Canadian Journal of Anaesthesia

, Volume 52, Issue 6, pp 591–594 | Cite as

Apnea during induction of anesthesia with sevoflurane is related to its mode of administration

  • Carlo Pancaro
  • Simone Giovannoni
  • Adelchi Toscano
  • Vito Aldo Peduto
General Anesthesia



The incidence and duration of apnea during sevoflurane anesthesia have not been fully characterized. We hypothesized that sevoflurane at slowly increasing concentrations reduces incidence and shortens the duration of apnea compared to administration of a highly concentrated anesthetic mixture.


131 women were randomly assigned to receive 35% oxygen in air and sevoflurane at: incremental concentrations of 1%, from 1% to 8% (group 1–8%,n = 42); decremental-incremental concentrations of 2%, from 8% to 4% and then from 4% to 8% (group 8–4-8%,n = 36); or fixed concentrations of 8% for induction of anesthesia (group 8%,n = 53). A blinded investigator observed whether and for how long patients stopped breathing. Results: All groups reached 2.5 minimum alveolar concentration of end-tidal sevoflurane. Although apnea was observed in all groups, it was more frequent in the 8% group than in 1 to 8% (68%vs 21%,P < 0.05) or 8 to 4 to 8% groups (68%vs 20%,P < 0.05). Duration of apnea was also more pronounced in the 8% group than in 1 to 8% and 8 to 4 to 8% groups ( 58 ± 25 svs 32 ± 18 sec,P < 0.05 andvs 35 ± 16 sec,P < 0.05, respectively).


Sevoflurane induces apnea more frequently and for longer duration at a fixed high concentration compared to incremental or decremental-incremental concentrations. Decrementalincremental concentrations offer the additional advantage of a speed of induction similar to that elicited by the 8% concentration.


Sevoflurane Enflurane Laryngeal Mask Airway Difficult Airway Minimum Alveolar Concentration 
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L’apnée pendant l’induction de l’anesthésie avec du sévoflurane est reliée au mode d’administration



L’incidence et la durée de l’apnée pendant l’anesthésie au sévoflurane n’ont pas été entièrement définies. Nous avons cru que le sévoflurane administré en concentrations lentement progressives réduisait l’incidence et la durée de l’apnée comparativement à un mélange anesthésique très concentré.


Nous avons réparti au hasard 131 femmes qui ont reçu un mélange de 35 % d’oxygène dans de l’air et du sévoflurane : en concentrations incrémentielles de 1 %, de 1 % à 8 % (groupe 1–8 %, n = 42); en concentrations décrémentielles-incrémentielles de 2 %, de 8 % à 4 %, puis de 4 % à 8 % (groupe 8–4–8 %, n = 36) ou en concentrations fixes de 8 %, pour l’induction de l’anesthésie (groupe 8 %, n = 53). Un chercheur impartial a vérifié la présence et le temps d’apnée.


Une concentration alvéolaire minimale de 2,5 de sévoflurane télé-expiratoire a été atteinte chez toutes les patients. L’apnée a été observée dans tous les groupes, mais était plus fréquente dans le groupe de 8 % que dans celui de 1 à 8 % (68 % vs 21 %,P < 0,05) ou de 8–4–8 % (68 % vs 20 %,P < 0,05). La durée de l’apnée a été aussi plus prononcée dans le groupe de 8 % que dans ceux de 1 à 8 % et de 8–4–8 % ( 58 ± 25 s vs 32 ± 18 s,P < 0,05 et vs 35 ± 16 s,P < 0,05, respectivement).


L’apnée est plus fréquente et dure plus longtemps avec de fortes concentrations fixes de sévoflurane qu’avec des concentrations incrémentielles ou décrémentielles-incrémentielles. Ces dernières concentrations ont un avantage supplémentaire, celui de permettre une induction aussi rapide qu’une concentration à 8 %.


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Copyright information

© Canadian Anesthesiologists 2005

Authors and Affiliations

  • Carlo Pancaro
    • 1
  • Simone Giovannoni
    • 2
  • Adelchi Toscano
    • 2
  • Vito Aldo Peduto
    • 2
  1. 1.Department of Anesthesiology and Perioperative MedicineBrigham and Women’s Hospital, Harvard Medical SchoolBostonUSA
  2. 2.Department of Anesthesiology and Intensive CareUniversity of PerugiaPerugia Italy

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