L’induction de l’anesthésie au sévoflurane, avec une réduction graduelle de la concentration, est bien tolérée par les patients âgés

Abstract

P Pu ur rp po os se e: : To establish the appropriate inhalation induction technique using a high concentration of sevoflurane in the elderly.M Me et th ho od ds s: : Forty-five patients, aged 70-79-yr-old, were randomly divided into three groups: 1) Group I: anesthesia was induced with propofol 2 mg·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. R Re es su ul lt ts s: : 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.C Co on nc cl lu us si io on ns s: : 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. II et III (P < 0,05 Objectif : Réaliser la technique appropriée d'induction par inhalation en utilisant une forte concentration de sévoflurane chez des patients âgés. Méthode : Quarante-cinq patients de 70-79 ans, ont été répartis de façon aléatoire en trois groupes : 1) groupe I : anesthésie induite avec 2 mg·kg -1 de propofol et du sévoflurane à 2 % (n = 15) ; 2) groupe II : anesthésie induite avec l'inhalation de sévoflurane à 8 % pendant 3 min ; 3) groupe III : anesthésie induite avec l'inhalation de sévoflurane selon la technique de réduction graduelle de la concentration (8, 6, 4 % pour chaque minute). Dans les groupes II et III, une induction par inhalation, avec modification de la capacité vitale, a été réalisée. La tension artérielle moyenne (TAM), la fréquence cardiaque (FR) et la saturation du sang en oxygène (SpO 2 ) ont été mesurées en continu pendant l'induction. De plus, le temps nécessaire à l'induction et les événements indésirables reliés à l'induction anesthésique ont été notés. Résultats : Le temps d'induction a été significativement plus court dans le groupe I que dans les groupes

Hemodynamic Profile of Target-Controlled Spinal Anesthesia Compared With 2 Target-Controlled General Anesthesia Techniques in Elderly Patients With Cardiac Comorbidities

“…19 Sevoflurane induction is a smooth and progressive technique that eliminates the transition phase from intravenous induction to volatile maintenance. Thus, this technique has been proposed in patients with diastolic dysfunction 20 and in the elderly, 6,21,22 using different sevoflurane induction concentrations. No significant differences were noted in hemodynamic parameters between 8% and 4% sevoflurane, but with a prolonged and occasionally unsuccessful induction if 4% was used.…”

“…21 Moreover, induction with 8% sevoflurane using a gradual reduction technique provided better cardiovascular stability than a 3-minute inhalation of sevoflurane 8%. 22 The sevoflurane induction used in our study is quite similar to a gradual reduction technique but with an initial 6% concentration. To avoid any overdose, we adjusted the sevoflurane concentration according to the BIS values because BIS is related linearly to sevoflurane concentration even in elderly patients.…”

Comparison of a propofol target‐controlled infusion and inhalational sevoflurane for fibreoptic intubation under spontaneous ventilation

“…Propofol TCI is proposed for general anaesthesia when a difficult intubation is planned with fibreoptic intubation under spontaneous ventilation because a TCI allows a progressive anaesthetic induction while maintaining spontaneous ventilation (14). Sevoflurane, using a facemask induction, was first practiced in children using high concentrations of sevoflurane (8%), and in elderly patients using incremental or gradual reduction concentrations (15, 16). Sevoflurane induction can be practiced without opioids, nevertheless minimum alveolar concentration and requirements for loss of consciousness increases (17, 18).…”

Guidelines for general anaesthesia in the elderly of the Committee on Quality and Safety in Anaesthesia, Polish Society of Anaesthesiology and Intensive Therapy

“…The Polish Society of Anaesthesiology and Intensive Therapy recommends inhaled induction in elderly patients [11]. Sevoflurane is particularly suited for inhaled induction and it is well tolerated by elderly patients [12][13][14]. 4.…”