1
|
Yao YT, He LX, Fang NX, Ma J. Anesthetic Induction With Etomidate in Cardiac Surgical Patients: A PRISMA-Compliant Systematic Review and Meta-Analysis. J Cardiothorac Vasc Anesth 2020; 35:1073-1085. [PMID: 33384231 DOI: 10.1053/j.jvca.2020.11.068] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Abstract] [Key Words] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/13/2020] [Revised: 11/28/2020] [Accepted: 11/30/2020] [Indexed: 01/10/2023]
Abstract
OBJECTIVE This meta-analysis aimed to systematically review the effects of etomidate (ETM) during anesthetic induction on patients undergoing cardiac surgery. DESIGN Systematic review and meta-analysis. SETTING Operating room. PARTICIPANTS Patients undergoing cardiac surgery. INTERVENTIONS ETM or control drugs. MEASUREMENTS AND MAIN RESULTS PubMed, Cochrane Library, OVID, and EMBASE were searched through August 31, 2020. Primary outcomes included hemodynamic profiles and stress responses. Secondary outcomes included morbidity, mortality, and postoperative recovery. For continuous/dichotomous variables, treatment effects were calculated as weighted mean difference (WMD)/odds ratio (OR) and 95% confidence interval (CI). A database search yielded 18 randomized controlled trials including 1,241 patients. The present meta-analysis demonstrated that ETM-anesthetized patients had lower heart rates (WMD, -3.31; 95% CI -5.43 to -1.19; p = 0.002), higher blood pressures (systolic blood pressure: WMD, 12.02; 95% CI 6.24 to 17.80; p < 0.0001; diastolic blood pressure: WMD, 5.23; 95% CI 2.39 to 8.08; p = 0.0003; mean arterial pressure (MAP): WMD, 8.64; 95% CI 5.85 to 11.43; p < 0.00001), less requirement for vasopressor (OR, 0.26; 95% CI 0.15 to 0.44; p < 0.00001), and more nitroglycerin usage (OR, 14.89; 95% CI 4.92 to 45.08; p < 0.00001) during anesthetic induction. Current meta-analysis also demonstrated that single-dose ETM lowered cortisol levels transiently and did not have a significant effect on endogenous norepinephrine and epinephrine levels and was not associated with increased postoperative inotrope and/or vasopressor requirement. Additionally, the meta-analysis suggested that ETM anesthesia was associated with neither increased mortality nor morbidity, except a higher incidence of transient adrenal insufficiency in ETM recipients. CONCLUSION The present meta-analysis suggested that single-dose ETM during anesthetic induction could be associated with more stable hemodynamics, transient and reversible lower cortisol levels, and a higher adrenal insufficiency incidence, but not worse outcomes in cardiac surgical patients.
Collapse
Affiliation(s)
- Yun-Tai Yao
- Department of Anesthesiology, Fuwai Hospital, National Center for Cardiovascular Diseases, Peking Union Medical College and Chinese Academy of Medical Sciences, Beijing, China.
| | - Li-Xian He
- Department of Anesthesiology, Fuwai Hospital, National Center for Cardiovascular Diseases, Peking Union Medical College and Chinese Academy of Medical Sciences, Beijing, China
| | - Neng-Xin Fang
- Department of Anesthesiology, Fuwai Hospital, National Center for Cardiovascular Diseases, Peking Union Medical College and Chinese Academy of Medical Sciences, Beijing, China
| | - Jie Ma
- Department of Pharmacy, Fuwai Hospital, National Center for Cardiovascular Diseases, Peking Union Medical College and Chinese Academy of Medical Sciences, Beijing, China
| |
Collapse
|
2
|
Sugita T, Umezawa N, Matumoto A, Takano T, Arisaka H. Modification of the use of mask for inhalation induction in uncooperative patients. Paediatr Anaesth 2019; 29:658. [PMID: 30907459 DOI: 10.1111/pan.13628] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/30/2022]
Affiliation(s)
- Takeo Sugita
- Division of Anesthesiology, Department of Highly Advanced Stomatology, Kanagawa Dental University Graduate School, Yokohama, Japan
| | - Nobuo Umezawa
- Division of Anesthesiology, Department of Highly Advanced Stomatology, Kanagawa Dental University Graduate School, Yokohama, Japan
| | - Akiko Matumoto
- Division of Anesthesiology, Department of Highly Advanced Stomatology, Kanagawa Dental University Graduate School, Yokohama, Japan
| | - Tomoko Takano
- Division of Anesthesiology, Department of Highly Advanced Stomatology, Kanagawa Dental University Graduate School, Yokohama, Japan
| | - Hirofumi Arisaka
- Division of Anesthesiology, Department of Highly Advanced Stomatology, Kanagawa Dental University Graduate School, Yokohama, Japan
| |
Collapse
|
3
|
Martín Serrano P, Martín Hernández JG, Martín Celemín R, de Antonio Antón N, Orús García R, Planas Roca A. Anaphylactic risk due to systemic mastocytosis: Perioperative management in cardiac surgery. ACTA ACUST UNITED AC 2019; 66:346-349. [PMID: 30850182 DOI: 10.1016/j.redar.2019.01.008] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/27/2018] [Revised: 01/22/2019] [Accepted: 01/22/2019] [Indexed: 10/27/2022]
Abstract
Mastocytosis is a disease characterised by an abnormal proliferation of mast cells. The degranulation of mast cells can be triggered by chemical, physical, and psychological factors, and in severe cases may be accompanied by cardiovascular alterations and shock. Tryptase concentrations greater than 20ug/L may be associated with an increased risk of mastocyte degranulation. The case is presented on a 71 year-old man that underwent an aortic valve replacement and aortic-coronary bypass surgery. He had an indolent systemic mastocytosis and a history of histaminergic crises, with a baseline value of tryptase prior to surgery of 58.1ug/L.
Collapse
Affiliation(s)
- P Martín Serrano
- Servicio de Anestesiología y Reanimación, Hospital Universitario de La Princesa, Madrid, España.
| | - J G Martín Hernández
- Servicio de Anestesiología y Reanimación, Hospital Universitario de La Princesa, Madrid, España
| | - R Martín Celemín
- Servicio de Anestesiología y Reanimación, Hospital Universitario de La Princesa, Madrid, España
| | - N de Antonio Antón
- Servicio de Cirugía Cardíaca, Hospital Universitario de la Princesa, Madrid, España
| | - R Orús García
- Servicio de Anestesiología y Reanimación, Hospital Universitario de Burgos, Burgos, España
| | - A Planas Roca
- Servicio de Anestesiología y Reanimación, Hospital Universitario de La Princesa, Madrid, España
| |
Collapse
|
4
|
Safety Evaluation of Sevoflurane as Anesthetic Agent in Mouse Model of Myocardial Ischemic Infarction. Cardiovasc Toxicol 2017; 17:150-156. [PMID: 27048291 DOI: 10.1007/s12012-016-9368-9] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 02/05/2023]
Abstract
The selection of anesthetics for patients with myocardial infarction is critically challenging. Sevoflurane is a volatile anesthetic gradually used in recent years. The intraoperative hemodynamic stability of sevoflurane was supported by several studies with some suggestions for its use for patients with cardiac events. The present study was undertaken to investigate the effect of sevoflurane on mice with myocardial infarction to evaluate the safety issue of this agent for possible application in patients with myocardial infarction. Mice of 7-12 weeks old were subjected to left anterior descending artery ligation to introduce acute myocardial infarction. The effect of sevoflurane on the hemodynamics was examined in comparison with that of currently available agent etomidate at low and moderate doses. The results showed that sevoflurane caused unstable hemodynamic changes in mice with myocardial infarction at both low and moderate inhaled concentrations relative to low and moderate doses of etomidate. In addition, the relative safety margin estimated from therapeutic index was decreased by 50 % when sevoflurane was used for mice with myocardial infarction relative to control mice, but only decreased by 20 % for etomidate. These analyses indicate that in comparison with currently available agent etomidate, sevoflurane should not be applied to patients with myocardial infarction or other cardiac events.
Collapse
|
5
|
Page RL, O'Bryant CL, Cheng D, Dow TJ, Ky B, Stein CM, Spencer AP, Trupp RJ, Lindenfeld J. Drugs That May Cause or Exacerbate Heart Failure: A Scientific Statement From the American Heart Association. Circulation 2016; 134:e32-69. [PMID: 27400984 DOI: 10.1161/cir.0000000000000426] [Citation(s) in RCA: 260] [Impact Index Per Article: 32.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 02/07/2023]
Abstract
Heart failure is a common, costly, and debilitating syndrome that is associated with a highly complex drug regimen, a large number of comorbidities, and a large and often disparate number of healthcare providers. All of these factors conspire to increase the risk of heart failure exacerbation by direct myocardial toxicity, drug-drug interactions, or both. This scientific statement is designed to serve as a comprehensive and accessible source of drugs that may cause or exacerbate heart failure to assist healthcare providers in improving the quality of care for these patients.
Collapse
|
6
|
Elgebaly AS, Eldabaa AA. Is I-gel airway a better option to endotracheal tube airway for sevoflurane-fentanyl anesthesia during cardiac surgery? Anesth Essays Res 2014; 8:216-22. [PMID: 25886229 PMCID: PMC4173615 DOI: 10.4103/0259-1162.134510] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/15/2022] Open
Abstract
BACKGROUND Anesthetists used lower doses of fentanyl, successfully with hemodynamic control by titrating volatile anesthetic agents or vasodilators for fast-tracking in cardiac surgery. HYPOTHESIS Lower total doses of anesthetics and fentanyl could be required with hemodynamic control by use of supraglottic devices than endotracheal tube (ETT) and helps in fast-tracking. DESIGN A prospective randomized observational clinical trial study. AIMS The authors compared the utility of I-gel airway with a conventional ETT during the induction and maintenance of anesthesia with sevoflurane and fentanyl in adults undergoing cardiac surgery. PATIENTS AND METHODS A total of 49 adult patients underwent cardiac surgery were randomized into two groups according to the airway management: I-gel group (n = 23) and ETT group (n = 26). Doses of fentanyl and hemodynamic parameters (heart rate [HR], mean arterial pressure [MAP] central venous pressure [CVP], pulmonary artery pressure [PAP], and pulmonary capillary wedge pressure [PCWP]) were recorded preoperative, 5 min following tracheal intubation or I-gel airway insertion, after skin incision, after stenotomy, and after weaning off bypass. RESULTS None of the patients in the I-gel group required additional doses of fentanyl during the I-gel insertion, compared with 74% of the patients during laryngoscopy and endotracheal insertion in the ETT group, for an average total dose of 22.6 ± 0.6 μg/kg. The MAP and HR did not significantly differ from the baseline values at any point of measurement in either group. Furthermore, CVP, PAP, and PCWP measured during the procedure were significantly lower in I-gel group than ETT group. Extubation required more amount of time in ETT than I- gel group. CONCLUSION The I-gel airway is well-tolerated by adult patients undergoing cardiac surgery, and requires lower total doses of anesthetics than endotracheal intubation with hemodynamic control and helps in fast-tracking.
Collapse
Affiliation(s)
- Ahmed Said Elgebaly
- Department of Anesthesia and PSICUD, Faculty of Medicine, Tanta University, Tanta, Egypt
| | - Ahmed Ali Eldabaa
- Department of Anesthesia and PSICUD, Faculty of Medicine, Tanta University, Tanta, Egypt
| |
Collapse
|
7
|
Marcos-Vidal JM, González R, García C, Soria C. Out-of-operating room anesthesia: use of the AnaConDa vaporizer with anesthesia. J Clin Anesth 2012; 24:346-7. [PMID: 22608592 DOI: 10.1016/j.jclinane.2011.05.008] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/26/2011] [Revised: 02/06/2011] [Accepted: 05/26/2011] [Indexed: 10/28/2022]
|
8
|
Landoni G, Biondi-Zoccai GGL, Zangrillo A, Bignami E, D'Avolio S, Marchetti C, Calabrò MG, Fochi O, Guarracino F, Tritapepe L, De Hert S, Torri G. Desflurane and Sevoflurane in Cardiac Surgery: A Meta-Analysis of Randomized Clinical Trials. J Cardiothorac Vasc Anesth 2007; 21:502-11. [PMID: 17678775 DOI: 10.1053/j.jvca.2007.02.013] [Citation(s) in RCA: 207] [Impact Index Per Article: 12.2] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/18/2006] [Indexed: 02/08/2023]
Abstract
OBJECTIVES The authors performed a meta-analysis to investigate whether the cardioprotective effects of volatile anesthetics translate into decreased morbidity and mortality in patients undergoing cardiac surgery. BACKGROUND It is commonly believed that the choice of the primary anesthetic agent does not result in different outcomes after cardiac surgery. Recent evidence, however, has indicated that volatile anesthetics improve postischemic recovery at a cellular level, in isolated hearts, in animals, and in humans. METHODS Four investigators independently searched BioMedCentral and PubMed. Inclusion criteria were random allocation to treatment and comparison of a total intravenous anesthesia regimen versus an anesthesia plan including desflurane or sevoflurane performed on cardiosurgical patients. Exclusion criteria were duplicate publications, nonhuman experimental studies, and no outcome data. The endpoints were the rate of perioperative myocardial infarction and hospital mortality. RESULTS The search yielded 22 studies, involving 1,922 patients. Volatile anesthetics were associated with significant reductions of myocardial infarctions (24/979 [2.4%] in the volatile anesthetics group v 45/874 [5.1%] in the control arm, odds ratio [OR] = 0.51 [0.32-0.84], p for effect = 0.008, and p for heterogeneity = 0.77) and mortality (4/977 [0.4%] v 14/872 [1.6%], OR = 0.31 [0.12-0.80], p for effect = 0.02, and p for heterogeneity = 0.88). CONCLUSIONS Desflurane and sevoflurane have cardioprotective effects that result in decreased morbidity and mortality. The present data show for the first time that the choice of an anesthetic regimen based on administration of halogenated anesthetics is associated with a better outcome after cardiac surgery.
Collapse
Affiliation(s)
- Giovanni Landoni
- Department of Cardiothoracic Anesthesia and Intensive Care, Università Vita-Salute San Raffaele, Milano, Milan, Italy.
| | | | | | | | | | | | | | | | | | | | | | | |
Collapse
|
9
|
Lewis MC, Gerenstein RI, Chidiac G. Onset Time for Sevoflurane/Nitrous Oxide Induction in Adults Is Prolonged with Increasing Age. Anesth Analg 2006; 102:1699-702. [PMID: 16717312 DOI: 10.1213/01.ane.0000205749.92049.91] [Citation(s) in RCA: 8] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/05/2022]
Abstract
Inhaled induction of anesthesia is occasionally used in adults. Using a modified vital capacity sevoflurane/nitrous oxide (N2O) inhaled induction, we evaluated the effect of increasing age on the onset time of anesthesia. Twenty patients, aged 26-65 yr, performed a vital capacity breath followed by regular tidal breathing from an anesthesia circuit primed with sevoflurane 8%/N2O/O2. The following values were recorded: time to loss of eyelash reflex (LOER); time to bispectral index < or =60 (BIS < or =60); expired fraction of sevoflurane at the time of induction, LOER and BIS < or =60. The mean times and 95% confidence intervals to LOER and BIS < or =60 were 54 s (37-70 s) and 175 s (143-207 s), respectively, and were significantly prolonged by aging (r = 0.65; P = 0.002). Times to LOER and BIS < or =60, predicted from the regression line, were 3.9 and 2 times longer in a 60-yr-old than in a 30-yr-old patient. The expired fraction of sevoflurane measured at time to LOER and BIS < or =60 decreases with increase in age. We conclude that inhaled induction with sevoflurane/N2O is dramatically prolonged with increased age.
Collapse
Affiliation(s)
- Michael C Lewis
- Department of Anesthesiology, Miller School of Medicine at the University of Miami, Miami, Florida 33101, USA.
| | | | | |
Collapse
|
10
|
Nouette-Gaulain K, Lemoine P, Cros AM, Sztark F. Induction par inhalation de sévoflurane à objectif de concentration chez l'adulte avec le respirateur ZEUS®. ACTA ACUST UNITED AC 2005; 24:802-6. [PMID: 15949912 DOI: 10.1016/j.annfar.2005.04.029] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/28/2004] [Accepted: 04/25/2005] [Indexed: 11/23/2022]
Abstract
OBJECTIVES To evaluate if the new anaesthesia platform ZEUS (Dräger Medical) allows the induction of anaesthesia with target-controlled inhalation of sevoflurane. STUDY DESIGN Prospective clinical study. PATIENTS Adult ASA I or II patients scheduled for elective surgery under general anaesthesia. METHODS After preoxygenation during 3 min at 100% oxygen, patients were asked to breathe normally; the target end-tidal concentration of sevoflurane was fixed at 4% without priming of the circuit. Sufentanil (target concentration 0.5 ng/ml) was administered 40 s after. RESULTS Ten patients (48+/-22 yrs) were included. Sevoflurane was detected in the circuit after 36+/-5 s; the target end-tidal concentration of sevoflurane was obtained at 130+/-19 s. Loss of consciousness was observed after 119+/-7 s. The induction was achieved in all patients without any incident. CONCLUSION This new anaesthesia system make available the induction of anaesthesia with sevoflurane without priming of the circuit.
Collapse
Affiliation(s)
- K Nouette-Gaulain
- Départements d'anesthésie-réanimation I et IV, CHU de Pellegrin, 33076 Bordeaux cedex, France
| | | | | | | |
Collapse
|
11
|
|
12
|
Lewis MC, TerRiet M, DeLaCruz L, Matadial CM, Gerenstein R, DeSouza G, Chidiac GJ. Rapid sevoflurane induction compared with thiopental. J Clin Anesth 2004; 16:271-5. [PMID: 15261318 DOI: 10.1016/j.jclinane.2003.09.007] [Citation(s) in RCA: 7] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/18/2003] [Revised: 09/02/2003] [Accepted: 09/02/2003] [Indexed: 11/26/2022]
Abstract
STUDY OBJECTIVES To examine whether the speed of induction of anesthesia with sevoflurane/nitrous oxide (N2O) utilizing a 10-second vital capacity rapid inhalation induction (VCRII) followed by tidal breathing was similar or faster than cautious intravenous (i.v.V) thiopental induction with inhaled N2O. DESIGN Prospective, randomized, double-blinded study. SETTING Veterans Affairs Medical Center. PATIENTS 50 male ASA physical status I, II, and III patients scheduled for general anesthesia. INTERVENTIONS Patients were randomized to receive either 8% sevoflurane or i.v. thiopental. Patients were allocated to one of two groups of 25 patients each. In both groups, the breathing circuit was initially primed for 5 minutes with (4 L/min) and O2 (2 L/min), while the Y-piece was occluded. In the sevoflurane group, the circuit was additionally primed with 8% sevoflurane. Patients were trained to perform a vital capacity breath. After maximal exhalation, the occluding plug was rapidly removed from the Y-piece and connected to the facemask. The patient then inspired to vital capacity, held his breath for 10 seconds, and then was allowed to breathe normally. At the end of the 10-second breathhold, and as the patient started normal breathing, either thiopental (thiopental group) or normal saline (sevoflurane group) was injected at a rate of 4 mL every 10 seconds. MEASUREMENTS A study-blinded observer recorded the time to induction, as defined by the time to loss of eyelash reflex, and noted the occurrence of side effects. MAIN RESULTS The speed of induction was the same for both groups (p > 0.05). An average of eight breaths was required before loss of eyelash reflex. Side effects occurred in 36% of the patients in the thiopental group, and 32% in the sevoflurane group (p > 0.05); these were minor and did not affect induction. CONCLUSION Sevoflurane/N2O VCRII as used in this investigation is an effective inhalation technique; it resulted in an induction time similar to that of slow i.v. thiopental with inhaled N2O.
Collapse
Affiliation(s)
- Michael C Lewis
- Department of Anesthesiology, V.A. Medical Center, Miami, FL 33125, USA.
| | | | | | | | | | | | | |
Collapse
|
13
|
Conventional stepwise vs. vital capacity rapid inhalation induction at two concentrations of sevoflurane. Eur J Anaesthesiol 2004. [DOI: 10.1097/00003643-200404000-00003] [Citation(s) in RCA: 11] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/25/2022]
|
14
|
Goodwin N, Campbell AE, Hall JE, Plummer S, Harmer M. A comparison of 8% and 12% sevoflurane for inhalation induction in adults. Anaesthesia 2004; 59:15-9. [PMID: 14687093 DOI: 10.1111/j.1365-2044.2004.03481.x] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/01/2022]
Abstract
Sevoflurane is a non-pungent volatile anaesthetic agent with a low blood-gas solubility coefficient. It has been studied in concentrations of up to 8% for induction of anaesthesia. Previous work has suggested that there may be a ceiling effect with increasing concentration of sevoflurane above 6%, but there are no published studies using 12% sevoflurane. This study compared 8 and 12% sevoflurane to induce anaesthesia in adults. Sevoflurane was administered using two adapted datum vaporisers with the interlock removed. Induction with 12% sevoflurane compared to 8% sevoflurane produced a significant decrease in the time to achieve central pupils, corresponding to surgical anaesthesia and the third part of Guedel's stage 3 of anaesthesia (mean time (SD) 201 s (81) and 247 s (39), respectively, p < 0.05). Twelve-percent sevoflurane produced a similar stable cardiovascular profile to 8% sevoflurane, and there was no increase in respiratory complications.
Collapse
Affiliation(s)
- N Goodwin
- Department of Anaesthetics, University of Wales College of Medicine, Heath Park, Cardiff CF14 4XW, UK.
| | | | | | | | | |
Collapse
|
15
|
Yamaguchi S, Ikeda T, Wake K, Okuda Y, Kitajima T. A sevoflurane induction of anesthesia with gradual reduction of concentration is well tolerated in elderly patients. Can J Anaesth 2003; 50:26-31. [PMID: 12514146 DOI: 10.1007/bf03020182] [Citation(s) in RCA: 19] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/20/2022] Open
Abstract
PURPOSE To establish the appropriate inhalation induction technique using a high concentration of sevoflurane in the elderly. METHODS Forty-five patients, aged 70-79-yr-old, were randomly divided into three groups: 1) Group I: anesthesia was induced with propofol 2 mg x kg(-1) and sevoflurane 2% (n = 15); 2) Group II: anesthesia was induced with a three- minute inhalation of sevoflurane 8%; 3) Group III: anesthesia was induced with inhalation of sevoflurane using a gradual reduction technique (8, 6, 4% for each minute). In Groups II and III, a modified vital capacity inhalation induction was performed. Mean arterial pressure (MAP), heart rate (HR) and oxygen saturation (SpO(2)) were measured continuously during induction. In addition, induction time and adverse events related to anesthetic induction were recorded. RESULTS The induction time in Group I was significantly shorter than that in Groups II and III (P < 0.05). However, there was no difference in the induction time between Groups II and III. In Groups II and III, the majority of patients required additional breaths. In comparison with the other groups, stability of MAP was maintained in Group III. The variations of HR in all groups were small. During induction, no patient experienced a decrease in SpO(2) below 96%, except for two patients in Group I. Severe respiratory adverse events were not observed. Other adverse events were similar in all groups. CONCLUSIONS Our results suggest that a high concentration sevoflurane induction using a gradual reduction technique may be an acceptable alternative to standard iv induction in elderly patients.
Collapse
Affiliation(s)
- Shigeki Yamaguchi
- Department of Anesthesiology, Dokkyo University School of Medicine, Mibu, Tochigi, Japan.
| | | | | | | | | |
Collapse
|