Comparison of Sevoflurane and Halothane for Induction of Anesthesia and Laryngeal Mask Airway Insertion in Pediatric Patients: A Tertiary Care Experience - Abstract
Introduction: Inhalational anaesthesia is the preferred technique of induction in the pediatric age group. Halothane with its negligible pungency and minimal effects on airway reactivity has been the cornerstone of pediatric inhalational induction despite its propensity to cause bradycardia, hypotension and arrhythmias. Sevoflurane with low blood gas solubility allows rapid induction and early emergence. Due to its pleasant odor, it is non-irritant to the airway which makes it an attractive alternative for inhalational induction in children.
Objective: To compare the induction characteristics and ease of laryngeal mask airway insertion with halothane and sevoflurane in pediatric patients.
Material and methods: This prospective observational study was conducted in Postgraduate Department of Anesthesiology and Critical Care, Government Medical College, Srinagar and associated hospitals. A total of 100 patients were studied. Patients receiving halothane designated “H” were compared with patients receiving sevoflurane designated “S”. Patients in the age group of 1-12 years belonging to ASA I and II undergoing short elective operative procedures under general anesthesia were included in the study. In patients receiving halothane, the inspired concentration was set at 0.5% initially followed by stepwise increase of 0.5% every 3 to 4 breaths up to a maximum of 3.5% until the loss of eyelash reflex occurred. In patients receiving sevoflurane, the inspired concentration was set at 1% initially and increased gradually by 1% up to a maximum of 6% until the loss of eyelash reflex occurred. Proper size Laryngeal Mask Airway- proseal was inserted using standard technique when eyeballs were centralized and the jaw was relaxed.
Results: The two groups were comparable in terms of age, weight, sex distribution, ASA status and surgical procedure performed. The difference was not statistically significant (p > 0.05). The time required from the onset of induction to centralization of eyeballs was 252.26s and 166.62s for the group H and group S respectively. The difference was statistically significant between the two groups (p < 0.001). In both the groups, condition at LMA insertion and patient response were found satisfactory, LMA was inserted successfully in first attempt in 49 patients in group H and 47 patients in group S. Full jaw opening was achieved in 48 patients in group H and 49 patients in group S at the time of LMA insertion. There was a gradual decrease in mean heart rate in group H during the course of induction with clinically significant bradycardia in 4 patients. Similarly, there was decrease in mean heart rate in group S with clinically significant
bradycardia in 1 patient. The reduction in mean heart rate was pronounced in group H. The difference was statistically significant. There was decrease in both systolic and diastolic blood pressure before LMA insertion and 1, 3, 5 min after insertion in both the groups. The difference was statistically significant (p < 0.001). However, there was slight increase in systolic/diastolic blood pressure at the time of LMA insertion in both the groups.
Conclusion: Sevoflurane was an excellent agent for inhalational anaesthesia and suitable alternative to halothane in children. It had a short induction time, rapid emergence, low incidence of airway complications or other intraoperative or postoperative side effects and better hemodynamic stability.