Sevoflurane EC50 for intravenous cannulation attempt and movement in children

Background and Aims: Literature documents EC 50 (End-tidal) of sevoflurane for CLMA (Classic Laryngeal Mask airway) insertion between 1.5 and 2% and most of these studies suggest maintaining the required end-tidal sevoflurane concentration for 10-25 minutes before LMA insertion. Waiting for this long interval for blood brain sevoflurane equilibration may not be feasible in children especially during failed ventilation. We aimed to estimate EC 50 of sevoflurane for CLMA insertion at equilibration time points of 2.5 min and 5.0 min. Material and Methods: In this randomized trial, children aged 2_8 years of either sex having American Society of Anesthesiologists status I undergoing elective cataract surgery were included. After inhalational induction of general anesthesia with 8% sevoflurane and 100% oxygen, intravenous cannulation was secured. The sevoflurane vaporizer was finely adjusted to maintain an end-tidal sevoflurane concentration at 2% for 2.5 min for first child in group 2.5 and 5 min in group 5.0. This was followed by LMA insertion which was considered to be unsuccessful if there was “movement” and successful if “no movement” occurred. End-tidal concentration was increased/decreased (step-size 0.2%) using Dixon and Massey up and down method in the next patient depending upon the previous patient's response. Results: EC 50 of sevoflurane for insertion of classic LMA in children aged 2-8 yrs in 100% oxygen was 1.1% (0.9-1.2) at 2.5 min and 1.6% (1.5-1.7) at 5.0 min. Derived EC 95 (95% CI) at 2.5 min was 1.8% (1.5-9.2) and at 5.0 min was 1.8% (1.4-8.8) respectively. Conclusion: We suggest maintaining end-tidal sevoflurane of 1.6% for 2.5 min and 1.8% for 5 min for successful CLMA insertion.

show abstract

“…It is accepted as the most widely used measure of anesthetic potency for volatile anesthetics including sevoflurane. [ 19 ]…”

Section: Discussionmentioning

confidence: 99%

EC₅₀ of sevoflurane for classic laryngeal mask airway insertion in children at different time points: A randomized blind trial

Sethi

Goel

Ghai

et al. 2020

J Anaesthesiol Clin Pharmacol

Self Cite

View full text Add to dashboard Cite

show abstract

Section: Methodsmentioning

confidence: 99%

“…No child in this study was premedicated with anxiolysis medications. Based on our clinical practice and studies evaluating depth of anesthesia for noninvasive procedures, 10 we kept patients at 1% to 1.5% minimum alveolar concentration (MAC) as maintenance. Per standard practice, an intravenous (IV) catheter was placed once adequate plane of anesthesia was reached, usually 2 to 4 minutes after loss of eyelash reflex, enough time to reach >90% brain partial pressure equilibrium with arterial sevoflurane.…”

Section: Anesthesiamentioning

confidence: 99%

See 1 more Smart Citation

Why a Propofol Infusion Should Be the Anesthetic of Choice for Auditory Brainstem Response Testing in Children

Kandil

Baroch

et al. 2021

Anesthesia &Amp; Analgesia

View full text Add to dashboard Cite

BACKGROUND: Auditory brainstem response (ABR) testing is considered to be relatively resistant to effects of volatile anesthetics. The impact of newer anesthetics on interpretability of ABR testing is unknown. This study compared sevoflurane versus propofol anesthesia on qualitative interpretability of ABR click-testing in children. METHODS: This prospective double-blind crossover study enrolled children (≤18 years old) receiving general anesthesia for elective ABR testing. All subjects received both sevoflurane and propofol anesthesias in the same ABR testing session. Deidentified ABR data were reviewed by 5 audiologists (blinded to anesthetic and patient) to determine threshold levels for hearing loss. The primary outcome was qualitative interpretability (false positive) of ABR click-testing. RESULTS: Each patient was tested at 4 different intensities in each ear: generating 624 records under each anesthetic, for a total of 1248 records. A few patients were tested at 5 different intensities in a single ear accounting for the additional 11 records, yielding 1259 records. Under sevoflurane anesthesia, 21 of the same patients (37 ears) were identified with abnormal ABR levels consistent with hearing loss (one or both ears). The probability of a patient being diagnosed with hearing "loss" in one or both ears was significantly less with propofol versus sevoflurane anesthesia (mid P =.0312). If patients with bilateral loss are compared, the mid P value is 0.0098. The effect size based on patients was medium to large, with a minimum value of Cohen w = 0.320. CONCLUSIONS: Sevoflurane produced more false positives for hearing loss and suggested more severe hearing loss than propofol. False-positive ABR tests, produced by certain anesthetic agents, can have significant life-long impact and negative psychosocial and developmental implications. Use of the intravenous anesthetic propofol is superior to sevoflurane for ABR testing in children. (Anesth Analg 2022;134:802-9) KEY POINTS• Question: Does the anesthetic agent used during auditory brainstem response (ABR) testing for hearing impairment in children influence interpretability of results? • Findings: Sevoflurane produced more false positives for hearing loss and suggested more severe hearing loss than propofol. • Meaning: Anesthetic regimens can lead to significant alteration in interpretability of ABR testing children-use of sevoflurane may cloud interpretability, and propofol seems to be a preferable anesthetic agent. GLOSSARYABR = auditory brainstem response; ASA = American Society of Anesthesiologists; AUC = area under the curve; CONSORT = Consolidated Standards of Reporting Trials; D/C = discontinue; IV = intravenous; MAC = minimum alveolar concentration; nHL = normal adult hearing level; SVM = support vector machine versions of this article on the journal's website (www.anesthesia-analgesia. org).

show abstract

Effective concentration (EC50) of sevoflurane for intraocular pressure measurement in anaesthetised children with glaucoma: A dose-finding study

Ravichandran,

Goel,

Ghai

et al. 2024

Indian Journal of Anaesthesia

View full text Add to dashboard Cite

Background and Aim: Sevoflurane, a preferred anaesthetic for children, exhibits a dose-dependent reduction in intraocular pressure (IOP). However, consensus is lacking regarding optimal end-tidal sevoflurane concentration for safe IOP measurement. This study aimed to identify the concentration at which IOP measurement could be attempted without inducing movements in paediatric patients after inhalational induction. Methods: Two paediatric groups (1–12 months and 12–36 months) with glaucoma undergoing examination under anaesthesia were recruited. After induction with 8% sevoflurane and 100% oxygen, the first child had an end-tidal sevoflurane concentration maintained at 2% for 4 min, followed by IOP measurement. Success was defined as ‘no movement’, and subsequent concentrations (adjusted in 0.2% steps) were determined using the Dixon and Massey method based on the previous patient’s responses. Results: The study included 75 children. The effective concentration of sevoflurane causing ‘no movement’ during IOP measurement in 50% of the study population for successful IOP measurement was 1.98% (95% confidence interval [CI] 1.63, 2.17, P = 0.017) for 1–12 months group and 0.55% (95% CI 0.39, 0.66, P = 0.002) for 12–36 months group. Probit regression analysis yielded effective concentration of sevoflurane causing ‘no movement’ during IOP measurement in 95% of the study population values of 2.47% (95% CI 2.24, 4.58, P = 0.017) for 1–12 months group and 0.94% (95% CI 0.78, 1.57, P = 0.002) for 12–36 months group. Conclusion: In paediatric patients, a higher end-tidal sevoflurane concentration of 2% is needed for IOP measurement in 1–12 months age group compared to 0.5% required in 12–36 months age group, achieving success in 50% of the study population.

show abstract

Sevoflurane EC50 for intravenous cannulation attempt and movement in children

Cited by 3 publications

References 15 publications

EC₅₀ of sevoflurane for classic laryngeal mask airway insertion in children at different time points: A randomized blind trial

EC₅₀ of sevoflurane for classic laryngeal mask airway insertion in children at different time points: A randomized blind trial

Why a Propofol Infusion Should Be the Anesthetic of Choice for Auditory Brainstem Response Testing in Children

Effective concentration (EC50) of sevoflurane for intraocular pressure measurement in anaesthetised children with glaucoma: A dose-finding study

Contact Info

Product

Resources

About

Sevoflurane EC50 for intravenous cannulation attempt and movement in children

Cited by 3 publications

References 15 publications

EC50 of sevoflurane for classic laryngeal mask airway insertion in children at different time points: A randomized blind trial

EC50 of sevoflurane for classic laryngeal mask airway insertion in children at different time points: A randomized blind trial

Why a Propofol Infusion Should Be the Anesthetic of Choice for Auditory Brainstem Response Testing in Children

Effective concentration (EC50) of sevoflurane for intraocular pressure measurement in anaesthetised children with glaucoma: A dose-finding study

Contact Info

Product

Resources

About

EC₅₀ of sevoflurane for classic laryngeal mask airway insertion in children at different time points: A randomized blind trial

EC₅₀ of sevoflurane for classic laryngeal mask airway insertion in children at different time points: A randomized blind trial