Tracheal Extubation of Deeply Anesthetized Pediatric Patients: A Comparison of Desflurane and Sevoflurane

Valley, Robert D.; Freid, Eugene B.; Bailey, Ann G.; Kopp, Vincent J.; Georges, Linda S.; Fletcher, James E.; Keifer, Anne

doi:10.1213/01.ane.0000058844.77403.16

Cited by 82 publications

(54 citation statements)

References 12 publications

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“…Topical lidocaine sprayed onto the vocal cords at induction has been shown to reduce the risk of laryngospasm following short procedures [182,183]. Airway reactivity varies with anaesthetic agent, with sevoflurane and propofol being the least irritant [29,[184][185][186][187][188]. Other adjuncts that have been used to prevent laryngospasm include intravenous lidocaine, doxapram, magnesium, and ketamine [104,181,189], and acupuncture [190].…”

Section: Strategies To Prevent Laryngospasm At Extubationmentioning

confidence: 99%

Difficult Airway Society Guidelines for the management of tracheal extubation

Mitchell¹,

Dravid²,

Patel³

et al. 2012

Anaesthesia

430

139

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SummaryTracheal extubation is a high‐risk phase of anaesthesia. The majority of problems that occur during extubation and emergence are of a minor nature, but a small and significant number may result in injury or death. The need for a strategy incorporating extubation is mentioned in several international airway management guidelines, but the subject is not discussed in detail, and the emphasis has been on extubation of the patient with a difficult airway. The Difficult Airway Society has developed guidelines for the safe management of tracheal extubation in adult peri‐operative practice. The guidelines discuss the problems arising during extubation and recovery and promote a strategic, stepwise approach to extubation. They emphasise the importance of planning and preparation, and include practical techniques for use in clinical practice and recommendations for post‐extubation care.

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Section: Strategies To Prevent Laryngospasm At Extubationmentioning

confidence: 99%

Difficult Airway Society Guidelines for the management of tracheal extubation

Mitchell¹,

Dravid²,

Patel³

et al. 2012

Anaesthesia

430

139

View full text Add to dashboard Cite

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“…3,4 Many studies have investigated strategies to attenuate hyperdynamic responses, including extubation under deep anaesthesia and the use of calcium-channel blockers, b-blockers or short-acting opioids. [5][6][7] However, although extubation during the deep planes of anaesthesia avoids cardiovascular stimulation, it can also depress the respiratory and circulatory systems and occasionally results in difficulty managing the upper airway; 5 drug treatments have not been fully successful. 6,7 Dexmedetomidine is a highly specific a2-agonist with sedative, analgesic and sympatholytic effects without significant respiratory depression.…”

Section: Introductionmentioning

confidence: 99%

Optimal dose of dexmedetomidine for attenuating cardiovascular response during emergence in patients undergoing total laparoscopic hysterectomy

Seo

Kim

2014

J Int Med Res

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Objective: To investigate the optimal dose of dexmedetomidine for attenuating the haemodynamic response during emergence from anaesthesia. Methods: Patients undergoing laparoscopic total hysterectomy were randomly allocated to receive 0.9% normal saline (control group) or dexmedetomidine (0.5 mg/kg, 0.75 mg/kg or 1.0 mg/kg 30 min) before extubation. Heart rate, systolic and diastolic arterial pressure and extubation time were measured before drug administration, immediately after the end of drug administration, 10 min after the end of drug administration, immediately after extubation and 5 min after extubation. Results: A total of 120 patients were included in the study (30 per group). Systolic and diastolic arterial pressure and heart rate after drug administration were significantly lower in all three dexmedetomidine groups compared with controls. Extubation times in the 0.75 and 1.0 mg/kg dexmedetomidine groups were significantly longer than in the control group. Conclusion: Intravenous infusion of 0.5 mg/kg dexmedetomidine 30 min before the end of surgery attenuated the haemodynamic responses during emergence without prolonging the extubation time. Dexmedetomidine doses higher than 0.5 mg/kg did not exert additional positive effects on cardiovascular responses, but did significantly prolong the extubation time.

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“…However, there was no increase in severe respiratory complications, such as laryngospasm or bronchospasm. Valley et al [13] also reported that coughing occurs more frequently with desflurane, but also that it does not increase the risk of severe respiratory complications.…”

Section: Discussionmentioning

confidence: 97%

The change of sevoflurane to desflurane after anesthesia induction induces rapid emergence without increased cardiovascular responses and emergence delirium in pediatric strabismus surgery patients

Hwang¹,

Kwon²,

Kim³

et al. 2015

Anesth Pain Med

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This is an Open Access article distributed under the terms of the Creative Commons Attribution Non-Commercial License (http://creativecommons.org/licenses/by-nc/3.0) which permits unrestricted non-commercial use, distribution, and reproduction in any medium, provided the original work is properly cited. Background:Desflurane has lower solubility and shows a more rapid induction and recovery than sevoflurane, although it often induces increased cardiovascular response, emergence delirium, and respiratory complications. The change of anesthetic agent from sevoflurane to desflurane after induction may provide a smooth induction and rapid emergence. The aim of this study was to evaluate the effect of changing sevoflurane to desflurane after induction on the cardiovascular response, emergence delirium, and recovery characteristics during pediatric strabismus surgery. Methods: For the study, 135 children scheduled for strabismus surgery were randomly divided into three groups: the S group (n = 45) and D group (n = 45) received sevoflurane or desflurane, respectively, for induction and maintenance, while the C group (n = 45) received sevoflurane for induction and desflurane for maintenance. Cardiovascular responses, pediatric anesthesia emergence delirium (PAED) scale scores, post-anesthesia care unit (PACU) length of stay, and the incidence of postoperative complications were compared between groups. Results: The blood pressure of the D group was significantly different from that of the S and C groups (P ＜ 0.05). The time to extubation and first crying were significantly longer in the S group (P ＜ 0.001). There were no significant differences in PAED score, PACU length of stay, and the incidence of postoperative complications, except for cough, among the three groups. Conclusions: The change of desflurane after sevoflurane induction in pediatric strabismus surgery provided rapid emergence compared with sevoflurane, and attenuated cardiovascular responses and lesser respiratory complications as compared to desflurane. The emergence delirium was not influenced by either inhalational anesthetic. (Anesth Pain Med 2015; 10: 128-133)

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Tracheal Extubation of Deeply Anesthetized Pediatric Patients: A Comparison of Desflurane and Sevoflurane

Cited by 82 publications

References 12 publications

Difficult Airway Society Guidelines for the management of tracheal extubation

Difficult Airway Society Guidelines for the management of tracheal extubation

Optimal dose of dexmedetomidine for attenuating cardiovascular response during emergence in patients undergoing total laparoscopic hysterectomy

The change of sevoflurane to desflurane after anesthesia induction induces rapid emergence without increased cardiovascular responses and emergence delirium in pediatric strabismus surgery patients

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