration required for US‐guided ilioinguinal/Iliohypogastric nerve block .…”

Section: Sequential Design Methodsmentioning

confidence: 99%

Sequential allocation trial design in anesthesia: an introduction to methods, modeling, and clinical applications

Görges

Zhou

Brant

et al. 2017

Pediatric Anesthesia

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Summary Estimation of the dose–response curve for new anesthetic protocols typically focuses on identifying minimum effective doses. The application of a sequential experimental method is appropriate, as it minimizes sample size requirements by updating dose assignments based on information accrued from successive subjects. One approach is the up‐and‐down method for estimating the median effective dose in a patient population (ED50). Designs better suited for achieving greater than 50% effectiveness, include the biased coin approach, and continual reassessment method. In this review we introduce different sequential design methods, provide examples of their use, and show through simulation how the method employed influences sample size and the accuracy of the estimated dose. Simulation studies are presented to illustrate the effects of dose parameter and stopping rule choice for up‐and‐down method and biased coin approach. For continual reassessment method, the effects of assumed dose–response model, prior guess, and cohort size are simulated. A binary response regression curve was fit to the data in Saidman and Eger's endtidal halothane dose‐finding study to provide a dose–response curve for generating simulations. A range of options exist when designing a study using sequential allocation with biased coin approach or continual reassessment method. Method choice influences the required sample size and confidence in estimated effect. In the halothane example, up‐and‐down method decreases the required sample size by 20–30% when the choice of design parameters is optimal. For both up‐and‐down method and biased coin approach designs, greater sample sizes, arising from adjusted stopping criteria, might be required to achieve reliable estimates. The continual reassessment method is only efficient if a limited range of doses can be chosen a priori. In conclusion the up‐and‐down method can be more efficient than nonsequential designs for the estimation of the median dose/intervention level for a given intervention (ED50). The biased coin approach or continual reassessment method are preferred for the estimation of higher or lower tail quantiles such as ED90 or ED10. Continual reassessment method may be superior if knowledge of the dose–response relationship is available for the drug of interest.

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Optimum sevoflurane concentration for I-gel insertion in unpremedicated children

Cited by 6 publications

References 23 publications

The optimum sevoflurane concentration for supraglottic airway device Blockbuster™ insertion with spontaneous breathing in obese patients: a prospective observational study

The optimum sevoflurane concentration for supraglottic airway device Blockbuster™ insertion with spontaneous breathing in obese patients: a prospective observational study

Sevoflurane EC50 for intravenous cannulation attempt and movement in children

Sequential allocation trial design in anesthesia: an introduction to methods, modeling, and clinical applications

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