Inhalation induction with sevoflurane in adult cardiac surgery patients. A case series.

INTRODUCTION: Anesthesia induction through volatile agents is a well-established technique in several fields but not in adult patients undergoing cardiac surgery. Successful inhalation induction requires a poorly soluble, reasonably potent and minimally irritant agent, and the benefits associated to this technique include reduced incidence of hypothermia and hypotension and lower costs when compared to some intravenous anesthetics agents. METHODS: Fifty-six patients undergoing coronary artery bypass grafting were observed at the induction of general anesthesia with sevoflurane in oxygen by facial mask. All patients received 2% sevoflurane in 100% oxygen initially for 30 seconds. The inspired concentration of sevoflurane was increased to 7% until loss of consciousness and then reduced back to 2%. Next, intravenous 0.5 µg/kg sufentanil and 0.1 mg/kg pancuronium were administered. Volume-controlled ventilation was started before tracheal intubation. RESULTS: All 56 patients tolerated the inhalational induction. No patient presented signs of airway irritation. Hypotension occurred in 30 patients and was managed with low dose phenylephrine. CONCLUSIONS: This case series showed that inhalation induction is feasible and safe even in adult patients undergoing cardiac surgery.

Inhalation induction with sevoflurane in adult cardiac surgery patients. A case series

Introduction: Anesthesia induction through volatile agents is a well-established technique in several fields butnot in adult patients undergoing cardiac surgery. Successful inhalation induction requires a poorly soluble, reasonablypotent and minimally irritant agent, and the benefits associated to this technique include reduced incidenceof hypothermia and hypotension and lower costs when compared to some intravenous anesthetics agents.Methods: Fifty-six patients undergoing coronary artery bypass grafting were observed at the induction ofgeneral anesthesia with sevoflurane in oxygen by facial mask. All patients received 2% sevoflurane in 100%oxygen initially for 30 seconds. The inspired concentration of sevoflurane was increased to 7% until loss ofconsciousness and then reduced back to 2%. Next, intravenous 0.5 ìg/kg sufentanil and 0.1 mg/kg pancuroniumwere administered. Volume-controlled ventilation was started before tracheal intubation.Results: All 56 patients tolerated the inhalational induction. No patient presented signs of airway irritation.Hypotension occurred in 30 patients and was managed with low dose phenylephrine.Conclusions: This case series showed that inhalation induction is feasible and safe even in adult patientsundergoing cardiac surgery.

Anaesthetic drugs and survival: a Bayesian network meta-analysis of randomized trials in cardiac surgery.

BACKGROUND: Many studies have compared desflurane, isoflurane, sevoflurane, total i.v. anaesthesia (TIVA), or all in cardiac surgery to assess their effects on patient survival. METHODS: We performed standard pairwise and Bayesian network meta-analyses; the latter allows indirect assessments if any of the anaesthetic agents were not compared in head-to-head trials. Pertinent studies were identified using BioMedCentral, MEDLINE/PubMed, Embase, and the Cochrane Library (last updated in June 2012). RESULTS: We identified 38 randomized trials with survival data published between 1991 and 2012, with most studies (63%) done in coronary artery bypass grafting (CABG) patients with standard cardiopulmonary bypass. Standard meta-analysis showed that the use of a volatile agent was associated with a reduction in mortality when compared with TIVA at the longest follow-up available [25/1994 (1.3%) in the volatile group vs 43/1648 (2.6%) in the TIVA arm, odds ratio (OR)=0.51, 95% confidence interval (CI) 0.33-0.81, P-value for effect=0.004, number needed to treat 74, I(2)=0%] with results confirmed in trials with low risk of bias, in large trials, and when including only CABG studies. Bayesian network meta-analysis showed that sevoflurane (OR=0.31, 95% credible interval 0.14-0.64) and desflurane (OR=0.43, 95% credible interval 0.21-0.82) were individually associated with a reduction in mortality when compared with TIVA. CONCLUSIONS: Anaesthesia with volatile agents appears to reduce mortality after cardiac surgery when compared with TIVA, especially when sevoflurane or desflurane is used. A large, multicentre trial is warranted to confirm that long-term survival is significantly affected by the choice of anaesthetic.