A Comparative Evaluation of Fixed High Concentration Versus Incremental Concentration of Sevoflurane for Induction And Intubation without Muscle Relaxant In Paediatric Patients
Journal Title: IOSR Journal of Dental and Medical Sciences (IOSR-JDMS) - Year 2017, Vol 16, Issue 9
Abstract
Background: Inhalational anesthesia is the preferred technique of induction in the paediatric age group. Halothane with its negligible pungency and minimal effects on airway reactivity has been the cornerstone of pediatric inhalational induction. Continued research to manufacture an inhalational agent which would match the induction properties of halothane, with minimal cardiac and hepatic side effects and requiring lesser time for induction and emergence led to the introduction of Sevoflurane. Materials and Methods: Sixty patients ASA Grade I and II aged 2-6 yrs were randomly divided into two groups. Group A patients were induced and intubated with 8% Sevoflurane in nitrous oxide and oxygen in a ratio of 2:1 without muscle relaxant. Group B patients were induced and intubated with incremental Sevoflurane in nitrous oxide and oxygen in a ratio of 2:1 with 1% increase every 2-3 breaths without muscle relaxant. In the high concentration group, the anesthesia circuit was primed with 8% sevoflurane in a 2:1 nitrous oxide: oxygen ratio. Patient breathed this gas mixture spontaneously through facemask until loss of eyelash reflex. In the incremental group, face mask was applied and 1% sevoflurane in the same gas ratio was administered. In this group sevoflurane was increased by 1% every 2 to 3 breaths. Induction time was noted and was taken from face mask application to loss of the eyelash reflex (T1). Intubation was attempted when pupils became constricted and centralized, and intubation time was recorded (face mask application to centralization of pupils). Results: Induction time (T1) was taken as the time from face mask application to the loss of eyelash reflex. Mean induction time ± standard deviation observed in Group A was 24.30 ± 9.60 seconds, while in Group B it was 130.93 ± 44.65 seconds. On comparing the two groups using unpaired student's 't' test, the difference between the two groups was found to be statistically highly significant (p value<0.01). T2 (intubation time) was taken as time during which intubation was attempted and was taken from face mask application to when pupils became centralized and constricted. Mean intubation time ± standard deviation observed in Group A was 123.26 ± 18.37 seconds, while in Group B it was 216.26 ± 45.67 seconds. On comparing the two groups using unpaired student's 't' test, the difference between the two groups was found to be statistically highly significant (p<0.01). Conclusion: Sevoflurane use as sole anesthetic agent for induction and intubation is associated with significant changes in heart rate ,blood pressure and oximetric values in both the groups.The induction and intubation time was significantly shorter in high concentration group. Since both the techniques (high concentration & incremental) of sevoflurane was associated with significant changes in haemodynamics and pulse oximetery , hence it is concluded that sevoflurane induction and intubation without use of muscle relaxant is not safe in paediatric age groups.
Authors and Affiliations
Gurpreet Singh, Sahir Rasool, Naseer Bashir Khanday, Nahida Saleem
Keywords
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- EP ID EP256061
- DOI 10.9790/0853-1609052835
- Views 110
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