الفهرس يوجد فقط 14 صفحة متاحة للعرض العام
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المستخلص
Sevoflurane possesses a number of characteristics that approach those of the ideal anesthetic. sevoflurane is versatile and can be used both as a mask induction inhalation anesthetic and a maintenance agent for pediatric or adult surgical procedures. its low blood:gas solubility allows precise control over the depth of anesthesia and a rapid, smooth induction and recovery period. other favorable features of sevoflurane include pleasant odour with no or little associated airway irritation. the ability to use sevoflurane for mask induction is particularly useful when the trachea is difficult to intubate or is obstructed, when an easily accessible intravenous site is unavailable, or for patients who are needle phobic.
Sevoflurane is particularly suitable for pediatric anesthesia, as it is a potent anesthetic that can be used for both induction and maintenance of anesthesia. induction and emergence with sevoflurane is more rapid than that with halothane in infants and children, with minimal perioperative side effects and greater patient/parental acceptance. sevoflurane also maintains greater cardiovascular stability than halothane, while having no risk for renal or hepatic impairment. finally, adverse complications, including cardiac arrhythmias following sevoflurane anesthesia in children, are rare, and unlike halothane, the potential for sevoflurane to initiate immune-mediated hepatitis appears to be insignificant.
The low solubility of sevoflurane in oil and water provides rapid induction and recovery from anesthesia, its lack of pungency and upper airway irritation result in patient acceptance and tolerance, permitting smooth induction. anesthesia can be induced while maintaining spontaneous ventilation in patients with potentially difficult airway anatomy.
In this study, sevoflurane was compared with halothane as regards its hemodynamic and respiratory parameters during inhalational induction of anesthesia in children 1-12 years old premedicated with midazolam nasal drops (0.1nrig/kg body weight) undergoing minor surgical procedures. the study groups were classified as follows:-
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Group I : Sevoflurane started by 1.5%, and increased every 5 breaths by 1.5% till 7%. Group II : Sevoflurane + Nitrous oxide (N20) in Oxygen (02) 50 : 50 started by 1.5% Sevoflurane, and increased every 5 breaths by 1.5% till 7%. Group III : Halothane started by 0.5%, and increased every 5 breaths by 0.5% till 5%. Group IV : Halothane + Nitrous oxide (N20) in Oxygen (02) 50 : 50 started by 0.5% Halothane, and increased every 5 breaths by 0.5% till 5%.
Intubation was attempted, after reaching the maximum inhalational concentration in each group, 3 minutes after loss of eye lash reflex.. An intubation score was determined using the following parameters; difficult mouth opening, gross muscle movement, bucking or movement of vocal
cords.
The heart rate, systolic and diastolic blood pressures, oxygen saturation, end tidal carbon dioxide concentration and body temperature were measured pre-operatively, after premedication, immediately before induction, after loss of eye lash reflex, immediately after intubation, 5, 10, 15, 20, and 30 minutes after intubation. Anesthesia was maintained using either sevoflurane or halothane in a concentration of 2-4% or 1-2% respectively.
Extubation was done 1-2 minutes after discontinuation of the inhalational anesthetic. Recovery degree was qualified considering the following parameters; eye opening, crying, presence or absence of purposeful movements and response to commands.
Induction with sevoflurane was not associated with any major airway complications, apart from 3 cases who showed coughing and one case who showed breath holding. Loss of eye lash reflex occurred faster with sevoflurane than with halothane.
Comparing sevoflurane with halothane, the former showed more stable results as regards systolic blood pressure, diastolic blood pressure and heart rate, while oxygen saturation, end tidal carbon dioxide concentration and body temperature, showed no significant difference between the two agents.
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When nitrous oxide was used with oxygen 50:50 for induction and maintenance during sevoflurane anesthesia, there was a significant DROP in both systolic and diastolic blood pressures 20 minutes after induction compared to the group receiving 100% oxygen with sevoflurane, while the heart rate showed no significant difference between the two groups all through the study.
On the other hand, when nitrous oxide was used with oxygen 50:50 for induction and maintenance during halothane anesthesia, no significant difference was observed in either systolic blood pressure, diastolic blood pressure or heart rate.
In sevoflurane group, only 2 patients showed bradycardia (heart rate< 80 beats/min.) which was treated by atropine in a dose of 0.2mg/kg body weight, compared to 7 cases in the halothane group.
Patients receiving sevoflurane recovered earlier than those receiving halothane and showed less side effects. None of the patients receiving sevoflurane showed emergence agitation.
from our study, we conclude that sevoflurane is superior to halothane as an inhalational induction agent producing less side effects either during induction, maintenance, or recovery specially in pediatric anesthesia.