Sevoflurane improves respiratory mechanics and gas exchange in a case series of infants with severe bronchiolitis-induced acute respiratory distress syndrome (original) (raw)
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Sevoflurane Inhalation for Severe Bronchial Obstruction in Infants with Bronchiolitis
International Journal of Immunopathology and Pharmacology, 2012
Bronchiolitis is a lower respiratory tract viral infection which may result in severe bronchial obstruction and respiratory failure despite treatment with beta-adrenergic agonists and glucocorticoids. Here we describe two otherwise healthy infants with severe bronchiolitis whose clinical course was complicated by marked bronchial obstruction and respiratory acidosis refractory to conventional medications OJ-stimulants, anticholinergics and corticosteroids) and non-invasive positive pressure ventilation. Sevofturane inhalation allowed both infants to attain a sustained, clinical improvement in ventilation and one patient to avoid mechanical ventilation. We suggest that sevofturane inhalation may be a therapeutic option in the treatment of young infants with severe bronchiolitis who respond poorly to conventional therapy.
Sevoflurane Therapy for Severe Refractory Bronchospasm in Children
Pediatric Critical Care Medicine, 2016
Objectives: To describe the effect of inhaled sevoflurane in the treatment of severe refractory bronchospasm in children. Design: Retrospective case series. Setting: Two PICUs of tertiary general university hospitals in Spain. Patients: Ten patients ranging from 5 months to 14 years old with severe bronchospasm and acute respiratory failure requiring tracheal intubation and mechanical ventilation and treated with sevoflurane from 2008 to 2015. Intervention: Inhaled sevoflurane therapy was initiated after failure of conventional medical management and mechanical ventilation. In two patients, sevoflurane was administered through a Servo 900C ventilator (Maquet, Bridgewater, NJ) equipped with a vaporizer and in the other eight patients via the Anesthetic Conserving Device (AnaConDa; Sedana medical, Uppsala, Sweden) with a critical care ventilator. Measurements and Main Results: Inhaled sevoflurane resulted in statistically significant decreases of Paco 2 of 34.2 torr (95% CI, 8.3-60), peak inspiratory pressure of 14.3 cm H 2 O (95% CI, 8.6-19.9), and improvement in pH of 0.17 (0.346-0.002) within 6 hours of administration. Only one patient presented hypotension responsive to volume administration at the beginning of the treatment. All patients could be extubated within a median time of 120 hours (interquartile range, 46-216). Conclusions: Inhaled sevoflurane therapy decreases the levels of Paco 2 and peak inspiratory pressure values, and it may be considered as a rescue therapy in patients with life-threatening bronchospasm refractory to conventional therapy.
Intubating conditions and adverse events during sevoflurane induction in infants
The aim of this study was to compare intubating conditions and adverse events after sevoflurane induction in infants, with or without the use of rocuronium or alfentanil. Seventy-five infants, aged 1-24 months, undergoing elective surgery under general anaesthesia were randomly assigned to receive 8% sevoflurane with either placebo (i.v. saline 0.5 ml kg⁻¹), rocuronium (0.3 mg kg⁻¹), or alfentanil (20 µg kg⁻¹). The primary outcome measure was intubating conditions evaluated 90 s after test drug injection by an anaesthetist unaware of the patient's group. The secondary outcome criteria were respiratory (Sp(O₂) <90%, laryngospasm, closed vocal cords preventing intubation, bronchospasm) and haemodynamic adverse events (heart rate and mean arterial pressure variations ≥30% control value). Intubating conditions were significantly better in the rocuronium group, with clinically acceptable intubating conditions in 92%, vs 70% in the alfentanil group and 63% in the placebo group (P=0.044). Adverse respiratory events were significantly less frequent in the rocuronium group: 0% vs 33% in the placebo group and 30% in the alfentanil group (P=0.006). Haemodynamic adverse events were more frequent in the alfentanil group: 48% vs 7% in the placebo group and 16% in the rocuronium group (P=0.0019).
European Journal of Anaesthesiology, 2013
CONTEXT Acute respiratory distress syndrome is characterised by activation of the inflammatory cascade. The only treatment that reduces the mortality rate associated with this syndrome is lung protective ventilation, which requires sedation of patients. Sedation in critical care units is usually induced intravenously, although there is reason to believe that inhaled anaesthetics are a suitable alternative. Sevoflurane has recently been shown to modulate the lung inflammatory response in a model of lung injury more favourably than propofol. OBJECTIVE The goal of this study was to confirm whether or not sevoflurane is more effective than propofol in ameliorating the inflammatory response in an animal model of acute respiratory distress syndrome. DESIGN A prospective, randomised, controlled study.
The Effect of Sevoflurane and Dexmedetomidine on Pulmonary Mechanics in ICU Patients
Turkish journal of anaesthesiology and reanimation, 2019
Objective: In intensive care unit (ICU) patients, intravenous (iv) and volatile agents are used for sedation. The aim of the present study was to investigate the effects of dexmedetomidine and sevoflurane on pulmonary mechanics in ICU patients with pulmonary disorders. Methods: After approval of the ethical committee and informed consent between the ages of 18-65 years were obtained, 30 patients with an American Society of Anesthesiologist status I-III, who were mechanically ventilated, who had pulmonary disorders and who needed sedation were included in the study. Exclusion criteria were severe hepatic, pulmonary and renal failures; pregnancy; convulsion and/or seizure history; haemodynamic instability and no indication for sedation. Patients were divided into two groups by randomised numbers generated by a computer. For sedation, 0.5%-1 % sevoflurane (4-10 mL h −1) was used by an Anaesthetic Conserving Device in Group S (n=15), and iv dexmedetomidine infusion (1 µg −1 kg −1 10 min −1 loading and 0.2-0.7 µg −1 kg −1 h −1 maintenance) was performed in Group D (n=15). Arterial blood gas analysis, airway resistance, positive end-expiratory pressure (PEEP), frequency, tidal volume (TV), peak airway pressure (Ppeak), static pulmonary compliance and end-tidal CO 2 values were recorded at baseline, 1, 3, 6, 9, 12 and 24 h. Results: Demographic data, airway resistance, PEEP, frequency, TV, Ppeak and static pulmonary compliance values were similar between the groups. PaCO 2 and end-tidal CO 2 values were higher in Group S than in Group D. Sedation and patient comfort scores were similar between the two groups. Conclusion: Both sevoflurane and dexmedetomidine are suitable sedative agents in ICU patients with pulmonary diseases.
2020
This study was done to ascertain the optimum fresh gas flow (FGF) offering the best balance between rapid induction and minimal waste in pediatric patients. Forty-five children (weighing 10-20 kg) undergoing elective procedures under general anesthesia were randomly assigned into 3 groups: 0.5 minute ventilation (MV), MV, and S (FGF = 6 L/min). After priming the pediatric closed circuit, anesthesia was induced using a face mask with 8% sevoflurane in 100% oxygen (Draeger Primus Vista 120 anesthesia machine) at FGF-determined MV per group allocation. After loss of eyelash reflex (time 1 [T1]), intravenous cannulation (T2) and laryngeal mask airway (LMA) placement (T3) were done. Total sevoflurane consumed during induction (measured using logbook function) was the primary outcome. The cost of sevoflurane, any reflex movement, tachycardia (heart rate change > 20%), or additional propofol boluses required were also recorded. Sevoflurane consumption (3.8 vs 5.8 vs 9.2 mL) and cost of ...
Management of respiratory distress syndrome: An update
Pediatric Pulmonology, 2001
Respiratory distress syndrome is the most common respiratory disorder in preterm infants. Over the last decade, because of improvements in neonatal care and increased use of antenatal steroids and surfactant replacement therapy, mortality from respiratory distress syndrome has dropped substantially. However, respiratory morbidity, primarily bronchopulmonary dysplasia, remains unacceptably high. The management of respiratory distress syndrome in preterm infants is based on various modalities of respiratory support and the application of fundamental principles of neonatal care. To obtain best results, a multidisciplinary approach is crucial. This review discusses surfactant replacement therapy and some of the current strategies in ventilatory management of preterm infants with respiratory distress syndrome.
Adjunctive Therapies for Treatment of Severe Respiratory Failure in Newborns
Klinische Padiatrie, 2015
Background: Severe respiratory failure of the newborn requires adjunctive therapies as application of surfactant, inhalation of nitric oxide (iNO), high frequency oscillatory ventilation (HFOV), or extracorporeal membrane oxygenation (ECMO). We designed this study to analyze the the usage and effectiveness of adjunctive therapies and the mortality of severe respiratory failure. Patients and Methods: The survey in Germany was done in collaboration with the "Erhebungseinheit für seltene pädiatrische Erkrankungen" (ESPED). 397 patients within 2 years were included into the study. Effectiveness of each adjunctive therapy was judged by the treating physician. Results: The most frequent diagnosis was respiratory distress syndrome (RDS) with 36.8%, followed by pneumonia sepsis (16.4%), meconium aspiration syndrome (MAS) and congenital diaphragmatic hernia (CDH). Surfactant was applied in 77.3% of all cases with a reported effectiveness of 71.6%. More than 40% of all patients were...
Randomized controlled trial of sevoflurane for intubation in neonates
Pediatric Anesthesia, 2007
Background: Our aim was to determine whether sevoflurane can be used with safety and efficacy for anesthesia during intubation in term and preterm neonates in a prospective randomizedcontrolled nonblinded study in a tertiary neonatal intensive care unit. Methods: Thirty-three neonates were randomly allocated to receive sevoflurane (inspired concentrations varying from 2% to 5%) or no medication (preoxygenation with 100% oxygen alone) before intubation. Minute by minute heart rate (HR), mean arterial blood pressure, SpO 2 and number of episodes of bradycardia (HR < 100 bAE min )1 ) and desaturation (SpO 2 < 85% for >30 s) were noted from 5 min before to 10 min after intubation. Operator experience, ease and number of attempts were noted. Results: No major adverse events were noted in the study group compared with the control group [hypotension (37.5% vs 37.5%, NS), number of desaturations [37.5% vs 44.5%, NS)]. Hypertension (25%, vs 56.3% P = 0.04) and incidence of bradycardias (8.3% vs 44.4%, P < 0.01) were greater in the control group. Intubation was easier in the study group: no movements: 95.5% vs 28% (P < 0.005); good glottis visualization: 73% vs 33% (P = 0.013). The failure rate was lower in the study group (25% vs 39%), but this difference was not statistically significant. Conclusion: Anesthesia for intubation with sevoflurane in neonates is well tolerated, even in the less mature. It facilitates the conditions for intubation and leads to fewer adverse events. Other studies are necessary to confirm these preliminary results.