Abstract
Purpose
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.
Methods
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).
Conclusions
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.
Résumé
Objectif
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.
Méthode
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.
Résultats
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).
Conclusion
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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This study has been supported by departmental funds from the University of Perugia.
This report was presented at the annual meeting of the American Society of Anesthesiologists, New Orleans, Louisiana, October 16, 2001.
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Pancaro, C., Giovannoni, S., Toscano, A. et al. Apnea during induction of anesthesia with sevoflurane is related to its mode of administration. Can J Anesth 52, 591–594 (2005). https://doi.org/10.1007/BF03015767
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DOI: https://doi.org/10.1007/BF03015767