Endotracheal Intubation With Sevoflurane in Surgical Pediatric Patients
Study Details
Study Description
Brief Summary
Aim of the study is to compare the optimal time needed for successful tracheal intubation with immediate 8% sevoflurane and incremental sevoflurane induction in surgical pediatric patients undergoing adenotonsillectomy without using muscle relaxants or opioids
| Condition or Disease | Intervention/Treatment | Phase |
|---|---|---|
| N/A |
Detailed Description
Investigators studied 100 pediatric surgical patients admitted to Sulaimani Teaching Hospital in the Otorhinolaryngology, Head and Neck Surgical Department, from the first of June 2011 to the first of September 2011, Children aged 2-7 years,both genders, ASA physical statuses І and II (ASA I: a healthy normal patient, while ASA II: a patient with mild systemic disease with no functional limitations) were scheduled for elective adenotonsillectomy operations. They were randomly divided into two equal groups according to the induction method.
Group 1 (G1) using incremental induction with sevoflurane (1-8 %) in 100% O2, the vapor concentration is increased by 1% every few breaths.
Group 2 (G2) high concentration of sevoflurane (8%) in 100% O2 from the beginning of induction.
None of them is given premedication or any other adjunct drugs until successful intubation is done; ventilation was assisted and then controlled when possible. If upper airway obstruction occurred, an oropharyngeal airway was immediately inserted. Attempts were made to obtain venous access before laryngoscopy. All patients monitored with electrocardiography (ECG), noninvasive blood pressure monitoring (NIBP), pulse oximetry, and temperature measurements.
Children with extreme weight, suspicion of difficult airway, moved during laryngoscopy, or more than one trial of laryngoscopy needed were excluded from this study.
The endotracheal tube (ETT) size was selected by using the formula (age/4) + 4.5. Only a single laryngoscopy attempt was allowed. Small, brief movements of extremities occurring after (ETT) placement did not considered as exclusion criteria. Anesthesia was delivered by anesthetic machine (Datex Ohmeda), using an Ayer's T-piece with Jackson Ree's modification system, with a fresh gas flow of 6 L/min through a Sevoflurane vaporizer.
Patients were observed until eyelash reflex disappears, pupils centered and constricted. Jaw relaxation and movements were monitored. Ventilation was controlled till the time of laryngoscopy; the vocal cords were completely visible, orotracheal intubation done with Macintosh laryngoscope blade size 2 by the same anesthetist for all the patients. The time from induction until successful tracheal intubation is recorded.
Study Design
Arms and Interventions
| Arm | Intervention/Treatment |
|---|---|
| Active Comparator: sevoflurane concentration 8% sevoflurane concentration 8% from the start |
Drug: Sevoflurane
use of 8% sevoflurane in compared to incremental dose increased each few breaths from 1% to 8%
Other Names:
|
| Active Comparator: incremental sevoflurane (1-8%) incremental increase of the concentration each few breaths from 1% to 8% |
Drug: Sevoflurane
use of 8% sevoflurane in compared to incremental dose increased each few breaths from 1% to 8%
Other Names:
|
Outcome Measures
Primary Outcome Measures
- induction to intubation time in seconds [during the surgery]
effect of high concentration of sevoflurane on shortening the induction to intubation time
Eligibility Criteria
Criteria
Inclusion Criteria:
- Children 2-7 years old American society of anesthesiologists physical status class 1 and 2 scheduled for elective adenotonsillectomy operations
Exclusion Criteria:
- Children with extreme weight, suspicion of difficult airway, moved during laryngoscopy, or more than one trial of laryngoscopy needed
Contacts and Locations
Locations
No locations specified.Sponsors and Collaborators
- University of Sulaimani
Investigators
- Study Director: Amir M. Boujan, board, School of Medicine
Study Documents (Full-Text)
None provided.More Information
Publications
- Baum VC, Yemen TA, Baum LD. Immediate 8% sevoflurane induction in children: a comparison with incremental sevoflurane and incremental halothane. Anesth Analg. 1997 Aug;85(2):313-6.
- Blair JM, Hill DA, Bali IM, Fee JP. Tracheal intubating conditions after induction with sevoflurane 8% in children. A comparison with two intravenous techniques. Anaesthesia. 2000 Aug;55(8):774-8.
- Chawathe M, Zatman T, Hall JE, Gildersleve C, Jones RM, Wilkes AR, Aguilera IM, Armstrong TS. Sevoflurane (12% and 8%) inhalational induction in children. Paediatr Anaesth. 2005 Jun;15(6):470-5.
- Dubois MC, Piat V, Constant I, Lamblin O, Murat I. Comparison of three techniques for induction of anaesthesia with sevoflurane in children. Paediatr Anaesth. 1999;9(1):19-23.
- Epstein RH, Stein AL, Marr AT, Lessin JB. High concentration versus incremental induction of anesthesia with sevoflurane in children: a comparison of induction times, vital signs, and complications. J Clin Anesth. 1998 Feb;10(1):41-5.
- Fenlon S, Pearce A. Sevoflurane induction and difficult airway management. Anaesthesia. 1997 Mar;52(3):285-6.
- Inomata S, Yamashita S, Toyooka H, Yaguchi Y, Taguchi M, Sato S. Anaesthetic induction time for tracheal intubation using sevoflurane or halothane in children. Anaesthesia. 1998 May;53(5):440-5.
- James Duke, Pediatric Anesthesia, Anesthesia Secrets, Philadelphia 2011, Fourth Edition, Chapter 57, Page 396.
- Jöhr M. Anaesthesia for tonsillectomy. Curr Opin Anaesthesiol. 2006 Jun;19(3):260-1. Review.
- Politis GD, Tobin JR, Morell RC, James RL, Cantwell MF. Tracheal intubation of healthy pediatric patients without muscle relaxant: a survey of technique utilization and perceptions of safety. Anesth Analg. 1999 Apr;88(4):737-41.
- Redhu S, Jalwal GK, Saxena M, Shrivastava OP. A Comparative Study of Induction, Maintenance and Recovery Characteristics of Sevoflurane and Halothane Anaesthesia in Pediatric Patients (6 months to 6 years). J Anaesthesiol Clin Pharmacol. 2010 Oct;26(4):484-7.
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