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Br J Anaesth ; 108(4): 648-54, 2012 Apr.
Artigo em Inglês | MEDLINE | ID: mdl-22265901

RESUMO

BACKGROUND: In children, sevoflurane is the most commonly used anaesthetic. Its excellent haemodynamic tolerance gives it a wide therapeutic index. This halogenated agent can abolish movement [minimal alveolar concentration (MAC)] or haemodynamic responses (MACBAR) to noxious stimulus in children as in adults. Reflex pupillary dilatation (RPD) has been demonstrated as a very sensitive measure of noxious stimulation. In order to investigate the effect of sevoflurane on the RPD, a subcortical reflex, we determined the MAC of sevoflurane inhibiting the RPD in 50% of the subjects in response to skin incision (MACpup) in pre- and post-pubertal subjects. METHODS: We included 30 pre-pubertal children and 19 post-pubertal subjects. Patients received sevoflurane at preselected concentrations according to an 'up and down' design, and after a steady-state period, skin incision was performed. The RPD was considered as significant when the pupillary diameter increased by more than 100%. Heart rate (HR) and bispectral index (BIS) changes were analysed according to the pupillary response. RESULTS: The MACpup of sevoflurane was 4.8% (95% confidence interval, 4.6-5.1%) in pre-pubertal children vs 3.4% (3.5-3.3%) in post-pubertal subjects (P<0.001). Inhibition of RPD was always associated with lack of significant HR response. In pre-pubertal children receiving high concentrations of sevoflurane, RPD in response to noxious stimulation was frequently associated with lack of HR response and low BIS values. CONCLUSIONS: MACpup was higher than MAC and close to the MACBAR. Inhibition of RPD in pre-pubertal children required higher sevoflurane concentrations compared with post-pubertal subjects, suggesting that the relationship between the brain structure sensitivities may differ with brain maturation.


Assuntos
Anestésicos Inalatórios/farmacologia , Procedimentos Cirúrgicos Dermatológicos , Éteres Metílicos/farmacologia , Alvéolos Pulmonares/metabolismo , Reflexo Pupilar/efeitos dos fármacos , Adolescente , Fatores Etários , Análise de Variância , Anestesia Geral , Anestésicos Inalatórios/farmacocinética , Criança , Pré-Escolar , Estudos Cross-Over , Relação Dose-Resposta a Droga , Eletroencefalografia/efeitos dos fármacos , Frequência Cardíaca/efeitos dos fármacos , Humanos , Lactente , Éteres Metílicos/farmacocinética , Monitorização Intraoperatória/métodos , Estudos Prospectivos , Sevoflurano
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