Comparison of Inhalation Induction with 2%, 4%, 6%, and 8% Sevoflurane in Nitrous Oxide for Pediatric Patients

利用2%、4%、6%及8% Sevoflurane作小兒吸入誘導麻醉的比較

徐永偉(Yung-Wei Hsu) ； 潘武熙(Mu-His Pan) ； 黃俊仁(Chun-Jen Huang) ； 鄭清榮(Ching-Rong Cheng) ； 吳國驊(Kuo-Hwa Wu) ； 魏志濤(Tze-Taur Wei)

《Acta Anaesthesiologica Sinica》 38卷2期 (2000/06) Pp. 73-78

https://doi.org/10.6955/AAS.200006.0073

摘要

背景：Sevoflurane是一理想的吸入誘導的麻醉劑，它的血中溶解度低、無刺激性味道，可用來做快速誘導。以前的研究著重於高濃度的sevoflurane用於小兒病人吸入誘導的效率。然而對於小兒病人願意接受吸入誘導，何種濃度才是較好的選擇，以前的研究未曾提及。本研究的目的是要以四種濃度的Scvoflurane用於小兒病人吸入誘導，比較其誘導效率及小兒病人的耐受度。
方法：一百二十位3到10歲的小兒病人，隨機分配接受四種濃度(2%、4%、6%、8%)的sevoflurane，合併50％笑氣進行吸入誘導。我們記錄睫毛反射消失的時間，是否有呼吸道反射，是否有非自主運動，和血液動力學的反應，比較其誘導效率及小兒病人的耐受度。
結果：九十九個孩子成功完成研究。睫毛反射消失的時間在2%、4%、6%、8%各組，分別是114士21秒、87士11秒、75士6秒、48士8秒。呼吸道反射包括咳嗽、喉頭痙變、憋氣等副作用，在8%功sevoflurane這組發生機率較高。四種濃度sevoflurane均含明顯降低收縮壓和舒張壓，心跳方面僅在4%、6%兩組有顯著的增加。
結論：6%　Sevoflurane用作吸入麻醉誘導，除可快速誘導外，其講發症較低。建議6% sevoflurane為小兒病人理想的吸入麻醉誘導濃度。

關鍵字

小兒 ； 吸入性麻醉劑 ； sevoflurane

並列摘要

Background: Sevoflurane is almost the idealest volatile anesthetic agent regarding inhalation induction of general anesthesia. Previous studies have established a role of sevoflurane in high concentration primed in the circuit for inhalation induction in pediatric patients. However, which concentration of sevoflurane is suitable has not yet been reported. This study was designed to compare the efficiency of different concentration of sevoflurane i.e. 2%, 4%, 6%, and 8% with N20 in 50% oxygen for induction of anesthesia in pediatric patients and at the same time to evaluate the tolerance of patients.
Methods: One hundred and twenty children who were 3 to 10 years old, of ASA class I, were randomly assigned to receive either 2%, 4%, 6%, and 8% sevoflurane and N20 in 50% 02 for induction of anesthesia. The time to loss of eyelash reflex, responses of airway reflex, involuntary movement, and hemodynamic responses were recorded.
Results: Ninety-nine children completed the study. The times to loss of eyelash reflex with 2% in sequence to 8% sevoflurane were 114 ± 21 s, 87 ± 11 s, 75 ± 6 s, and 48 ± 8 s respectively. Incidence of airway reflex response including coughing, laryngospasm, and breath holding was the highest in the 8% group (P ＜ 0.05). Inhalation induction with sevoflurane significantly decreased systolic as well as diastolic blood pressure compared with baseline blood pressure in all the four groups. The extent of decrease of blood pressure was within 20% range of baseline blood pressure in all groups. Significant increase of heart rate was only observed in the 4% and 6% groups.
Conclusions: Sevoflurane 6% for inhalation induction apparently caused low incidence of adverse effects and hastened induction. We suggest that 6% sevoflurene is a concentration more practical for inhalation induction in pediatric patients.

並列關鍵字

Pediatrics ； Anesthetics ； inhalation ； Sevoflurane