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Investigation of the Optimum Time for Intravenous Access After Anesthesia Induction with Sevoflurane in Pediatric Patients Without Premedication.

ABSTRACT: Objective:Anesthesia induction is usually achieved with sevoflurane for pediatric patients without vascular access. The aim of this study was to investigate the optimum intravenous access time and to evaluate the corresponding bispectral index (BIS) value in pediatric patients after sevoflurane induction. Method:This prospective study included 100 children enrolled between January 1, 2017 and January 1, 2018 at Istanbul Medeniyet University Goztepe Training and Research Hospital. Anesthesia was induced with 8% sevoflurane and oxygen. Measurements included mask adaptation time, time to loss of the ciliary reflex, time to recovery of regular breathing, and optimal timing of intravenous access time with the corresponding BIS values, as well as the time elapsed for the BIS value to fall below 60. Results:The mean mask adaptation time was 27.8±28.4 s, time to loss of the ciliary reflex was 39.7±10.3 s, and time to reach regular respiration was 88.5±116.9 s, with mean BIS value of 80.4±16.9, 70.2±10.4, and 52.4±12.1, respectively. The mean time for BIS to fall below 60 was 72.54±24.41 s. The mean time required for the the iniation of optimal intravenous access was 104.92±36.45 s, with a mean BIS value of 30±10.1. Conclusion:Following anesthesia induction with sevoflurane in children, the BIS value below 60 which is the upper limit for surgical anesthesia, was found to be insufficient for intravenous intervention. For pediatric patients undergoing sevoflurane induction it has been concluded that, the BIS value below 30 or an average waiting time of 104.9 s is ideal for initiation of optimal intravenous access.

SUBMITTER: Orhon ZN

PROVIDER: S-EPMC7384515 | biostudies-literature | 2020

REPOSITORIES: biostudies-literature

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Investigation of the Optimum Time for Intravenous Access After Anesthesia Induction with Sevoflurane in Pediatric Patients Without Premedication.

Orhon Zeynep Nur ZN Orhon Cem C

Medeniyet medical journal 20200630 2

<h4>Objective</h4>Anesthesia induction is usually achieved with sevoflurane for pediatric patients without vascular access. The aim of this study was to investigate the optimum intravenous access time and to evaluate the corresponding bispectral index (BIS) value in pediatric patients after sevoflurane induction.<h4>Method</h4>This prospective study included 100 children enrolled between January 1, 2017 and January 1, 2018 at Istanbul Medeniyet University Goztepe Training and Research Hospital. ...[more]

PMID: 32733756

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Project description:Background and aimTotal intravenous anesthesia (TIVA) has proven advantage over inhalational anesthesia in terms of stable hemodynamic, eco-friendly, and good recovery profile, but apprehension regarding adequate depth of anesthesia and intraoperative recall is still pertaining. This study aims to compare propofol-dexmedetomidine-based TIVA with sevoflurane-based inhalational anesthesia in modified radical mastectomy in terms of depth of anesthesia, intraoperative recall, recovery profile, and hemodynamic status.Settings and designThis prospective randomized controlled study was conducted at a tertiary care center over a time frame of 1 year.MethodologyIn this randomized controlled study, 100 patients were randomly distributed into two groups: TIVA (Group T) and inhalational anesthesia (Group I). Group T patients received injection dexmedetomidine: 1 μg.kg-1 over 10 min followed by 0.7 μg.kg-1.h-1 and injection propofol: 25-100 μg.kg-1.min-1. Ventilation was maintained with oxygen-air gas flow. In Group I, patients were ventilated with nitrous oxide-oxygen (50:50) and sevoflurane. Rest of anesthesia for both the groups was same. Primary objective was to achieve adequate depth of anesthesia as monitored by intraoperative bispectral index value (BIS, 40-60). Hemodynamic variables, recovery profile, and amount of individual anesthetic agent consumed were recorded for comparison between two groups. For comparison of scale variables between two groups, independent sample t-test for significant difference between two sample means has been followed.ResultsIntraoperative BIS and hemodynamic variables were comparable (P > 0.05). Emergence time was 5.10 min in the TIVA group versus 8.38 min in the inhalational group (P = 0.00). Modified Aldrete score was comparable in two groups (P > 0.05). Cost of TIVA agents consumed per patient was 40% lesser than inhalational agents.ConclusionTIVA maintains adequate depth of anesthesia along with stable hemodynamic and good recovery profile, at low cost in an eco-friendly manner.

Project description:Functional Endoscopic Sinus Surgery (FESS) has been performed under controlled hypotension to increase operating field visibility. Intranasal (IN) dexmedetomidine is easy, noninvasive, and possesses lower C max, accompanied by lower pharmacodynamic action, including hypotension, bradycardia, and sedation. This trial aimed to compare IN and intravenous (IV) dexmedetomidine for hypotensive anesthesia during FESS. This randomized, controlled, triple-blinded clinical trial involved sixty cases scheduled for FESS. Patients were divided into two equal groups by random manner. 45-60 min before anesthesia induction, group IN: received 1 μg/kg IN dexmedetomidine diluted in 10 ml of saline 0.9 % intranasally preoperative. Group IV: received 1 μg/kg dexmedetomidine diluted in 10 ml of saline 0.9 % infused over 10 min. The primary outcome was the total amount of administered atropine. The secondary outcomes included hemodynamic, through 1 h before surgery, intraoperatively and postoperatively at different time intervals. The quality of the operative field, sedation, adverse reactions and hemostatic stuffing after FESS were also assessed. The total amount of consumed atropine decreased significantly in group IN compared to group IV. Preoperative Ramsay Sedation scores at T0, T5, T50 and T60 were comparable between the two groups, while at T10, T15, T20, T30, and T40 were lower significantly in the IN group compared with the IV group. Preoperative mean arterial blood pressure at T0, T5 and T60 had comparable differences across both groups while reduced at T10 to T 45 significantly in the IV group than IN group. Both groups had comparable satisfaction, postoperative Ramsey sedation, hemostatic suffering, quality of operative field and complications. In conclusion, IN dexmedetomidine administration is relatively simple and appropriate; moreover, it decreases first-pass metabolism. Onset is prolonged relative to IV dosing; thus, it should be administered nearly 1 h before surgery and recommended in adult patients as they require minor sedation preoperatively.

Dataset Information

Investigation of the Optimum Time for Intravenous Access After Anesthesia Induction with Sevoflurane in Pediatric Patients Without Premedication.

Publications

Investigation of the Optimum Time for Intravenous Access After Anesthesia Induction with Sevoflurane in Pediatric Patients Without Premedication.

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