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PEDIATRIC ANESTHESIA

Respiratory Mechanics During Sevoflurane Anesthesia in Children With and Without Asthma

Walid Habre, MD^*, Pietro Scalfaro, MD, Craig Sims, FANZCA, Katrina Tiller, BMath, and Peter D. Sly, MD, FRACP

*Division of Anaesthesia, Geneva Children’s Hospital, Geneva, Switzerland; Division of Clinical Sciences, Institute for Child Health Research, Perth, Australia; and Department of Anaesthesia, Princess Margaret Hospital for Children, Perth, Western Australia

Address correspondence and reprint requests to Walid Habre, MD, Division of Paediatric Anaesthesia, Geneva Children’s Hospital, 6, rue Willy Donze, 1205 Geneva, Switzerland. Address e-mail to Walid.Habre{at}hcuge.ch

We studied lung function in children with and without asthma receiving anesthesia with sevoflurane. Fifty-two children had anesthesia induced with sevoflurane (up to 8%) in a mixture of 50% nitrous oxide in oxygen and then maintained at 3% with children breathing spontaneously via face mask and Jackson-Rees modification of the T-piece. Airway opening pressure and flow were then measured. After insertion of an oral endotracheal tube under 5% sevoflurane, measurements were repeated at 3%, as well as after increasing to 4.2%. Respiratory system resistance (Rrs) and compliance during expiration were calculated using multilinear regression analysis of airway opening pressure and flow, assuming a single-compartment model. Data from 44 children were analyzed (22 asthmatics and 22 normal children). The two groups were comparable with respect to age, weight, ventilation variables, and baseline respiratory mechanics. Intubation was associated with a significant increase in Rrs in asthmatics (17% ± 49%), whereas in normal children, Rrs slightly decreased (-4% ± 39%). At 4.2%, Rrs decreased slightly in both groups with almost no change in compliance system resistance. We concluded that in children with mild to moderate asthma, endotracheal intubation during sevoflurane anesthesia was associated with increase in Rrs that was not seen in nonasthmatic children.

Implications: Tracheal intubation using sevoflurane as sole anesthetic is possible and its frequency is increasing. When comparing children with and without asthma, tracheal intubation under sevoflurane was associated with an increase in respiratory system resistance in asthmatic children. However, no apparent clinical adverse event was observed.

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