Respiratory Mechanics During Sevoflurane Anesthesia in Children With and Without Asthma

Abstract

We studied lung function in children with and without asthma receiving anesthesia with sevoflurane. Fiftytwo children had anesthesia induced with sevoflurane (up to 8%) in a mixture of 50% nitrous oxide in oxygen and then maintained at 3% with children breathing spontaneously via face mask and Jackson-Rees modification of the T-piece. Airway opening pressure and flow were then measured. After insertion of an oral endotracheal tube under 5% sevoflurane, measurements were repeated at 3%, as well as after increasing to 4.2%. Respiratory system resistance (Rrs) and compliance during expiration were calculated using multilinear regression analysis of airway opening pressure and flow, assuming a single-compartment model. Data from 44 children were analyzed (22 asthmatics and 22 normal children). The two groups were comparable with respect to age, weight, ventilation variables, and baseline respiratory mechanics. Intubation was associated with a significant increase in Rrs in asthmatics (17% Ϯ 49%), whereas in normal children, Rrs slightly decreased (Ϫ4% Ϯ 39%). At 4.2%, Rrs decreased slightly in both groups with almost no change in compliance system resistance. We concluded that in children with mild to moderate asthma, endotracheal intubation during sevoflurane anesthesia was associated with increase in Rrs that was not seen in nonasthmatic children. Implications: Tracheal intubation using sevoflurane as sole anesthetic is possible and its frequency is increasing. When comparing children with and without asthma, tracheal intubation under sevoflurane was associated with an increase in respiratory system resistance in asthmatic children. However, no apparent clinical adverse event was observed.

Sevoflurane: Approaching the Ideal Inhalational Anesthetic A Pharmacologic, Pharmacoeconomic, and Clinical Review

“…Sevoflurane has been used successfully for pediatric anesthesia in high-risk situations. Respiratory mechanics were measured during sevoflurane anesthesia in 44 children with and without asthma (112). In children with asthma, tracheal intubation was associated with an increase in respiratory system resistance.…”

Halothane, an Effective Infrequently Used Drug, in the Treatment of Pediatric Status Asthmaticus: A Case Report

“…Inhalational anesthetics have only been used sporadically for the treatment of refractory status asthmaticus in pediatric patients (Table 1) (6)(7)(8)(9)(10). Halothane is a relatively safe and effective inhalational anesthetic approved for clinical use in 1956.…”

Salbutamol premedication in children with a recent respiratory tract infection

“…albuterol or fenoterol, has been shown to reduce total respiratory resistance following tracheal intubation in adults (27–29). Because salbutamol has been shown to prevent the increase in respiratory resistance caused by tracheal intubation during sevoflurane anesthesia in asthmatic children (17,30), the use of salbutamol in children with bronchial hyperreactivity caused by a recent RTI does most probably have the same underlying mechanism leading to a decrease in the incidence of respiratory adverse events as highlighted by this audit. It is noteworthy that salbutamol exerts its bronchodilatory effects by acting only on the airway compartment of the lung, thus protecting from the cholinergic‐induced bronchoconstriction encountered under anesthesia (31,32).…”