Brazilian Journal of Anesthesiology
https://bjan-sba.org/article/doi/10.1590/S0034-70942001000400002
Brazilian Journal of Anesthesiology
Scientific Article

Influência do óxido nitroso na velocidade de indução e de recuperação do halotano e do sevoflurano em pacientes pediátricos

Effect of nitrous oxide on the induction and recovery times of halothane and sevoflurane in pediatric patients

Maria Angela Tardelli; Nilza Mieko Iwata; José Luiz Gomes do Amaral; Roberto Manara Victório Ferreira; Luciano Borges Rocha

http://dx.doi.org/10.1590/S0034-70942001000400002 Braz J Anesthesiol, vol.51, n4, p.273-284, 2001
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Resumo

JUSTIFICATIVA E OBJETIVOS: A utilização de múltiplos de CAM, não comparáveis, do sevoflurano e do halotano, além da diferente contribuição do N2O na CAM destes dois agentes, em pacientes pediátricos, são os fatores citados para explicar igual velocidade de indução e de recuperação destes agentes com diferentes solubilidades sangüíneas. O objetivo deste trabalho foi avaliar o tempo de indução através de múltiplos da CAM e a recuperação da anestesia mantida com concentração expirada fixa de 1 CAM de halotano ou sevoflurano, associados ou não ao N2O, em crianças sob anestesia peridural sacra. MÉTODO: Foram estudadas 63 crianças divididas em 4 grupos de acordo com o agente inalatório utilizado para indução e manutenção da anestesia: Grupo 1: Halotano; Grupo 2: Halotano + N2O; Grupo 3: Sevoflurano; Grupo 4: Sevoflurano + N2O. Todas foram submetidas à peridural sacra. A indução sob máscara foi iniciada com 1 CAM do halogenado e incrementos de 0,5 CAM a cada 3 movimentos respiratórios até atingir 3 CAM, no máximo. Foram analisados os seguintes parâmetros: freqüência cardíaca, pressão arterial sistólica e diastólica, fração expirada dos agentes inalatórios e os tempos de indução, de emergência e de resposta a comandos. RESULTADOS: Os tempos cirúrgicos não mostraram diferença significativa entre os grupos. Os tempos para perda do reflexo ciliar, para o término da indução, de emergência e orientação dos grupos 1 e 2 foram maiores que dos grupos 3 e 4, sem diferença entre os grupos 1 e 2 e entre os grupos 3 e 4. A freqüência cardíaca e as pressões arteriais sistólica e diastólica não diferiram entre os grupos, nos diferentes tempos considerados. CONCLUSÕES: Nesta faixa etária, com a técnica anestésica empregada, os tempos de indução e de recuperação da anestesia foram diferentes entre os grupos do halotano e do sevoflurano, mas não apresentaram diferença com a associação de óxido nitroso.

Palavras-chave

ANESTESIA, ANESTÉSICOS, Gasoso, Volátil

Abstract

BACKGROUND AND OBJECTIVES: The use of different MAC multiples of sevoflurane and halothane, and the different effect of N2O on the MAC of these agents in children, are usually argued as the reason for the same induction and recovery times of these agents which have different blood solubilities. This study evaluated the induction time to different MAC multiples and the recovery time of anesthesia maintained with a fixed expired concentration (1 MAC) of halothane or sevoflurane, associated or not to N2O, in children under epidural caudal anesthesia. METHODS: Participated in this study 63 children allocated in 4 groups according to the anesthetic drug used. Group 1 = Halothane; Group 2 = Halothane plus N2O; Group 3 = Sevoflurane; Group 4 = Sevoflurane plus N2O. All children were submitted to caudal epidural blockade. Mask Induction was started with 1 MAC of halogenate followed by 0.5 MAC increments at every three respiratory movements until a maximum of 3 MAC was obtained. The following parameters were recorded: heart rate, systolic and diastolic blood pressure, inhaled agent expired fraction and times for induction, recovery and response to commands. RESULTS: Duration of surgery did not differ significantly among groups. The times to eyelash reflex loss, end of induction, emergence and oriented responses for groups 1 and 2 were longer than for groups 3 and 4 (p < 0.001) without significant differences between groups 1 and 2 and between groups 3 and 4. There were no differences in heart rate and systolic and diastolic blood pressure. CONCLUSIONS: In the age range studied and with the anesthetic technique used, induction and recovery times were different between the halothane and the sevoflurane group, but did not differ when nitrous oxide was added to the halogenate.

Keywords

ANESTHESIA, ANESTHETICS, Gaseous, Volatile

Referencias

Kleinman S, Lerman J, Yentis S. Sevoflurane: minimum alveolar concentration (MAC) and hemodynamic responses in children, with and without nitrous oxide. Anesthesiology. 1992;77:A1144.

Katoh T, Ikeda K. The minimum alveolar concentration of sevoflurane in humans. Anesthesiology. 1987;66:301-303.

Saidman LJ, Eger II EI. Effect of nitrous oxide and of narcotic premedication on the alveolar concentration of halothane required for anesthesia. Anesthesiology. 1964;25:302-306.

Murray DJ, Mehta MP. Forbes RB et al - Additive contribution of nitrous oxide to halothane MAC in infants and children. Anesth Analg. 1990;71:120-124.

Lerman J, Sikich N, Kleinman S. The pharmacology of sevoflurane in infants and children. Anesthesiology. 1994;80:814-824.

Naito Y, Tamai S, Shingu K. Comparison between sevoflurane and halothane for paediatric ambulatory anaesthesia. Br J Anaesth. 1991;67:387-389.

Piat V, Dubois M, Johanet S. Induction and recovery characteristics and hemodinamic responses to sevoflurane and halothane in children. Anesth Analg. 1994;79:840-844.

Sarner JB, Levine M, Davis PJ. Clinical characteristics of sevoflurane in children: a comparison with halothane. Anesthesiology. 1995;82:38-46.

Cagnolati CA, Nunes AMM, Serzedo PSM. Estudo comparativo sobre sevoflurano e halotano na indução e manutenção de anestesia pediátrica ambulatorial. Rev Bras Anestesiol. 1995;45:215-223.

Tardelli MA, Joaquim EHG, Iwata NM. Anestesia com sevoflurano e halotano em crianças. Rev Bras Anestesiol. 1997;47:1-9.

Taivainen T, Tiainen P, Meretoja OA. Comparison of the effects of sevoflurane and halothane on the quality of anaesthesia and serum glutathione transferase alpha and fluoride in paediatric patients. Br J Anaesth. 1994;73:590-595.

Meretoja OA, Taivainen T, Raiha L. Sevoflurane-nitrous oxide or halothane-nitrous oxide for paediatric bronchoscopy and gastroscopy. Br J Anaesth. 1996;76:767-771.

Bowdle TA, Horita A, Kharasch ED. The Pharmacologic Basis of Anesthesiology. 1994:497:500.

Himes RS, DiFazio CA, Burney RG. Effects of lidocaine on the anesthetic requirements for nitrous oxide and halothane. Aneshtesiology. 1977;47:437-440.

Hodgson PS, Liu SS, Gras TW. Does epidural anesthesia have general anesthetic effects?. Anesthesiology. 1999;91:1687-1692.

Quasha AL, Eger EI, Tinker JH. Determination and applications of MAC. Anesthesiology. 1980;53:315-334.

Muzi M, Colinco MD, Robinson BJ. The effects of premedication on inhaled induction of anesthesia with sevoflurane. Anesth Analg. 1997;85:1143-1148.

Viitanen H, Annila P, Viitanen M. Premedication with midazolam delays recovery after ambulatory sevoflurane anesthesia in children. Anesth Analg. 1999;89:75-79.

Bowdle TA, Horita A, Kharasch ED. The Pharmacologic Basis of Anesthesiology. 1994:523:540.

Waud BE, Waud DR. On Dose - Response curves and anesthetics. Anesthesiology. 1970;33:1-4.

Eger II EI. On dose - response curves and anesthetics. Anesthesiology. 1971;34:202-203.

Swan HD, Crawford MW, Pua HL. Additive contribution of nitrous oxide to sevoflurane minimum alveolar concentration for tracheal intubation in children. Anesthesiology. 1999;91:667-671.

Katoh T, Ikeda K, Bito H. Does nitrous oxide antagonize sevoflurane-induced hypnosis?. Br J Anaesth. 1997;79:465-468.

Rampil IJ, Mason P, Singh H. Anesthetic potency (MAC) is independent of forebrain structures in the rat. Anesthesiology. 1993;78:707-712.

Antognini JF, Schwartz KS. Exaggerated anesthetic requirements in the preferentially anesthetized brain. Anesthesiology. 1993;79:1244-1249.

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