ABSTRACT
Background and objectives - Sevoflurane is a new anhalational agent with low blood solubility which provides rapid induction and recovery, desirable characteristics in outpatient anesthesia. The aim of this study was to compare sevoflurane and halothane regarding quality of induction, cardiovascular stability and characteristics of post-anesthetic recovery in pediatric outpatients. Methods - Forty-one physical status ASA I pediatric outpatients were allocated into two groups, as they received sevoflurane or halothane in N2O/O2 (50/50 per cent) for induction and maintenance of anesthesia. Orotracheal intubation was performed after a sigle dose of succinylcholine. Monitoring throughout the study included PET CO2, ET N2O, ET O2, ET SEVO, ET HALO, SBP, DBP and HR. Results - Exposure time to the anesthetics were similar in both groups. There were no significant differences in induction times between the groups. Times to eye opening, to obey command, to orientation, and to discharge from phase I recovery were significantly shorter in the sevoflurane group as compared to the halothane group. Time to discharge from phase II recovery was also shorter in the sevoflurane group, although not statistically significant. The incidence of adverse effects was similar in both groups. Cardiovascular stability was good with both agents. Conclusions - The smooth and rapid induction, the good cardiovascular stability and the relatively low incidence of adverse effects make sevoflurane a good anesthetic for pediatric outpatients. The results of thie study regarding postanesthetic recovery time indicate some advantage of sevoflurane over halothane. Nevertheless, the early arousal causes intense pain perception soon after discontinuation of the anesthetic, thus requiring an effective method of postoperative analgesia
Subject(s)
Humans , Infant, Newborn , Infant , Child, Preschool , Child , Adolescent , Anesthesia, Inhalation/methods , Halothane , Halothane/adverse effectsABSTRACT
Background and Objectives - Sufentanil is 5 to 10 times more potent than fentanyl and this property parallels its greateraffinity for opioid receptors. The aims of thisnon-comparative study were to determine the dose requirements of sufentanil used as part of a balanced technique and to evaluate the cardiovascular consequences and the recovery from anesthesia following its use. Methods - Fifty adult ASA physical status I-II patients, aged 41.02 +- 11.45 years undergoing elective intra-abdominal surgeries were studied. Anesthesia was induced with midazolam 0.2 mg.Kg-1 and sufentanil 3.0 ug.Kg-1, followed by pancuronium and tracheal intubation. Patients received N2O/O2 (50/50 per cenmt) and were maintained under mechanical controlled ventilation in a rebreathing circuit with CO2 absorbant. Sufentanil infusion rate was adjusted in order to avoidsigns of light anesthesia. Both the opioid and N2O were discontinued 10 min before the presumed end surgery. Using non-invasive methods, systolic (SAP), diastolic (DAP) and mean (MAP) arterial pressure, heart rate (HR) and oxygen saturation (SpO2) were monitored throughout the procedure. Total consumption of sufentanil and infusion rate requirements were evaluated, as well as duration and quality anesthesia recovery, residual analgesia and perioperative complications. Results - The mean duration of the procedures was 162.42+-69.16 min, the mean total dose of sufentanil was 6.78+-2.29 ug.Kg-1 and the mean infusion rate was 0.024+-0.06 ug.Kg-1. The mean time for recovery to stage IV (well oriented in time and space) was 39.88+-13.95 min. Forty patients (80 per cent) required naloxone to antagonize respiratory depression 30 minafter the discontinuation of opioid infusion. Despiste the reduction in SAP, DAP and MAP following induction, tracheal intubation and surgical incision, there was good cardiovascular stability. Residual analgesia lasting more than 6 hours after discontinuation of sufentanil was observed in 66 per cent of the patients. Conclusions - The technique provides good anesthesia for intra-abdominal surgeries. In order to avoid light anesthesia, sufentanil infusion rate should be titrated for each patient. The high incidence of respiratory depression in the immediate postoperative period requires special observation of these patients in the recovery room
Subject(s)
Anesthetics, Intravenous , Cholecystostomy , Colectomy , Gastrectomy , Hysterectomy , PancreatectomyABSTRACT
Background and objectives - Sevoflurane is a new inhalational anesthetic with short induction and recovery times, which make it appropriate for outpatient surgery. The purpose of this study is to present our experience with sevoflurane in adult outpatients. Methods - Sevoflurane was used for maintenance of anesthesia in 40 adult patients, with age range of 30.9 +- 10.5 years and ASA physical status I or II, undergoing ambulatory procedures. Induction of anesthesia was obtained with midazolam 0.25 mg/Kg-1 and alfetanil 30 ug/Kg-1 and the patients were maintained with N2O/O2 (60/40 per cent), under tracheal intubation and controlled mechanical vntilation, in a rebreating system with CO2 absorption. Sevoflurane was administered via the Ohmeda Sevotec 5 vaporizer. Monitoring included SpO2, PETCO2, ETN2O, and ETSEVO, with the aid of the CapnomacOhmeda Datex. Systol;ic and diastolic blood pressure and heart rate were registered at the following moments: 1) one minute before induction; 2) one minute after tracheal intubation; 3) one minute before surgical incision; 4) five minutes after surgical incision; 5) ten minutes after discontinuation of sevoflurane. The following parameters related to recovery from anesthesia were studied: awakening time, time to verbal command, time to orientation, time to liberation from phase I, time to liberation from phase II (hospital discharge). Time of exposure to sevoflurane and untoward effects were also registered. Results - Mean time of exposure to sevoflurane was 81.1 +- 43.9 min and mean values of end tidal sevoflurane were 1.07 +- 0.40 per cent one miute after tracheal intubation, 1.75 +- 0.38 per cent one minute before surgical incision and 1.85 +- 0.61 per cent five minutes after surgical incision. Recovery times from anesthesia were as follows: awakening 19.1 +- 9.5 min; response to command 21.8 +- 11.2 min; orientation 26.8 +- 11.5 min; phase I 53.2 +- 9.7 min; phase II 144.9 +- 41.7 min. Hypotension (decrease in SBP greater than 30 per cent of pre induction values) ocurred in 17 patients (42.5 per cent) and was promptly controlled by reducing the inspired concentration of sevoflurane. Awareness did not occur and acceptance was good in all cases. Conclusions - The fast recovery and the low incidence of untoward effects indicate that sevoflurane is an appropriate anesthetic for outpatients