Przydatność kliniczna indukcji znieczulenia ogólnego metodą wziewną z zastosowaniem sewofluranu

Ewa Karpel¹, Agnieszka Misiewska-Kaczur², Ryszard Woźnica²

Summary
Background. Inhalation induction is rarely used in adult patients, although sevoflurane offers the possibility of a rapid and well-tolerated commencement of anaesthesia. In this prospective, randomized study we compared vital capacity induction with 8% sevoflurane, with intravenous induction using 2 mg kg^-1 propofol. Methods. 60 female patients, scheduled for minor gynecological surgery, were randomly allocated to two groups of 30 women each, to receive either sevoflurane or propofol. The induction time was measured as the time from the beginning of induction to the loss of ciliary reflex, and the time to BIS reading<60 was also measured. Rocuronium was used to facilitate intubation in both groups. Anaesthesia was maintained with propofol or sevoflurane, depending on the drug used for induction. Fentanyl was given for analgesia. Results. The mean time to the loss of the ciliary reflex was longer in the sevoflurane group (48.3 vs. 35.5 sec), and the time to obtain BIS<60 was also longer (50.0 vs. 35.9 sec). Arterial blood pressure during intubation was higher in the propofol group. There were no differences in heart rate, ECG recording or pulse oximetry. BIS readings were lower during anaesthesia in the sevoflurane group. Discussion and conclusions. Vital capacity sevoflurane induction was slower, compared with propofol, nevertheless it provided an adequate level of anaesthesia, free of major side effects. Higher BIS readings, observed during laryngoscopy and intubation, may indicate need for better suppression of the brain cortex during this period. Vital capacity induction can offer a useful alternative to intravenous induction in selected patients.

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