Single-breath vital capacity high concentration sevoflurane induction in children: with or without nitrous oxide?

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Abstract

Background

Single-breath vital capacity inhalation induction with high concentration sevoflurane (SBVC-HC) is a rapid and ‘needleless’ technique, preferred and well tolerated in the cooperative child. The addition of nitrous oxide may speed up induction by its second gas effects. Previous studies done in children looking at the effect of N2O on this technique lacked power and showed conflicting results. This study aims to investigate the effect of N2O on induction time for SBVC-HC sevoflurane induction in children.

Methods

Eighty unpremedicated, ASA I and II children, aged 5–15 yr having elective surgical procedures under general anaesthesia, were recruited and randomized to: Group A: 8% sevoflurane in O2 6 litre min−1, and Group B: 8% sevoflurane in N2O 4 litre min−1 and O2 2 litre min−1. The primary outcome was the time to ‘loss of eyelash reflex’. The time to return of ‘regular respiration’ and ‘conjugate gaze’ were also noted.

Results

The difference in the ‘time to loss of eyelash reflex’ was small but statistically significant. Group B: mean duration 53.6 s, standard deviation (SD) 16.1, compared with Group A: 63.5 s, SD 16.1 (mean difference 9.9, 95% confidence interval 2.5–17.3, P=0.01). Differences in the time to return of ‘regular breathing’ and ‘conjugate gaze’ were not statistically significant. Patients receiving N2O had less excitatory movements (P=0.007), but incidence of other adverse events was low and did not differ significantly between both groups. More than 94% of children would choose this method of induction again in both groups.

Conclusions

We conclude that for SBVC-HC sevoflurane induction in children, the addition of N2O resulted in faster loss of consciousness and reduced excitatory movements.

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