Abstract
Purpose
Inhalation induction using isoflurane is associated with airway irritability, coughing, breath-holding and laryngospasm. These complications are more common in children. This study was designed to determine if humidification of isoflurane in oxygen/nitrous oxide would reduce respiratory complications and hypoxic episodes at induction.
Methods
Fifty-nine unpremedicated children, aged three months to 12 yr, were enrolled in the study and randomised to receive either humidified isoflurane (n = 27, Group A), or non-humidified isoflurane (n = 32, Group B). All inductions of anaesthesia were with isoflurane 4% in 50% oxygen/nitrous oxide. Subjects were observed for the occurrence of breath-holding, coughing, laryngospasm, bronchospasm, secretions, and hiccoughs. The severity of each complication was graded on a scale of 0–3. The need to administer 100% oxygen and/or succinylcholine was also identified.
Results
Coughing (33% vs 53%) was more frequent in Group B (P < 0.05). Coughing severity scores (13 vs 36) and breath-holding severity scores (8 vs 19) were also greater in Group B (P < 0.05). A change in FiO2 was required more frequently in Group B (4% vs 16%). Although there was a high incidence of laryngospasm in both groups (52% vs 59%), no other differences were identified, breath-holding (26% vs 31%), secretions (30% vs 31%), hiccough (11% vs 12.5%) (P > 0.05).
Conclusion
Humidification of inspired isoflurane reduces the frequency and severity of coughing, the severity of breath-holding, and the need to increase supplemental inspired oxygen concentration, when isoflurane is used for inhalation induction of anaesthesia in children. Humidification has no effect, however, on the frequency and severity of laryngospasm, or on the frequency of occurrence of arterial oxygen desaturation.
Résumé
Objectif
L’induction par inhalation d’isoflurane est associée à l’irritabilité des voies aériennes, à la toux, à l’apnée et au laryngospasme. Ces complications surviennent surtout chez les enfants. Cette étude visait à déterminer si l’humidification de l’isoflurane en oxygène/protoxyde d’azote pouvait diminuer l’incidence des complications respiratoires et les épisodes d’hypoxie à l’induction.
Méthodes
Cinquante enfants non prémédiqués, âgés de trois mois à 12 ans ont été assignés à cette étude aléatoirement pour recevoir soit de l’isoflurane humidifié (n = 27, groupe A), soit de l’isoflurane non humidifié (n = 32, groupe B). L’induction a toujours été réalisée à l’isoflurane dans un mélange oxygène/N2O 50:50. On recherchait spécifiquement l’apnée, la toux, le laryngospasame, les sécrétions et le hoquet. Un score de gravité de 0–3 était assigné à chacune de ces complications. La nécessité d’administrer de l’oxygène à 100% et/ou de la succinylcholine était aussi notée.
Résultats
La toux (33% vs 53%) a été plus fréquente dans le groupe B (P < 0,05). Les scores de gravité pour la toux (13 vs 36) et l’apnée (8 vs 19) étaient aussi plus élevés dans le groupe B (P < 0,05). Il a fallu changer la FiO2 plus fréquemment dans le groupe B (4% vs 16%). Bien que l’incidence du laryngospasme ait été élevée dans les deux groupes (52% vs 59%), on n’a pas noté d’autres différences: apnée (26% vs 32%), sécrétions (30% vs 31%), hoquet, (11% vs 12,5%) (P > 0,05).
Conclusion
L’humidification de l’isoflurane inspiré diminue la fréquence et la gravité de la toux, de l’apnée et le besoin d’oxygène inspiré supplémentaire lorsqu’on utilise l’isoflurane comme agent d’induction inhalatoire chez les enfants. Toutefois, l’humidification n’a aucun effet sur la fréquence et la gravité du laryngospasme ni sur l’incidence de la désaturation artérielle en oxygène.
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Cregg, N., Wall, C., Green, D. et al. Humidification reduces coughing and breath-holding during inhalation induction with isoflurane in children. Can J Anaesth 43, 1090–1094 (1996). https://doi.org/10.1007/BF03011833
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DOI: https://doi.org/10.1007/BF03011833