Central Journal of ISA

Open Access Open Access  Restricted Access Subscription Access

Identification of Optimal Anesthetic Depth with Sevoflurane using Different Stimuli for a Pain Free Intravenous Cannulation in Children


Affiliations
1 Department of Anaesthesia, Nizwa Hospital, Nizwa, Oman
2 Department of Anesthesia and ICU, Khoula Hospital, Muscat, Oman
3 5th Year Anesthesia Resident, Oman Medical Specialty Board, Muscat, Oman
 

The ideal time for intravenous cannulation following inhalational induction with sevoflurane in children is debatable. Loss of eyelash reflex or centralization of eyeballs has been recommended to assess adequate depth for painless cannulation but occasional patient may still respond to pain. Trapezius Squeeze Test (TST) elicits toe/body movement if the patient feels pain while being induced with sevoflurane. We tested the hypothesis that the loss of response to TST under sevoflurane anesthesia would give an accurate optimal time for pain-free intravenous cannulation.

37 patients between the age ranges of 1 to 8 years of either gender weighing 8-20 kg undergoing minor day care surgery were included in the study. Patients were randomly assigned to Group I (eyeball centralization), Group II (loss of eye lash reflex + 3.5 min), and Group III (Unresponsive to TST). All children were induced with a gradually increasing concentration of sevoflurane. After one minute of induction, the study indicators (eyeballs centralizing effect, loss of eye lash reflex + 3.5 min or negative response to TST) were checked every 15 s till the end point of the indicator had been reached. A person not associated with the study performed intravenous cannulation and noted movement, if any.

None of the TST group patients (Group III) showed any motor response to cannulation (0%). In contrast, 7.1% and 16.7% of Group I and II patients demonstrated some motor response respectively. Grade-3 response to the cannulation in the form of movement of the limb or head and neck accompanied with coughing and/or laryngospasm was not observed in any patient.


Keywords

Induction of Anesthesia, Pediatric Anesthesia, Sevoflurane, Venous Cannulation.
User
Notifications
Font Size

  • Joshi A, Lee S, Pawar D. An optimum time for intravenous cannulation after induction with sevoflurane in children. Paediatr Anaesth. 2012; 22(5):445-8.

  • Kaul N, Khan RM, Al-Jadidi AM. An optimum time for intravenous cannulation after induction with sevoflurane in children. Paediatr Anaesth. 2012; 22(5):490.

  • Chang CH, Shim YH, Shin YS, et al. Optimal conditions for laryngeal mask airway insertion can be determined by the trapezius squeezing test. J Clin Anesth. 2008; 20(2):99-102.

  • Hooda S, Kaur K, Rattan KN, et al. Trapezius squeeze test as an indicator for depth of anesthesia for laryngeal mask airway insertion in children. J Anaesthesiol Clin Pharmacol. 2012; 28(1):28-31.

  • Kumar KR, Sinha R, Chandiran R, et al. Evaluation of optimum time for intravenous cannulation after sevoflurane induction of anesthesia in different pediatric age groups. J Anaesthesiol Clin Pharmacol. 2017; 33(3):371-4.

  • Kilicaslan A, Gök F, Erol A, et al. Determination of optimum time for intravenous cannulation after induction with sevoflurane and nitrous oxide in children premedicated with midazolam. Paediatr Anaesth. 2014; 24(6):620-4.

  • Vakkuri A, Yli-Hankala A, Sarkela M, et al. Sevoflurane mask induction of anaesthesia is associated with epileptiform EEG in children. Acta Anaesthesiol Scand. 2001; 45(7):805-11.

  • Constant I, Seeman R, Murat I. Sevoflurane and epileptiform EEG changesReview article. Paediatr Anaesth. 2005; 15(4):266-74.


Abstract Views: 458

PDF Views: 106




  • Identification of Optimal Anesthetic Depth with Sevoflurane using Different Stimuli for a Pain Free Intravenous Cannulation in Children

Abstract Views: 458  |  PDF Views: 106

Authors

Hassan Hamed Khalfan Al-Salmi
Department of Anaesthesia, Nizwa Hospital, Nizwa, Oman
Nikhil Madhukant Gosalia
Department of Anesthesia and ICU, Khoula Hospital, Muscat, Oman
Rashid Manzoor Khan
Department of Anesthesia and ICU, Khoula Hospital, Muscat, Oman
Naresh Kaul
Department of Anesthesia and ICU, Khoula Hospital, Muscat, Oman
Fathiya Ali Abdallah Al Shamsi
5<sup>th</sup> Year Anesthesia Resident, Oman Medical Specialty Board, Muscat, Oman

Abstract


The ideal time for intravenous cannulation following inhalational induction with sevoflurane in children is debatable. Loss of eyelash reflex or centralization of eyeballs has been recommended to assess adequate depth for painless cannulation but occasional patient may still respond to pain. Trapezius Squeeze Test (TST) elicits toe/body movement if the patient feels pain while being induced with sevoflurane. We tested the hypothesis that the loss of response to TST under sevoflurane anesthesia would give an accurate optimal time for pain-free intravenous cannulation.

37 patients between the age ranges of 1 to 8 years of either gender weighing 8-20 kg undergoing minor day care surgery were included in the study. Patients were randomly assigned to Group I (eyeball centralization), Group II (loss of eye lash reflex + 3.5 min), and Group III (Unresponsive to TST). All children were induced with a gradually increasing concentration of sevoflurane. After one minute of induction, the study indicators (eyeballs centralizing effect, loss of eye lash reflex + 3.5 min or negative response to TST) were checked every 15 s till the end point of the indicator had been reached. A person not associated with the study performed intravenous cannulation and noted movement, if any.

None of the TST group patients (Group III) showed any motor response to cannulation (0%). In contrast, 7.1% and 16.7% of Group I and II patients demonstrated some motor response respectively. Grade-3 response to the cannulation in the form of movement of the limb or head and neck accompanied with coughing and/or laryngospasm was not observed in any patient.


Keywords


Induction of Anesthesia, Pediatric Anesthesia, Sevoflurane, Venous Cannulation.

References