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PEDIATRIC ANESTHESIA

Salbutamol Prevents the Increase of Respiratory Resistance Caused by Tracheal Intubation During Sevoflurane Anesthesia in Asthmatic Children

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

*Pediatric Intensive Care Unit, Pediatric Department, CHUV University Hospital, Lausanne, Switzerland; Division of Clinical Sciences, Telethon Institute for Child Health Research, Perth, University of Western Australia; Department of Anesthesia, Princess Margaret Hospital for Children, Perth, Western Australia; and Pediatric Anesthesia Unit, Geneva Children’s Hospital, Geneva, Switzerland

Address correspondence and reprint requests to Dr. W. Habre, Division of Pediatric Anesthesia, Geneva Children’s Hospital, 6, Rue Willy Donze, 1205 Geneva, Switzerland. Address e-mail to Walid.Habre{at}hcuge.ch

Asthmatic children having their tracheas intubated with sevoflurane often have an increase in respiratory system resistance (Rrs). In this randomized, placebo-controlled, double-blinded study, we investigated the protective effect of an inhaled ß₂-adrenergic agonist. Either salbutamol or placebo was administered 30 to 60 min before anesthesia to 30 mildly to moderately asthmatic children scheduled for elective surgery. Induction was performed with sevoflurane in a mixture of 50% nitrous oxide in oxygen and maintained at 3%, with children breathing spontaneously via a face mask and Jackson-Rees modification of the T-piece. Airway opening pressure and flow were measured before and after insertion of an oral endotracheal tube. Rrs and respiratory system compliance were calculated with multilinear regression analysis. The groups were comparable with respect to age, weight, asthma history, and breathing pattern. Intubation induced a different Rrs response in the two groups: children treated with salbutamol showed a 6.0% (-25.2% to +13.2%) decrease (mean, 95% confidence interval), whereas in the Placebo group there was a 17.7% (+4.4% to +30.9%) increase (P = 0.04). Neither asthma history nor the serum inflammation marker eosinophilic cationic protein was predictive for this response. We conclude that when using sevoflurane in mildly to moderately asthmatic children, a preanesthetic treatment with inhaled salbutamol is protective of an increase in Rrs.

IMPLICATIONS: Tracheal intubation with sevoflurane as the sole anesthetic is now often performed in children. It can induce an increase in respiratory system resistance in children with asthma. This study shows that in children with mild to moderate asthma, a preanesthetic treatment with inhaled salbutamol can prevent the increase of respiratory system resistance.

Anesthesia & Analgesia® is published for the International Anesthesia Research Society® by Lippincott Williams & Wilkins with the assistance of Stanford University Libraries' HighWire Press®. Copyright 2006 by the International Anesthesia Research Society. Online ISSN: 1526-7598   Print ISSN: 0003-2999