Abstract
Rectal methohexitone has been used to induce anaesthesia in paediatric patients for a number of years. This study was conducted in order to confirm the safety of this method of induction for uncomplicated routine paediatric patients. Children between the ages of six months and six years were considered candidates for induction with methohexitone (10%, 25–30 mg · kg−1). Patients were monitored with a continuous oxygen saturation recording. Forty-nine patients participated in this study and anaesthesia was induced successfully in 44. The mean age of the patients was 2.7 ±1.6 yr. The mean weight was 13.8 ±4.3 kg and the mean dose of methohexitone for successful induction was 27.0 ±3.0 mg kg−1. Continuous oximeter recordings were available in 31 of the 42 patients who allowed oximeter placement prior to administration of methohexitone. No major desaturation events were noted in any patient. Two brief episodes of desaturation occurred. One with a nadir of 90% which lasted for 45 sec and another with a nadir of 86% which lasted for 26 sec. Both children had their heads flexed over their parents’ shoulders at the time of the event resulting in partial airway obstruction. Both of these episodes were the result of upper airway obstruction which was clinically diagnosed by the anesthetist and readily corrected by repositioning the head. This study confirms the efficacy and safety of rectal methohexitone for induction of general anaesthesia in children. Mechanical obstruction of the airway following induction seems to be the most likely cause for oxygen desaturation. Monitoring of pulse oximetry does not appear necessary provided the child is carefully observed for adequacy of air exchange.
Résumé
Le méthohexitone par voie rectale a été utilisé pour un grand nombre d’années afin d’induire l’anesthésie chez les patients pédiatriques. Cette étude fut entreprise afin de confirmer la sécurité de cette méthode d’induction pour des patients pédiatriques n’ayant aucune complication. Les enfants entre l’âge de six mois et six ans furent considérés comme candidats à l’induction avec le méthohexitone (10%, 25–30 mg · kg−1). Les patients furent surveillés avec un enregistrement continu de la saturation en oxygène. Quarante-neuf patients ont participé à cette étude et l’anesthésie fut induite avec succès chez 44. L’âge moyen des patients était de 2,7 ±1,6 ans. Le poids moyen était de 13,8 ±4,3 kg et la dose moyenne de méthohexitone pour l’induction était de 27,0 ±3,0 mg · kg−1. Les enregistrements continus de l’oxymètre furent disponibles chez 31 des 42 patients chez qui on pouvait installer l’oxymètre avant l’administration de méthohexitone. Aucune saturation majeure ne fut notée chez aucun des patients. Deux épisodes brèves de désaturation sont survenues. Un avec un nadir de 90% qui a duré 45 secondes et un autre avec un nadir de 86% qui a duré 26 sec. Les deux enfants avaient leur tête fléchie sur l’épaule des parents au moment où l’évènement est survenu à cause d’obstruction partielle des voies aériennes. Ces deux épisodes furent cliniquement diagnostiqués par l’anesthésiologiste et corrigés par le repositionnement de la tête. Cette étude confirme l’efficacité et la sécurité de l’administration rectale de methohexitone pour l’induction de l’anesthésie générale chez les enfants. L’obstruction mécanique des voies aériennes après l’induction apparaît comme la cause la plus probable de la désaturation en oxygène. La surveillance de la saturométrie de pouls n’apparaît pas nécessaire si l’enfant est surveillé attentivement concernant l’échange gazeux adéquat.
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Supported in part by an equipment grant from Nellcor, Inc., Hayward, CA 94545.
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Daniels, A.L., Coté, C.J. & Polaner, D.M. Continuous oxygen saturation monitoring following rectal methohexitone induction in paediatric patients. Can J Anaesth 39, 27–30 (1992). https://doi.org/10.1007/BF03008668
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DOI: https://doi.org/10.1007/BF03008668