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Çocuklarda sevofluran ile nitröz oksit veya kaudal blok uygulamasının gözlemsel karşılaştırılması

Year 2019, Volume: 10 Issue: 1, 1 - 5, 21.03.2019
https://doi.org/10.18663/tjcl.472892

Abstract

Amaç:  Sevofluran
çocuklarda anestezi indüksiyonu ve idamesinde en sık tercih edilen volatil
anestezik ajandır. Çalışmamızda genel anestezinin analjezik komponentini N2O
veya kaudal blok ile sağlayarak ve anestezi süresince bisepektral indeks (BIS)
monitörizasyonu ile anestezi derinliğini sabit tutarak; bu iki uygulama
şeklinin minimal alveolar konsantrasyon (MAK) ve hemodinami üzerindeki
etkilerini gözlemsel olarak karşılaştırmayı amaçladık
.

Gereç ve
Yöntemler:
Genel anestezi
altında günübirlik operasyon geçirecek 40 çocuk hastaya; %40 O2/hava (grup K)
veya %40 O2/N2O (grup N) karışımı içinde %8 sevofluran kullanılarak
inhalasyon indüksiyonu uygulandı. Gurup K’daki çocuklara yan yatar
pozisyonda,  22 G kaudal iğneyle 0.7 mL/kg,  % 0.2  bupivakain
solüsyonu kullanılarak kaudal blok uygulandı. Operasyon süresince her iki
grubun hemodinamik parametreleri, BIS ve MAK değerleri takip edilerek kaydedildi.

Bulgular: Her iki grubun hemodinamik parametreleri benzer bulunmuştur.
Sevofluranın, N2O katkısı olmaksızın kaudal blok yapılan grupta istatiksel
yönden anlamlı olmamakla birlikte daha düşük MAK değerlerinde
sürdürülebildiği tespit edilmiştir.







Sonuç: İntraoperatif ve postoperatif analjezi sağlamanın yanı sıra çevre kirliliğini azaltması
yönünden de bir avantaj sağladığı için kaudal bloğun, anestezi sırasında
uygun koşullarda N2O’e göre daha öncelikle tercih edilmesi gerektiği düşüncesindeyiz.

References

  • 1. Lew V, McKay E, Maze M. Past, present, and future of nitrous oxide. Br Med Bull 2018; 125: 103-19.
  • 2. Peyton PJ, Chao I, Weinberg L, Robinson GJ, Thompson BR. Nitrous oxide diffusion and the second gas effect on emergence from anesthesia. Anesthesiology 2011; 114: 596-602.
  • 3. Baum VC. When nitrous oxide is no laughing matter: nitrous oxide and pediatric anesthesia. Paediatr Anaesth 2007; 17: 824-30.
  • 4. Silvani P, Camporesi A, Agostino MR, Salvo I. Caudal anesthesia in pediatrics: an update. Minerva Anestesiol 2006; 72: 453-59.
  • 5. Davidson AJ, Ironfield CM, Skinner AV, Frawley GP. The effects of caudal local anesthesia blockade on the bispectral index during general anesthesia in children. Paediatr Anaesth 2006; 16: 828-33.
  • 6. Kain ZN, Mayes LC, Caldwell-Andrews AA, Karas DE, McClain BC. Preoperative anxiety, postoperative pain, and behavioral recovery in young children undergoing surgery. Pediatrics 2006; 118: 651-58.
  • 7. Taddio A, Katz J, Ilersich AL, Koren G. Effect of neonatal circumcision on pain response during subsequent routine vaccination. Lancet 1997; 349: 599-603.
  • 8. Tobias JD. Postoperative analgesia and intraoperative inhalational anesthetic requirements during umbilical herniorrhaphy in children: postincisional local infiltration versus preincisional caudal epidural block. J Clin Anesth 1996; 8: 634-38.
  • 9. Kim SH, Chun DH, Chang CH, Kim TW, Kim YM, Shin YS. Effect of caudal block on sevoflurane requirement for lower limb surgery in children with cerebral palsy. Paediatr Anaesth 2011; 21: 394-98.
  • 10. Ivani G, Mossetti V. Regional anesthesia for postoperative pain control in children: focus on continuous central and perineural infusions. Paediatr Drugs 2008; 10: 107-14.
  • 11. Kihara S, Yaguchi Y, Inomata S, Watanabe S, Brimacombe JR, Taguchi N, Komatsuzaki T. Influence of nitrous oxide on minimum alveolar concentration of sevoflurane for laryngeal mask insertion in children. Anesthesiology 2003; 99: 1055-58.
  • 12. Myles PS, Chan MT, Kasza J, Paech MJ, Leslie K, Peyton PJ, Sneyd JR. Severe nausea and vomiting in the evaluation of nitrous oxide in the gas mixture for anesthesia II trial. Anesthesiology 2016; 124: 1032-40.
  • 13. Pichardo D, Luginbuehl IA, Shakur Y, Wales PW, El-Sohemy A, O'connor DL. Effect of nitrous oxide exposure during surgery on the homocysteine concentrations of children. Anesthesiology 2012; 117: 15-21.
  • 14. Chen Y, Liu X, Cheng CH, Gin T, Leslie K, Myles P, Chan MT. Leukocyte DNA damage and wound infection after nitrous oxide administration: a randomized controlled trial. Anesthesiology 2013; 118: 1322-31.
  • 15. Hodgson PS, Liu SS, Gras TW. Does epidural anesthesia have general anesthetic effects? A prospective, randomized, double-blind, placebo-controlled trial. Anesthesiology 1999; 91: 1687-92.
  • 16. Hodgson PS, Liu SS. Epidural lidocaine decreases sevoflurane requirement for adequate depth of anesthesia as measured by the Bispectral Index monitor. Anesthesiology 2001; 94: 799–803.
  • 17. Desgranges FP, Desebbe O, Pereira de Souza Neto E, Raphael D, Chassard D. Respiratory variation in aortic blood flow peak velocity to predict fluid responsiveness in mechanically ventilated children: a systematic review and meta-analysis. Paediatr Anaesth 2016; 26: 37-47.
  • 18. Suresh S, Ecoffey C, Bosenberg A, Lonnqvist PA, de Oliveira GS Jr, de Leon Casasola O, Ivani G. The European Society of Regional Anaesthesia and Pain Therapy/American Society of Regional Anesthesia and Pain Medicine Recommendations on Local Anesthetics and Adjuvants Dosage in Pediatric Regional Anesthesia. Reg Anesth Pain Med 2018; 43: 211-6.

Observational comparison of sevoflurane and nitrous oxide or caudal block in pediatric patients

Year 2019, Volume: 10 Issue: 1, 1 - 5, 21.03.2019
https://doi.org/10.18663/tjcl.472892

Abstract

Aim: Sevoflurane is the most preferred volatile anesthetic
agent for the induction and maintenance of anesthesia in children. In our
study, the analgesic component of general anesthesia was provided by N2O
or caudal block and during anesthesia, the depth of the anesthesia was kept
constant by means of the monitoring of bispectral index (BIS). We aimed to make
an observational comparison the effects of these two methods on minimal
alveolar concentration (MAC) and hemodynamics.

Material
and Methods:
Forty pediatric patients scheduled to undergo on day case based surgery
under general anesthesia were included in the study. Inhalation induction using
8% sevoflurane in a mixture of 40% O2/Air (group K) or 40% O2/N2O (group N)
were used in all children.  Then,
patients in Group K received caudal block in lateral decubitus position with 0.7
mL/kg, 0.2% bupivacaine solution using 22 G caudal needle. Hemodynamic
parameters, BIS and MAC values were recorded during the operation in all patients.

Results: Hemodynamic
parameters were similar in both groups. It was determined that sevoflurane was
not statistically significant in the caudal block group without the
contribution of N2O, but could be maintained in lower MAC values.







Conclusion: We recommend
use of caudal block since it ensures adequately satisfactory intraoperative and
postoperative analgesia without any harm to atmosphere in comparison to N2O
during general anesthesia in the presence of no medical contraindications.

References

  • 1. Lew V, McKay E, Maze M. Past, present, and future of nitrous oxide. Br Med Bull 2018; 125: 103-19.
  • 2. Peyton PJ, Chao I, Weinberg L, Robinson GJ, Thompson BR. Nitrous oxide diffusion and the second gas effect on emergence from anesthesia. Anesthesiology 2011; 114: 596-602.
  • 3. Baum VC. When nitrous oxide is no laughing matter: nitrous oxide and pediatric anesthesia. Paediatr Anaesth 2007; 17: 824-30.
  • 4. Silvani P, Camporesi A, Agostino MR, Salvo I. Caudal anesthesia in pediatrics: an update. Minerva Anestesiol 2006; 72: 453-59.
  • 5. Davidson AJ, Ironfield CM, Skinner AV, Frawley GP. The effects of caudal local anesthesia blockade on the bispectral index during general anesthesia in children. Paediatr Anaesth 2006; 16: 828-33.
  • 6. Kain ZN, Mayes LC, Caldwell-Andrews AA, Karas DE, McClain BC. Preoperative anxiety, postoperative pain, and behavioral recovery in young children undergoing surgery. Pediatrics 2006; 118: 651-58.
  • 7. Taddio A, Katz J, Ilersich AL, Koren G. Effect of neonatal circumcision on pain response during subsequent routine vaccination. Lancet 1997; 349: 599-603.
  • 8. Tobias JD. Postoperative analgesia and intraoperative inhalational anesthetic requirements during umbilical herniorrhaphy in children: postincisional local infiltration versus preincisional caudal epidural block. J Clin Anesth 1996; 8: 634-38.
  • 9. Kim SH, Chun DH, Chang CH, Kim TW, Kim YM, Shin YS. Effect of caudal block on sevoflurane requirement for lower limb surgery in children with cerebral palsy. Paediatr Anaesth 2011; 21: 394-98.
  • 10. Ivani G, Mossetti V. Regional anesthesia for postoperative pain control in children: focus on continuous central and perineural infusions. Paediatr Drugs 2008; 10: 107-14.
  • 11. Kihara S, Yaguchi Y, Inomata S, Watanabe S, Brimacombe JR, Taguchi N, Komatsuzaki T. Influence of nitrous oxide on minimum alveolar concentration of sevoflurane for laryngeal mask insertion in children. Anesthesiology 2003; 99: 1055-58.
  • 12. Myles PS, Chan MT, Kasza J, Paech MJ, Leslie K, Peyton PJ, Sneyd JR. Severe nausea and vomiting in the evaluation of nitrous oxide in the gas mixture for anesthesia II trial. Anesthesiology 2016; 124: 1032-40.
  • 13. Pichardo D, Luginbuehl IA, Shakur Y, Wales PW, El-Sohemy A, O'connor DL. Effect of nitrous oxide exposure during surgery on the homocysteine concentrations of children. Anesthesiology 2012; 117: 15-21.
  • 14. Chen Y, Liu X, Cheng CH, Gin T, Leslie K, Myles P, Chan MT. Leukocyte DNA damage and wound infection after nitrous oxide administration: a randomized controlled trial. Anesthesiology 2013; 118: 1322-31.
  • 15. Hodgson PS, Liu SS, Gras TW. Does epidural anesthesia have general anesthetic effects? A prospective, randomized, double-blind, placebo-controlled trial. Anesthesiology 1999; 91: 1687-92.
  • 16. Hodgson PS, Liu SS. Epidural lidocaine decreases sevoflurane requirement for adequate depth of anesthesia as measured by the Bispectral Index monitor. Anesthesiology 2001; 94: 799–803.
  • 17. Desgranges FP, Desebbe O, Pereira de Souza Neto E, Raphael D, Chassard D. Respiratory variation in aortic blood flow peak velocity to predict fluid responsiveness in mechanically ventilated children: a systematic review and meta-analysis. Paediatr Anaesth 2016; 26: 37-47.
  • 18. Suresh S, Ecoffey C, Bosenberg A, Lonnqvist PA, de Oliveira GS Jr, de Leon Casasola O, Ivani G. The European Society of Regional Anaesthesia and Pain Therapy/American Society of Regional Anesthesia and Pain Medicine Recommendations on Local Anesthetics and Adjuvants Dosage in Pediatric Regional Anesthesia. Reg Anesth Pain Med 2018; 43: 211-6.
There are 18 citations in total.

Details

Primary Language Turkish
Subjects Health Care Administration
Journal Section Orıgınal Artıcle
Authors

Nesrin Alpaslan This is me

Demet Coskun 0000-0002-5773-0624

Sıdıka Hülya Çelebi This is me

Publication Date March 21, 2019
Published in Issue Year 2019 Volume: 10 Issue: 1

Cite

APA Alpaslan, N., Coskun, D., & Çelebi, S. H. (2019). Çocuklarda sevofluran ile nitröz oksit veya kaudal blok uygulamasının gözlemsel karşılaştırılması. Turkish Journal of Clinics and Laboratory, 10(1), 1-5. https://doi.org/10.18663/tjcl.472892
AMA Alpaslan N, Coskun D, Çelebi SH. Çocuklarda sevofluran ile nitröz oksit veya kaudal blok uygulamasının gözlemsel karşılaştırılması. TJCL. March 2019;10(1):1-5. doi:10.18663/tjcl.472892
Chicago Alpaslan, Nesrin, Demet Coskun, and Sıdıka Hülya Çelebi. “Çocuklarda Sevofluran Ile nitröz Oksit Veya Kaudal Blok uygulamasının gözlemsel karşılaştırılması”. Turkish Journal of Clinics and Laboratory 10, no. 1 (March 2019): 1-5. https://doi.org/10.18663/tjcl.472892.
EndNote Alpaslan N, Coskun D, Çelebi SH (March 1, 2019) Çocuklarda sevofluran ile nitröz oksit veya kaudal blok uygulamasının gözlemsel karşılaştırılması. Turkish Journal of Clinics and Laboratory 10 1 1–5.
IEEE N. Alpaslan, D. Coskun, and S. H. Çelebi, “Çocuklarda sevofluran ile nitröz oksit veya kaudal blok uygulamasının gözlemsel karşılaştırılması”, TJCL, vol. 10, no. 1, pp. 1–5, 2019, doi: 10.18663/tjcl.472892.
ISNAD Alpaslan, Nesrin et al. “Çocuklarda Sevofluran Ile nitröz Oksit Veya Kaudal Blok uygulamasının gözlemsel karşılaştırılması”. Turkish Journal of Clinics and Laboratory 10/1 (March 2019), 1-5. https://doi.org/10.18663/tjcl.472892.
JAMA Alpaslan N, Coskun D, Çelebi SH. Çocuklarda sevofluran ile nitröz oksit veya kaudal blok uygulamasının gözlemsel karşılaştırılması. TJCL. 2019;10:1–5.
MLA Alpaslan, Nesrin et al. “Çocuklarda Sevofluran Ile nitröz Oksit Veya Kaudal Blok uygulamasının gözlemsel karşılaştırılması”. Turkish Journal of Clinics and Laboratory, vol. 10, no. 1, 2019, pp. 1-5, doi:10.18663/tjcl.472892.
Vancouver Alpaslan N, Coskun D, Çelebi SH. Çocuklarda sevofluran ile nitröz oksit veya kaudal blok uygulamasının gözlemsel karşılaştırılması. TJCL. 2019;10(1):1-5.


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