Vital Capacity Induction with Sevoflurane in Children Results in Less Incidence of Withdrawal after Rocuronium than Tidal Volume Induction / 대한마취과학회지

BACKGROUND: The Vital capacity technique is known to have some advantages over the tidal volume technique during inhalation induction of anesthesia.The aim of this study was to compare the incidence of withdrawal movement associated with the intravenous administration of rocuronium 0.3 mg/kg in children during inhalation induction with sevoflurane using the tidal volume and vital capacity techniques. METHODS: We randomly assigned 130 patients (aged 5-12 years) to either tidal volume (group T) or vital capacity (group V) groups for inhalation induction with sevoflurane.Rocuronium 0.3 mg/kg was administrated after loss of the eyelash reflex.The time to loss of the eyelash reflex was recorded and adverse events during induction were documented.The patient's response to rocuronium injection was graded using a four-point scale. RESULTS: No significant differences were observed between the groups with respect to age, weight, and gender.The time to loss of the eyelash reflex was more rapid in group V than in group T (P < 0.05).Excitatory movement developed more frequently in group T, and no significant differences were found in the incidence of other adverse events between the groups.The incidence of withdrawal movement associated with the injection of rocuronium was significantly lower in group V compared to group T (30 vs. 60%; P < 0.05). CONCLUSIONS: Inhalation induction with sevoflurane using the vital capacity technique decreased the incidence of withdrawal movement during the injection of rocuronium compared to the tidal volume technique.

Effects of Diltiazem with Sevoflurane on Coronary Flow and Myocardial Contractility in the Isolated Rat Heart / 대한마취과학회지

BACKGROUND: Calcium channel blockers and volatile anesthetics have depressant effects on myocardial contractility by limiting Ca2+ entry and altering intracellular Ca2+ release. The aim of this study was to compare the direct cardiac effects of isoflurane, desflurane and new volatile anesthetics, sevoflurane, in combination with diltiazem on the isolated rat heart. METHODS: Sprague-Dawley rat hearts (N = 60) were isolated and perfused with oxygenated modified Krebs solution at 55 mmHg with 0.5, 1, 2 MAC of isoflurane, desflurane or sevoflurane in combination with diltiazem 42 ng/ml (group 1) and 84 ng/ml (group 2). Isovolumetric left ventricular pressure (LVP), rate of change ventricular pressure (dP/dt), heart rate and coronary flow were measured. To examine the indirect metabolic effect due to autoregulation of coronary flow, O2 delivery (DO2), myocardial O2 consumption (MVO2) and percent O2 extraction (POE) were also monitored. RESULTS: Diltiazem plus volatile anesthetics depressed LVP and dP/dt and increased coronary flow dose-dependently. They also decreased heart rate. In the group 2, at 2 MAC of inhaled anesthetics heart rate was significantly decreased than group 1. There were no statistical significance between isoflurane, desflurane and sevoflurane on myocardial contractility and myocardial oxygenation. CONCLUSIONS: These in vitro RESULTS demonstrate that clinical dose of diltiazem plus isoflurane, desflurane or sevoflurane has similar effects on myocardial contractility and coronary flow.

A Comparative Study of Arrhythmogenic Doses of Epinephrine during Sevoflurane or Halothane Anesthesia in the Dogs / 대한마취과학회지

BACKGROUND: Epinephrine used in surgery to provide hemostasis may elicit ventricular arrhythmias. A desirable anesthetic would not sensitize the myocardium to exogenously administered epinephrine. So the effect of sevoflurane, which was introduced to clinical anesthesia recently, on cardiac arrhythmias induced by the infusion of epinephrine was compared with those of halothane which was already known to epinephrine-induced arrhythmia in the 14 mongrel dogs. METHODS: The authors compared the arrhythmogenicity (three or more premature ventricular contractions, PVCs)of intravenously administered epinephrine in 14 mongrel dogs who were randomly assigned to receive sevoflurane (1.7 vol%) or halothane (0.75 vol%) anesthesia equipotently. The arrhythmogenic doses of epinephrine determined in this comparative study were expressed by both infusion rates of epinephrine during sevoflurane and halothane anesthesia. RESULTS: The mean values of the arrythmogenic infusion rates of epinephrine were 27.1 7.6 g/kg for sevoflurane and 2.7 0.8 g/kg for halothane. CONCLUSIONS: We concluded that the arrythmogenic doses of epinephrine during sevoflurane were significantly higher than those during halothane anesthesia.

The Study for Renal Effects of Increased Serum and Urinary Inorganic Fluoride Levels after Prolonged Sevoflurane Anesthesia / 대한마취과학회지

BACKGROUND: Sevoflurane (CH2F-O-CH(CF3)2) is a fluorinated derivative of ethyl isoprophyl ether. Sevoflurane has a blood/gas partition coefficient of 0.60 that allows a rapid induction and emergence of anesthesia. But sevoflurane is metabolized to inorganic fluoride known as the etiologic agent of anesthetic nephrotoxicity, more than halothane and isoflurane. It is not known whether sevoflurane biotransformation produce high inorganic plasma fluoride level, thus increasing the potential for fluoride-induced renal dysfunction. The aim of this prospective study was to dertermine the levels of serum inorganic fluoride and the influnce of renal function after prolonged sevoflurane anesthesia METHODS: In this study the serum and urine inorganc fluoride ions concentration were measured before, during, and after sevoflurane anesthesia, respectively, with urine volume and osmolarity in the prolonged sevoflurane anesthesia group (brain aneurysm patients, n=6, anesthetic time: 360 min). RESULTS: The peak serum fluoride concentration was 71.68 microgrammol/L, 6 hours during anesthesia and then the concentration of serum inorganic fluoride decreased quickly. Peak urinary fluoride concentration was 1344+/-303.29 microgrammol/L, 8 hours after cessation of sevoflurane anesthesia, and its concentration was less than 100 microgrammol/L on the third postoperative day. No evidence of abnormal hepatorenal function occurred in the postoperative period. CONCLUSIONS: Anesthesia with sevoflurane is safe without significant adverse effects in the patients. Although the mean peak serum fluoride levels were 71.68 microgrammo l/L no evidence of abnormal renal function occurred in any of the patients in the postoperative period.