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Evidence-based Practice and Quality Improvement

How much do our children suffer during anesthesia induction?


Sánchez, Hernández A.; Soliveres, J.; Hernández, M. J.; Balaguer, J.; Gómez, L.; Solaz, C.

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European Journal of Anaesthesiology (EJA): June 2013 - Volume 30 - Issue - p 20-20
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General anesthesia may be induced by inhaled or intravenous routes, though the former is most often used for children because it avoids awake venous access. Nevertheless it is not worldwide used because although many anesthesiologists believe it is less psychologically traumatic, it is known that children may become apprehensive and resist the application of the mask, which may prolong the induction and be emotionally traumatic for the child.

Although among all inhalational anesthetics sevoflurane is considered the agent of choice in children, it is said that avoiding sevoflurane and using propofol as anesthetic agent is associated with a smoother recovery profile.

The aim of this randomized trial is to evaluate children anxiety during induction, quality of anesthesia induction and postoperative period and induction time parameters in these different anesthesia techniques.

Materials and Method: After local ethics committee approval, written informed consent was obtained from the parents of 40 ASA I pediatric patients scheduled for tonsillectomy. Those with previous surgery were excluded. Patients were randomly allocated to receive intravenous propofol applying anesthetic cream before punction or inhaled sevoflurane induction.

Modified Yale Preoperative Anxiety Scale (mYPAS) measures children's anxiety during induction. mYPAS scores>40 were classified as anxious.

Induction Compliance Checklist (ICC) represents negative behaviors during induction; ICC≥4 was considered poor behavioural compliance.

Smoothness Induction Index (SII) measures children behavioral compliance during induction. SII=1 (smooth induction) calm children, SII=2 (moderate induction) children crying, SII=3 (traumatic induction) children fighting.

Children's behaviour in the postanesthetic care unit (PACU) was assessed using a 5-point scale: child sleeping, awake and calm, crying, inconsolable crying, and disorientation.

Student's t test or Chi square were used as appropiate. A p< 0,05 was considered significant.

Results: See table. No child was withdrawn. Children receiving inhalational induction showed significantly lower levels of anxiety (mYPAS=37.8±10.1) as compared with children receiving intravenous induction (mYPAS=78.9±5.2).

Conclusions: Children receiving inhalational induction suffer less anxiety and better induction compliance without prolonging the time of anesthesia induction. There did not exist major index of postoperatory agitation with sevoflurane.

© 2013 European Society of Anaesthesiology