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PEDIATRIC ANESTHESIA

The Awakening Concentration of Sevoflurane in Children

Shinichi Kihara, MD^*, Shinichi Inomata, MD^*, Yuichi Yaguchi, MD^*, Hidenori Toyooka, MD^*, Yasuyuki Baba, BSPharm, and Yukinao Kohda, PhD

Departments of *Anesthesiology and Clinical Pharmacology, University of Tsukuba, Tsukuba City, Ibaraki, Japan

Address correspondence and reprint requests to Dr. Shinichi Kihara, Department of Anesthesia, Mito Saiseikai General Hospital, Futabadai 3-3-10, Mito, Ibaraki 311-4198, Japan. Address e-mail to sin-ki{at}fa2.so-net.ne.jp

Sevoflurane is frequently used as a rapidly acting drug for the induction of anesthesia. We investigated the awakening concentration (MAC-awake) of sevoflurane in ASA physical status I children (age range 2–10 yr). We also investigated the effects of two different doses of clonidine (2 and 4 µg/kg) on the MAC-awake of sevoflurane. Subjects were randomly divided into three groups and received placebo (n = 24), clonidine 2 µg/kg (n = 17), or clonidine 4 µg/kg (n = 22) orally, 100 min before the induction of anesthesia. Sedation scores were estimated, by using a five-point scale, after entry into the operating room, and anesthesia was induced and maintained with sevoflurane in oxygen and balanced nitrogen, without an additional anesthetic. After surgery, end-tidal sevoflurane was decreased stepwise by 0.2% at 15-min intervals, a standardized verbal command was played to the patients, and the MAC-awake was determined. The MAC-awake of sevoflurane alone was 0.78% ± 0.24% (mean ± SD), which decreased to 0.36% ± 0.09% and 0.36% ± 0.16% (both P <0.0001, compared with the control group) after premedication with the small and large doses of clonidine, respectively. The lack of any dose-response relationship might be explained by a plateau effect.

Implications: The awakening concentration of sevoflurane in unpremedicated children was 0.78%. Oral clonidine premedication at a dose of 2 µg/kg reduced the awakening concentration to 0.36%. However, an additional decrease in this value was not observed after the administration of the larger dose of clonidine premedication (4 µg/kg).

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