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A sevoflurane induction of anesthesia with gradual reduction of concentration is well tolerated in elderly patients

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



To establish the appropriate inhalation induction technique using a high concentration of sevoflurane in the elderly.


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 threeminute 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 (SpO2) were measured continuously during induction. In addition, induction time and adverse events related to anesthetic induction were recorded.


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 SpO2 below 96%, except for two patients in Group I. Severe respiratory adverse events were not observed. Other adverse events were similar in all groups.


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.



Réaliser la technique appropriée d’induction par inhalation en utilisant une forte concentration de sévoflurane chez des patients âgés.


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 à2%(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 (SpO2) 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.


Le temps d’induction a été significativement plus court dans le groupe I que dans les groupes II et III (P < 0,05). Aucune différence de temps d’induction n’a été relevée entre les groupes II et III. Dans ces groupes II et III, la majorité des patients ont eu besoin de ventilation supplémentaire. Comparativement aux autres groupes, la stabilité de la TAM a été maintenue dans le groupe III. Les variations de FC ont été faibles dans tous les groupes. Pendant l’induction, aucun patient n’a subi de baisse de la SpO2 en dessous de 96 %, sauf deux patients du groupe I. Aucune complication respiratoire sévère n’a été observée. Les autres événements indésirables ont été comparables d’un groupe à l’autre.


Nos résultats montrent qu’une induction avec une forte concentration de sévoflurane, selon une technique de réduction graduelle, peut remplacer l’induction iv habituelle de façon acceptable chez les patients âgés.


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Correspondence to Shigeki Yamaguchi.

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Yamaguchi, S., Ikeda, T., Wake, K. et al. A sevoflurane induction of anesthesia with gradual reduction of concentration is well tolerated in elderly patients. Can J Anesth 50, 26–31 (2003).

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  • Mean Arterial Pressure
  • Sevoflurane
  • Vital Capacity
  • Induction Time
  • Anesthetic Induction