Sevoflurane in Paediatric Anaesthesia
Tóm tắt
Sevoflurane is an ether inhalation anaesthetic agent with low pungency, a non-irritant odour and a low blood: gas partition coefficient. It can be rapidly and conveniently administered without discomfort, and its low solubility facilitates precise control over the depth of anaesthesia and a rapid and smooth induction of, and emergence from, general anaesthesia. As an induction and maintenance agent for ambulatory and nonambulatory surgery in children, sevoflurane provides more rapid induction of, and emergence from, anaesthesia than halothane, and has similar or better patient acceptability. Time to discharge from the recovery area is usually at least as fast with sevoflurane as with halothane. While rapid emergence from sevoflurane lessens the time spent under anaesthesia, postoperative pain may be more intense and occur earlier than during more gradual emergence. Sevoflurane has been used successfully as an induction agent for tracheal intubation and laryngeal mask airway (LMA) insertion: time to LMA insertion is faster with sevoflurane than halothane, but the 2 drugs provide similar conditions for tracheal intubation. The pattern and incidence of induction and emergence events such as cough, laryngospasm and agitation/excitement is similar with sevoflurane and halothane; however, sevoflurane may cause less postoperative nausea and vomiting. At present, differences have not been consistently shown between the 2 drugs in their propensity to cause postoperative excitement or agitation. Compared with halothane, sevoflurane has low potential for arrhythmogenicity. Clinical experience does not substantiate concerns over the potential nephrotoxicity of the sevoflurane byproducts pentafluoroisopropenyl fluoromethyl ether (‘Compound A’) and plasma F− ions; no renal impairment has been documented in children receiving sevoflurane in clinical trials. The potential for sevoflurane hepatotoxicity also appears negligible. There are few trials comparing sevoflurane with agents other than halothane in paediatric anaesthesia. As well, pharmacoeconomic analyses are scarce and incompletely published; further studies are needed to determine whether shortened times to emergence will translate into cost savings.
Conclusion: Sevoflurane is a preferred anaesthetic agent for induction and maintenance of paediatric anaesthesia because of its rapid induction and recovery characteristics, lack of pungency and agreeable odour, and acceptable cardiovascular profile. Although the issue of postoperative excitement requires clarification, sevoflurane anaesthesia can be considered a rational choice for ambulatory and nonambulatory surgery in children. Sevoflurane is a nonpungent ether inhalation anaesthetic agent. The anaesthetic potency of sevoflurane is age-dependent, sevoflurane being less potent in children than in adults. Concomitant use with nitrous oxide (N2O), clonidine, or opioids increases the potency of sevoflurane. The effects of sevoflurane on various body systems generally parallel those produced by other inhalation anaesthetics (most systems are depressed in a dose-related manner). The cerebrovasodilatory effect of sevoflurane was similar to that of halothane in 18 children. Sevoflurane also has cardiovascular depressant effects that are similar in type to those of desflurane and isoflurane in patients and healthy volunteers, although comparisons with halothane in children give variable results. Administration with N2O 60%, spontaneous ventilation or prolonged exposure to sevoflurane attenuate cardiovascular depression and myocardial contractility. Statistically significant increases in heart rate occur in infants and children aged ≤12 years during or soon after induction of anaesthesia with sevoflurane (see also Tolerability summary). Blood pressure is decreased in this population but to a lesser extent than with desflurane, a similar extent to that with isoflurane and generally to a similar or significantly lower extent versus halothane. Sevoflurane, in common with other inhalation anaesthetic agents, causes dose-dependent ventilatory depression which can lead to a decrease in blood pH and to apnoea. Sevoflurane caused greater respiratory depression or changes than halothane at 1 minimum alveolar concentration (MAC) in 30 infants aged 6 to 24 months. Comparison of sevoflurane and isoflurane (both at 1 MAC) in 40 children showed the 2 agents to produce a similar extent and pattern of respiratory depression. Sevoflurane has the advantage over several other inhalation anaesthetic agents, including desflurane, isoflurane and enflurane, of causing negligible airway irritation. Sevoflurane is degraded by CO2 absorbents (used in the anaesthesia circuit) to pentafluoroisopropenyl fluoromethyl ether (PIFE; ‘Compound A’), which is nephrotoxic in rats but has not been shown to cause clinically significant renal injury in patients undergoing anaesthesia. Many studies conducted in adults receiving sevoflurane anaesthesia have detected laboratory markers of renal injury but, overall, sevoflurane does not appear to be associated with a higher risk of renal toxicity than isoflurane, enflurane or propofol, even when sevoflurane is administered at low flow rates in comparisons with isoflurane. Because of its low blood: gas solubility, sevoflurane is rapidly taken up and eliminated. The alveolar ‘wash-in’ rate in children is about 50% higher with sevoflurane than with halothane when either is given with N2O. Like other fluorinated ethers, sevoflurane undergoes dose-independent hepatic biotransformation by cytochrome P450 (CYP) 2E1, principally to inorganic fluoride ions (F−) and hexafluoroisopropanol (HEIP). Up to 50% of plasma F− is cleared via uptake into bone. Sevoflurane undergoes negligible renal defluorination compared with methoxyflurane. Sevoflurane is eliminated more rapidly than halothane in children; the alveolar ‘washout’ rate is halved. Sevoflurane reduces time to induction and emergence compared with halothane in children undergoing ambulatory and nonambulatory surgery, although the clinical importance of the difference in time to induction has been questioned. Time to induction is reduced with increasing sevoflurane concentration, use of high concentration versus incremental concentrations and the addition of N2O. The rapid emergence from sevoflurane anaesthesia is desirable but appears to result in earlier and more intense discomfort or pain (as measured by objective pain/discomfort scores and use of postoperative analgesia). Time to discharge from the recovery area is generally at least as fast, and patient acceptability of the anaesthetic is at least as good, with sevoflurane as with halothane. Data are insufficient to allow any firm conclusions regarding the relative anaesthetic efficacy of sevoflurane compared with desflurane or propofol. Several clinical studies demonstrate that children can successfully undergo tracheal intubation without a muscle relaxant or LMA insertion while receiving sevoflurane induction anaesthesia. Although sevoflurane has been the subject of a number of theoretical cost analyses, detailed data are scarce and well designed formal cost effectiveness comparisons with other agents are not available. The incidence of adverse events occurring most often during induction and emergence — coughing, laryngospasm, breath-holding and agitation/excitement — is generally similar for sevoflurane and halothane. Available evidence does not consistently show differences between the 2 drugs in their propensity to cause postoperative excitement. EEG patterns for the 2 drugs have been shown to be dissimilar, but seizure-like movement seen during sevoflurane anaesthesia has not been causally related to the drug. Sevoflurane increases heart rate to a greater extent than halothane during induction but causes fewer instances of arrhythmias and bradycardia during anaesthesia. Sevoflurane may cause postoperative nausea and vomiting (PONV) less often than halothane; individual trials show a similar incidence of PONV for sevoflurane compared with desflurane, isoflurane and propofol. Despite elevated plasma F− levels, sevoflurane and other inhalation anaesthetic agents are not associated with nephrotoxicity. Numerous trials in children demonstrate that plasma F− levels remain below the theoretical ‘toxic threshold’ of 50 μmol/L (for methoxyflurane) during sevoflurane anaesthesia lasting up to 9 MAC · h, with no renal impairment evident. There have been no reports of PIFE-associated nephrotoxicity in children or adults anaesthetised with sevoflurane. The potential for hepatic injury with sevoflurane is expected to be negligible; sevoflurane does not generate antigenic trifluoroacetyl proteins and its organic metabolite HFIP has a low binding affinity for hepatic tissue and is rapidly glucoronidated and excreted. Increases in levels of serum glutathione S-transferase α seen in one series of children anaesthetised with sevoflurane or halothane were not evident in another group given sevoflurane. Like other inhalation anaesthetic agents, sevoflurane has the potential to cause malignant hyperthermia; only 2 such cases have been reported in children to date. Sevoflurane prolongs the duration of neuromuscular blockade induced by non-depolarising muscle relaxants such as vecuronium to a greater extent than halothane or isoflurane. Dosages of neuromuscular blockers should be reduced when sevoflurane anaesthesia is used. Agents such as isoniazid and alcohol that induce cytochrome P450 2E1 may increase sevoflurane metabolism. Whether sevoflurane may displace highly bound drugs such as phenytoin is unknown, but this interaction has occurred with other volatile fluorinated anaesthetics. Sevoflurane is synergistic with lidocaine (lignocaine) and procainamide in prolonging ventricular activation time. Sevoflurane is administered by inhalation with a vaporiser specifically calibrated for the agent. Delivery should be individualised according to the patient’s response. Sevoflurane concentrations needed to induce anaesthesia are greater in children than in adults. Inspired sevoflurane concentrations of 7 or 8% have been used successfully to induce anaesthesia in many studies in children. Sevoflurane is most often administered with N2O plus O2. Sevoflurane concentrations of 0.5 to 3% are sufficient to maintain anaesthesia during surgery. There are no flow rate restrictions in most countries where sevoflurane is approved. Sevoflurane is contraindicated in patients with known or suspected genetic susceptibility to malignant hyperthermia and should be used with caution in patients with renal insufficiency. Levels of the organic metabolite PIFE are higher when barium hydroxide lime rather than soda lime is used as a CO2 absorbent.
Tài liệu tham khảo
Patel SS, Goa KL. Sevoflurane: a review of its pharmacodynamic and pharmacokinetic properties and its clinical use in general anaesthesia. Drugs 1996 Apr; 51: 658–700
Malviya S, Lerman J. The blood/gas solubilities of sevoflurane, isoflurane, halothane, and serum constituent concentrations in neonates and adults. Anesthesiology 1990 May; 72: 793–6
Lockwood GG, Sapsed-Byrne SM, Smith MA. Effect of temperature on the solubility of desflurane, sevoflurane, enflurane and halothane in blood. Br J Anaesth 1997 Oct; 79: 517–20
Targ A, Yasuda N, Eger II EI. Solubility of I-653, sevoflurane, isoflurane and halothane in plastics and rubber composing a conventional anesthetic circuit. Anesth Analg 1989 Aug; 69(2): 218–25
Abbott Laboratories Limited. Sevoflurane product information. Abbot Park (IL), USA, 1999
Young CJ, Apfelbaum JL. Inhalational anesthetics: desflurane and sevoflurane. J Clin Anesth 1995 Nov; 7: 564–77
Iyer RA, Baggs RB, Anders MW. Nephrotoxicity of the glutathione and cysteine S-conjugates of the sevoflurane degradation product 2-(fluoromethoxy)-1,1,3,3,3-pentafluoro-1-propene (compound A) in male Fischer 344 rats. J Pharmacol Exp Ther 1997 Dec; 283: 1544–51
Kharasch ED, Frink Jr EJ, Zager R, et al. Assessment of low-flow sevoflurane and isoflurane effects on renal function using sensitive markers of tubular toxicity. Anesthesiology 1997 Jun; 86: 1238–53
Cunningham DD, Huang S, Webster J, et al. Sevoflurane degradation to compound A in anaesthesia breathing systems. Br J Anaesth 1996 Oct; 77: 537–43
Bito H, Ikeuchi Y, Ikeda K. Effects of the water content of soda lime on compound A concentration in the anesthesia circuit in sevoflurane anesthesia. Anesthesiology 1998 Jan; 88: 66–71
Higuchi H, Sumita S, Wada H, et al. Effects of sevoflurane and isoflurane on renal function and on possible markers of nephrotoxicity. Anesthesiology 1998 Aug; 89: 307–22
Bito H, Ikeuchi Y, Ikeda K. Effects of low-flow sevoflurane anesthesia on renal function: comparison with high-flow sevoflurane anesthesia and low-flow isoflurane anesthesia. Anesthesiology 1997 Jun; 86: 1231–7
Eger II EI, Koblin DD, Bowland T, et al. Nephrotoxicity of sevoflurane versus desflurane anesthesia in volunteers. Anesth Analg 1997 Jan; 84: 160–8
Goldberg ME, Cantillo J, Larijani GE, et al. Sevoflurane versus isoflurane for maintenance of anesthesia: are serum inorganic fluoride ion concentrations of concern? Anesth Analg 1996 Jun; 82: 1268–72
Ebert TJ, Frink JEJ, Kharasch ED. Absence of biochemical evidence for renal and hepatic dysfunction after 8 hours of 1.25 minimum alveolar concentration sevoflurane anesthesia in volunteers. Anesthesiology 1998 Mar; 88: 601–10
Eisenman TS, Fragen RJ, Groudine SB, et al. Renal function evaluation following low-flow sevoflurane compared to isoflurane [abstract no. A1134]. Anesthesiology 1997 Sep; 87 Suppl.
Mazze RI, Friedman M, Delgado-Herrera L, et al. Renal toxicity of compound A plus sevoflurane compared with isoflurane in non-human primates [abstract no. A490]. Anesthesiology 1998 Sep; 89(3A Suppl.)
Eger II EI, Ionescu P, Laster MJ, et al. Baralyme® dehydration increases and soda lime dehydration decreases the concentration of compound A resulting from sevoflurane degradation in a standard anesthetic circuit. Anesth Analg 1997 Oct; 85: 892–8
Fang ZX, Eger II EI, Laster MJ, et al. Carbon monoxide production from degradation of desflurane, enflurane, isoflurane, halothane and sevoflurane by soda lime and Baralyme. Anesth Analg 1995 Jun; 80(6): 1187–93
Frink Jr EJ, Nogami WM, Morgan SE. Production of carbon monoxide using dry Baralyme with desflurane, enflurane, isoflurane, halothane or sevoflurane anesthesia in pigs [abstract no. A1018]. Anesthesiology 1996 Sep; 85 Suppl.
Fee JPH, Murray JM, Luney SR. Molecular sieves: an alternative method of carbon dioxide removal which does not generate compound A during simulated low-flow sevoflurane anaesthesia. Anaesthesia 1995 Oct; 50: 841–5
Artru AA, Lam AM, Johnson JO, et al. Intracranial pressure, middle cerebral artery flow velocity, and plasma inorganic fluoride concentrations in neurosurgical patients receiving sevoflurane or isoflurane. Anesth Analg 1997 Sep; 85: 587–92
Bundgaard H, von Oettingen G, Larsen KM, et al. Effects of sevoflurane on intracranial pressure, cerebral blood flow and cerebral metabolism: a dose-response study in patients subjected to craniotomy for cerebral tumours. Acta Anaesthesiol Scand 1998 Jul; 42: 621–7
Cho S, Fujigaki T, Uchiyama Y, et al. Effects of sevoflurane with and without nitrous oxide on human cerebral circulation: transcranial Doppler study. Anesthesiology 1996 Oct; 85: 755–60
Heath KJ, Gupta S, Matta BF. The effects of sevoflurane on cerebral hemodynamics during propofol anesthesia. Anesth Analg 1997 Dec; 85: 1284–7
Watts A, Herrick I, Gelb A, et al. Electrocorticographic effects of sevoflurane and isoflurane in patients with seizure disorders [abstract no. A1068]. Anesthesiology 1997 Sep; 87 Suppl.
Galinkin JL, Janiszewski D, Young CJ, et al. Subjective, psychomotor, cognitive, and analgesic effects of subanesthetic concentrations of sevoflurane and nitrous oxide. Anesthesiology 1997 Nov; 87: 1082–8
Iwasaka H, Itoh K, Miyakawa H, et al. Glucose intolerance during prolonged sevoflurane anaesthesia. Can J Anaesth 1996 Oct; 43: 1059–61
Oyama T, Murakawa T, Matsuki A. Endocrine evaluation of sevoflurane, a new inhalation anesthetic agent. Acta Anaesthesiol Belg 1989; 40: 269–74
Rooke GA, Ebert T, Muzi M, et al. The hemodynamic and renal effects of sevoflurane and isoflurane in patients with coronary artery disease and chronic hypertension. Anesth Analg 1996 Jun; 82: 1159–65
Bito H, Ikeda K. Renal and hepatic function in surgical patients after low-flow sevoflurane or isoflurane anesthesia. Anesth Analg 1996 Jan; 82: 173–6
Motoyama EK. Sevoflurane in pediatric ear, nose, and throat procedures. Int Anesthesiol Clin 1997; 35(3): 93–7
Lerman J, Sikich N, Kleinman S, et al. The pharmacology of sevoflurane in infants and children. Anesthesiology 1994 Apr; 80: 814–24
Miller RD, Wahrenbrock EA, Schroeder CF, et al. Ethylene-halothane anesthesia: addition or synergism? Anesth Analg 1969 Oct; 31(4): 301–4
Stevens WC, Dolan WM, Gibbons RT, et al. Minimum alveolar concentrations (MAC) of isoflurane with and without nitrous oxide in patients of various ages. Anesthesiology 1975 Feb; 42(2): 197–200
Rampil IJ, Lockhart SH, Zwass MS, et al. Clinical characteristics of desflurane in surgical patients: minimum alveolar concentration. Anesthesiology 1991 Mar; 74(3): 429–33
Hwee LP, Crawford MW, Swan H, et al. Interaction between nitrous oxide and sevoflurane with respect to MAC for tracheal intubation in children [abstract no. A1260]. Anesthesiology 1998; 89(3A)
Inomata S, Yaguchi Y, Kihara S, et al. The effects of oral clonidine premedication on MAC and MAC for tracheal intubation (MAC-E1) of sevoflurane in children [abstract no. A1258]. Anesthesiology 1998; 89(3A)
Nishina K, Mikawa K, Shiga M, et al. Oral clonidine premedication reduces minimum alveolar concentration of sevoflurane for tracheal intubation in children. Anesthesiology 1997 Dec; 87: 1324–7
Berkowitz RA, Hoffman WE, Cunningham F, et al. Changes in cerebral blood flow velocity in children during sevoflurane and halothane anesthesia. J Neurosurg Anesthesiol 1996; 8(3): 194–8
Kern C, Erb T, Frei FJ. Haemodynamic responses to sevoflurane compared with halothane during inhalational induction in children. Paediatr Anaesth 1997; 7(6): 439–44
Tanaka H, Takata M, Yamamoto S, et al. Cardiovascular interaction during sevoflurane anesthesia in children assessed by transesophageal acoustic quantification [abstract no. A132]. Anesthesiology 1994 Sep; 81 Suppl.
Kawana S, Wachi J, Nakayama M, et al. Comparison of haemodynamic changes induced by sevoflurane and halothane in paediatric patients. Can J Anaesth 1995 Jul; 42: 603–7
Rieger A, Hass I, Striebel HW, et al. Marked increases in heart rate associated with sevoflurane but not with halothane following suxamethonium administration in children. Eur J Anaesthesiol 1996 Nov; 13: 616–21
Komatsu H, Chujo K, Morita J, et al. Spontaneous breathing with the use of a laryngeal mask airway in children: comparison of sevoflurane and isoflurane. Paediatr Anaesth 1997; 7(2): 111–5
Fairgrieve R, Fletcher GC, Colquhoun AD. Comparison of sevoflurane and halothane anaesthesia in children undergoing outpatient dental surgery [abstract]. Br J Anaesth 1997 May; 78 Suppl. 1: 102
Sarner JB, Levine M, Davis PJ, et al. Clinical characteristics of sevoflurane in children: a comparison with halothane. Anesthesiology 1995 Jan; 82: 38–46
Kataria B, Epstein R, Bailey A, et al. A comparison of sevoflurane to halothane in paediatric surgical patients: results of a multicentre international study. Paediatr Anaesth 1996; 6(4): 283–92
Wodey E, Pladys P, Copin C, et al. Comparative hemodynamic depression of sevoflurane versus halothane in infants: an echocardiographic study. Anesthesiology 1997 Oct; 87: 795–800
Holzman RS, van der Velde ME, Kaus SJ, et al. Sevoflurane depresses myocardial contractility less than halothane during induction of anesthesia in children. Anesthesiology 1996 Dec; 85: 1260–7
Taylor RH, Lerman J. Minimum alveolar concentration of desflurane and hemodynamic responses in neonates, infants and children. Anesthesiology 1991 Dec; 75(6): 975–9
van Knobelsdorff G, Schmidt-Ott S, Haun C, et al. The effects of sevoflurane versus halothane on systemic hemodynamics during induction for congenital heart disease in infants [abstract no. A1257]. Anesthesiology 1998; 89(3A)
Noguchi I, Suzuki G, Hiyama A, et al. Effects of sevoflurane anesthesia on serum levels of myoglobin and CPK in anesthetized children: a comparison with halothane [in Japanese]. Masui 1988 Apr; 37: 421–7
Zimmerman AA, Ibrahim AE, Epstein MR, et al. The effects of halothane and sevoflurane on cardiac electrophysiology in children undergoing radiofrequency catheter ablation [abstract no. A1066]. Anesthesiology 1997 Sep; 87 Suppl.
Kinouchi K, Tanigami H, Tashiro C, et al. Duration of apnea in anesthetized infants and children required for desaturation of hemoglobin to 95%. The influence of upper respiratory infection. Anesthesiology 1992 Dec; 77: 1105–7
Brown K, Aun C, Stocks J, et al. Acomparison of the respiratory effects of sevoflurane and halothane in infants and young children. Anesthesiology 1998 Jul; 89: 86–92
Doi M, Ikeda K. Respiratory effects of sevoflurane. Anesth Analg 1987; 66: 241–4
Rooke GA, Choi J-H, Bishop MJ. The effect of isoflurane, halothane, sevoflurane, and thiopental/nitrous oxide on respiratory system resistance after tracheal intubation. Anesthesiology 1997 Jun; 86: 1294–9
Mitsuhata H, Saitoh J, Shimizu R, et al. Sevoflurane and isoflurane protect against bronchospasm in dogs. Anesthesiology 1994 Nov; 81(5): 1230–4
Wilklund CU, Rehder K, Ebberyd A, et al. Effects of sevoflurane on the isolated guinea pig trachea [abstract no. A1439]. Anesthesiology 1994; 81
Hashimoto Y, Hirota K, Ohtomo N, et al. In vivo direct measurement of the bronchodilating effect of sevoflurane using a superfine fiberoptic bronchoscope: comparison with enflurane and halothane. J Cardiothorac Vasc Anesth 1996 Feb; 10: 213–6
Callan C, Mayer D, Delgado-Herrera L. Effects of sevoflurane on serum creatinine concentration: a retrospective, 22 study, comparative evaluation of renal function in adult surgical patients [abstract no. S162]. Anesth Analg 1998 Feb; 86 Suppl.
Nishimori A, Tanaka K, Ueno K, et al. Effects of sevoflurane anaesthesia on renal function. J Int Med Res 1997 Mar–Apr; 25: 87–91
Nishiyama T, Aibiki M, Hanaoka K. Inorganic fluoride kinetics and renal tubular function after sevoflurane anesthesia in chronic renal failure patients receiving hemodialysis. Anesth Analg 1996 Sep; 83: 574–7
Tsukamoto N, Hirabayashi Y, Shimizu R, et al. The effects of sevoflurane and isoflurane anesthesia on renal tubular function in patients with moderately impaired renal function. Anesth Analg 1996 May; 82: 909–13
Lerman J, Sikich N, Levine M. Wash-in of sevoflurane in healthy children [abstract no. A1133]. Anesthesiology 1995 Sep; 83 Suppl.
Yasuda N, Lockhart SH, Eger II EI, et al. Comparison of kinetics of sevoflurane and isoflurane in humans. Anesth Analg 1991 Mar; 72: 316–24
Kharasch ED, Hankins DC. P450-dependent and nonenzymatic human liver microsomal defluorination of fluoromethyl-2,2-difluoro-1-(trifluoromethyl)vinyl ether (compound A), a sevoflurane degradation product. Drug Metab Dispos 1996 Jun; 24: 649–54
Kharasch ED, Hankins DC, Thummel KE. Human kidney methoxyflurane and sevoflurane metabolism: intrarenal fluoride production as a possible mechanism of methoxyflurane nephrotoxicity. Anesthesiology 1995 Mar; 82(3): 689–99
Michel I, Van Obbergh LJ, Wallemacq P, et al. Extrahepatic metabolism of sevoflurane (S) in children during the anhepatic phase (AP) of orthotopic liver transplantation (OLT) [abstract no. S525]. Anesth Analg 1997 Feb; 84 Suppl.
Landais A, Saint-Maurice C, Hamza J, et al. Sevoflurane elimination kinetics in children. Paediatr Anaesth 1995; 5(5): 297–301
Binstock WB, Berkowitz R, Eyrich K, et al. A comparison of sevoflurane and halothane for induction and maintenance of anesthesia in pediatric ASA I and II outpatients [abstract no. A1313]. Anesthesiology 1994 Sep; 81 Suppl.
Furuya Y, Tachibana C, Kobayashi N, et al. Comparison of sevoflurane and halothane in pediatric anesthesia [in Japanese]. Masui 1993 Jan; 42: 46–51
Lerman J, Davis PJ, Welborn LG, et al. Induction, recovery, and safety characteristics of sevoflurane in children undergoing ambulatory surgery: a comparison with halothane. Anesthesiology 1996 Jun; 84: 1332–40
Meretoja OA, Taivainen T, Räihä L, et al. Sevoflurane-nitrous oxide or halothane-nitrous oxide for paediatric bronchoscopy and gastroscopy. Br J Anaesth 1996 Jun; 76: 767–71
Welborn LG, Hannallah RS, Norden JM, et al. Comparison of emergence and recovery characteristics of sevoflurane, desflurane, and halothane in pediatric ambulatory patients. Anesth Analg 1996 Nov; 83: 917–20
Guard BC, Sikich N, Lerman J, et al. Maintenance and recovery characteristics after sevoflurane or propofol during ambulatory surgery in children with epidural blockade. Can J Anaesth 1998; 45(11): 1072–8
Picard V, Dumont L, Pellegrini M, et al. Quality of recovery in children: sevoflurane vs propofol [abstract]. Br J Anaesth 1998 May; 80Suppl. 1: 138–9
Ariffin SA, Whyte JA, Malins AF, et al. Comparison of induction and recovery between sevoflurane and halothane supplementation of anaesthesia in children undergoing outpatient dental extractions. Br J Anaesth 1997 Feb; 78: 157–9
Paris ST, Cafferkey M, Tarling M, et al. Comparison of sevoflurane and halothane for outpatient dental anaesthesia in children. Br J Anaesth 1997 Sep; 79: 280–4
Walker SM, Haugen RD, Richards A. A comparison of sevoflurane with halothane for paediatric day case surgery. Anaesth Intensive Care 1997 Dec; 25: 643–9
Stead SW, Miller J, Beatie CD, et al. Rapidity of induction and elimination of halothane and sevoflurane in pediatric outpatients [abstract no. A1314]. Anesthesiology 1994 Sep; 81 Suppl.
Sury MRJ, Black A, Hemington L, et al. A comparison of the recovery characteristics of sevoflurane and halothane in children. Anaesthesia 1996 Jun; 51: 543–6
Chong ZK, Jawan B, Poon YY, et al. Comparison of sevoflurane with halothane in pediatric ambulatory anesthesia: an experience in Taiwan. Acta Anaesthesiol Sin 1997 Mar; 35: 21–4
Calderon E, Torres LM. Comparative study of recovery from general anesthesia with halothane or sevoflurane in pediatrics [in Spanish]. Rev Esp Anestesiol Reanim 1996 Oct; 43: 272–5
Piat V, Dubois M-C, Johanet S, et al. Induction and recovery characteristics and hemodynamic responses to sevoflurane and halothane in children. Anesth Analg 1994 Nov; 79: 840–4
Johannesson GP, Florén M, Lindahl SGE. Sevoflurane for ENT-surgery in children: a comparison with halothane. Acta Anaesthesiol Scand 1995 May; 39: 546–50
Rieger A, Schröter G, Philippi W. Acomparison of sevoflurane with halothane in outpatient adenotomy in children with mild upper respiratory tract infections. J Clin Anesth 1996 May; 8: 188–93
Cravero JP, Beach M, Dodge CP, et al. Emergence characteristics of sevoflurane compared to halothane in pediatric patients [abstract no. A1310]. Anesthesiology 1998 Sep; 89(3A)
O’Brien K, Robinson DN, Morton N. Induction and emergence in infants less than 60 weeks post-conceptual age: comparison of thiopental, halothane, sevoflurane and desflurane. Br J Anaesth 1998 Apr; 80: 456–9
Funk W, Moldaschl J, Fushita Y, et al. Advantage of sevoflurane over halothane in anesthesia induction and emergence of pediatric patients [abstract no. A1315]. Anesthesiology 1994 Sep; 81 Suppl.
Taivainen T, Tiainen P, Meretoja OA, et al. Comparison of the effects of sevoflurane and halothane on the quality of anaesthesia and serum glutathione transferase alpha and fluoride in paediatric patients. Br J Anaesth 1994 Nov; 73: 590–5
Dubois MC, Piat V, Lamblin O, et al. Which method of induction with sevoflurane in children: incremental or high concentration, with or without nitrous oxide? [abstract]. Br J Anaesth 1998 May; 80Suppl. 1: 138
Epstein RH, Stein AL, Marr AT, et al. High concentration versus incremental induction of anesthesia with sevoflurane in children: a comparison of induction times, vital signs, and complications. J Clin Anesth 1998 Feb; 10: 41–5
Haga S, Shima T, Momose K, et al. Anesthetic induction of children with high concentrations of sevoflurane [in Japanese]. Masui 1992 Dec; 41: 1951–5
Agnor RC, Sikich N, Lerman J. Single-breath vital capacity rapid inhalation induction in children. Anesthesiology 1998 Aug; 89: 379–84
Baum VC, Yemen TA, Baum LD. Immediate 8% sevoflurane induction in children: a comparison with incremental sevoflurane and incremental halothane. Anesth Analg 1997 Aug; 85: 313–6
Sigston PE, Jenkins AMC, Jackson EA, et al. Rapid inhalation induction in children: 8% sevoflurane compared with 5% halothane. Br J Anaesth 1997 Apr; 78: 362–5
Inomata S, Watanabe S, Taguchi M, et al. End-tidal sevoflurane concentration for tracheal intubation and minimum alveolar concentration in pediatric patients. Anesthesiology 1994 Jan; 80: 93–6
Taguchi M, Watanabe S, Asakura N, et al. End-tidal sevoflurane concentrations for laryngeal mask airway insertion and for tracheal intubation in children. Anesthesiology 1994 Sep; 81: 628–31
Inomata S, Nishikawa T. Determination of end-tidal sevoflurane concentration for tracheal intubation in children with the rapid method. Can J Anaesth 1996 Aug; 43: 806–11
Inomata S, Yamashita S, Toyooka H, et al. Anaesthetic induction time for tracheal intubation using sevoflurane or halothane in children. Anaesthesia 1998 May; 53: 440–5
O’Brien K, Kumar R, Morton NS. Sevoflurane compared with halothane for tracheal intubation in children. Br J Anaesth 1998 Apr; 80: 452–5
Thwaites AJ, Kendall JB, Tomlinson AA, et al. A double blind comparison of sevoflurane versus propofol and succinylcholine for tracheal intubation in children undergoing tonsillectomy [abstract no. A1256]. Anesthesiology 1998 Sep; 89(3A)
Nakae Y, Miyabe M, Sonoda H, et al. Comparison of intubating condition under sevoflurane and halothane anesthesia in pediatric patients [in Japanese]. Masui 1995 Feb; 44: 239–43
Erb T, Christen P, Kern C, et al. Children breathing spontaneously via a laryngeal mask airway: comparison of sevoflurane and halothane [abstract no. A1043]. Anesthesiology 1997 Sep; 87 Suppl.
Inagaki Y, Wat L, Joshi GP, et al. Sevoflurane facilitates insertion of the laryngeal mask airway in children: a comparison with halothane [abstract no. S434]. Anesth Analg 1997 Feb; 84 Suppl.
Köprülü A, Dogruer K, Karpat H, et al. Sevoflurane versus halothane for laryngeal mask insertion (LMI) [abstract]. Br J Anaesth 1997 May; 78Suppl. 1: 8
Kwek TK, Ng A. Laryngeal mask insertion following inhalational induction in children: a comparison between halothane and sevoflurane. Anaesth Intensive Care 1997 Aug; 25: 413–6
Davis PJ, Greenberg JA, Gendelman M, et al. Recovery characteristics of sevoflurane and halothane in preschool-aged children undergoing bilateral myringotomy and pressure equalization tube insertion. Ped Anesth 1999; 88: 34–8
Rhodes SP, Ridley S. Economic aspects of general anaesthesia. PharmacoEconomics 1993 Feb; 3: 124–30
McCulloch DA, Smith I. Sevoflurane for induction of pediatric anesthesia — a cost comparison with propofol [abstract no. A973]. Anesthesiology 1996 Sep; 85 Suppl.
Watcha MF. Cost comparisons of halothane and sevoflurane for pediatric outpatient surgery [abstract no. 477]. Anesth Analg 1996 Feb; 82 Suppl.
Watcha MF. Sevoflurane use does not decrease operating room stays in pediatric outpatient surgery [abstract no. A1091]. Anesthesiology 1996 Sep; 85 Suppl.
Bailey AR, Jones JG. Patients’ memories of events during general anaesthesia. Anaesthesia 1997 May; 52: 460–76
Elwood W. Low-flow sevoflurane is the way to go. Inpharma 1998 Apr 18; 1133: 7–8
Johansen JW, Mashman D, Starr M. Cost minimization of sevoflurane anesthesia in children: low-flow during maintenance and perioperative efficiency [abstract no. S35]. Anesth Analg 1998 Feb; 86 Suppl.
Daniel M. Cost of volatile anaesthetic agents [letter]. Br J Anaesth 1996 Sep; 77: 437
Epstein RH. Cost implications of reduced-flow sevoflurane administration in pediatric anesthesia [abstract no. S30]. Anesth Analg 1998 Feb; 86 Suppl.
Westrin P, Beskow A. Sevoflurane causes more postoperative agitation in children than does halothane [abstract no. A1061]. Anesthesiology 1997 Sep; 87 Suppl.
Weldon BC, Abele A, Simeon R, et al. Postoperative agitation in children: sevoflurane vs halothane [abstract no. A1057]. Anesthesiology 1997 Sep; 87(3A)
Aono J, Ueda W, Mamiya K, et al. Greater incidence of delirium during recovery from sevoflurane anesthesia in preschool boys. Anesthesiology 1997 Dec; 87(6): 1298–300
Zacharias M. Convulsive movements with sevoflurane in children [letter]. Anaesth Intensive Care 1997 Dec; 25: 727
Baines D. Convulsive movements with sevoflurane [letter]. Anaesth Intensive Care 1998 Jun; 26: 329
Adachi M, Ikemoto Y, Kubo K, et al. Seizure-like movements during induction of anaesthesia with sevoflurane. Br J Anaesth 1992 Feb; 68: 214–5
Saitoh K, Tsukamoto N, Mitsuhata H, et al. Convulsions associated with epidural analgesia during sevoflurane anaesthesia. Paediatr Anaesth 1996; 6(6): 495–7
Schultz B, Schultz A. Epileptiform EEG potentials with sevoflurane [letter]. Anaesth Intensive Care 1998 Jun; 26: 329
Woodforth IJ, Hicks RG, Crawford MR, et al. Electroencephalographic evidence of seizure activity under deep sevoflurane anesthesia in a nonepileptic patient. Anesthesiology 1997 Dec; 87: 1579–82
Komatsu H, Taie S, Endo S, et al. Electrical seizures during sevoflurane anesthesia in two pediatric patients with epilepsy. Anesthesiology 1994 Dec; 81: 1535–7
Constant I, Dubois MC, Piat V, et al. Electroencephalographic changes during induction of anesthesia with halothane or sevoflurane in children [abstract no. A1253]. Anesthesiology 1998 Sep; 89(3A)
Higuchi H, Ura T, Taoda M, et al. Minimum alveolar concentration of sevoflurane for tracheal extubation in children. Acta Anaesthesiol Scand 1997; 41: 911–3
Allison CE, de Lange JJ, Zuurmond WW, et al. A comparison of the incidence of the oculocardiac reflex during sevoflurane or halothane anesthesia for outpatient surgical correction of strabismus in children [abstract]. Anesthesiology 1997 Sep; 87 Suppl.: 1072
Tomatir E, Yildirim C, Serin S, et al. May sevoflurane be preferred to halothane in paediatric ophthalmological anaesthesia? [abstract]. Br J Anaesth 1998 May; 80Suppl. 1: 139
Oddby E, Reinhard J, Hirsch K, et al. Postoperative nausea and vomiting (PONV) in pediatric outpatients: sevoflurane vs. spinal anesthesia with propofol sedation [abstract]. Region Anesth Pain Med 1998 May–Jun; 23 Suppl.: 15
Kranke P, Apfel CC, Papenfuss T, et al. Sevoflurane does not reduce postoperative nausea and vomiting compared with enflurane and isoflurane [abstract]. Br J Anaesth 1998 May; 80Suppl. 1: 133
Levine MF, Sarner J, Lerman J, et al. Plasma inorganic fluoride concentrations after sevoflurane anesthesia in children. Anesthesiology 1996 Feb; 84: 348–53
Min KT, Shin YS, Kim JR, et al. Comparison of plasma inorganic fluoride concentration with sevoflurane-N2O and enflurane-N2O anesthesia. Yonsei Med J 1994 Jun; 35: 218–22
Kataria B, Montana J. Inorganic fluoride levels after inhalation of sevoflurane anesthetic in healthy children [abstract no. A1317]. Anesthesiology 1994 Sep; 81 Suppl.
Frink Jr EJ, Green Jr WB, Brown EA, et al. Compound A concentrations during sevoflurane anesthesia in children. Anesthesiology 1996 Mar; 84: 566–71
Wiesner G, Wild K, Schwurzer S, et al. Serum inorganic fluoride concentrations and renal function with sevoflurane or enflurane anaesthesia in patients without renal disease: a phase III, open-label, randomised, comparative study [in German]. Anaesthesist 1996 Jan; 45: 31–6
Van Obbergh LJ, Michel Y, Wallemacq P, et al. Fluoride production and hepatocellular integrity after sevoflurane anesthesia in children with liver disease [abstract no. A1080]. Anesthesiology 1996 Sep; 85 Suppl.
Kudoh A, Hirota K, Sakai T, et al. Effect of sevoflurane anesthesia on plasma CK, GOT, GPT, LDH levels in children: a comparison with isoflurane [abstract no. S256]. Anesth Analg 1995 Feb; 80 Suppl
Otsuka H, Komura Y, Mayumi T, et al. Malignant hyperthermia during sevoflurane anesthesia in a child with central core disease. Anesthesiology 1991 Oct; 75: 699–701
Ochiai R, Toyoda Y, Nishio I, et al. Possible association of malignant hyperthermia with sevoflurane anesthesia. Anesth Analg 1992 Apr; 74: 616–8
Schmidt J, Sengebusch U, Albrecht DM. Influence of isoflurane and sevoflurane on the time course of action of vecuronium in children [abstract no. 038]. Acta Anaesthesiol Scand 1996; 40Suppl. 109: 217
Taivainen T, Meretoja OA. The neuromuscular blocking effects of vecuronium during sevoflurane, halothane and balanced anaesthesia in children. Anaesthesia 1995 Dec; 50: 1046–9
O’Neill BL, Foley EP. The neuromuscular blocking effect of cisatracurium in children during sevoflurane anesthesia [abstract no. A1058]. Anesthesiology 1996 Sep; 85 Suppl.
Sarner JB, Cook DR, Motoyama EK, et al. The cumulative dose-response relationship of vecuronium in children during halothane-N2O or sevoflurane-N2O anesthesia [abstract no. S367]. Anesth Analg 1993 Feb; 76 Suppl.
Kaplan RF, Garcia M, Hannallah RS. Mivacurium-induced neuromuscular blockade during sevoflurane and halothane anaesthesia in children. Can J Anaesth 1995 Jan; 42: 16–20
Bevan JC, Bevan DR, Reimer EJ, et al. Reduction of mivacurium requirements by sevoflurane in adults and children [abstract 429]. Anesth Analg 1998 Feb; 86 Suppl.
Martínez-Telleria A, Cano ME, Rodriguez MM. Neuromuscular effects of mivacurium in children. Effects of sevoflurane [abstract]. Br J Anaesth 1998 May; 80Suppl. 1: 139
Kameue T. The influence of different volatile inhaled anesthetics on the plasma protein binding of lidocaine [in Japanese]. Masui 1991 Mar; 40(3): 421–30
Hashimoto H, Inamura S, Ikeda K, et al. Electrophysiologic interaction between class I antiarrhythmic drugs and volatile anesthetics in depressant effects on ventricular activation in a canine myocardial infarction model. Jpn J Pharmacol 1994 Apr; 64: 235–41
Kobori M, Negishi H, Hosoyamada A. Effects of nicardipine on hemodynamics and skin blood flow [in Japanese]. Masui 1993 Oct; 42(10): 1435–9
Fukusaki M, Tomiyasu S, Tsujita T, et al. Interaction of cardiovascular effect of of calcium channel blocking drugs and those of inhalational anesthetics in humans [in Japanese]. Masui 1993 Jun; 42(6): 845–55
Goresky GV, Muir J. Inhalation induction of anaesthesia. Can J Anaesth 1996 Nov; 43: 1085–9
Patel SS, Goa KL. Desflurane: a review of its pharmacodynamic and pharmacokinetic properties and its efficacy in general anaesthesia. Drugs 1995 Oct; 50: 742–67
Wodey E, Copin C, Pladys P, et al. Comparative haemodynamic effects of sevoflurane and halothane in infants at the intubation MAC [in French]. Ann Fr Anesth Reanim 1998 Mar; 17: 108–13