SYNOPSIS

FOR THE THESIS FOR THE DEGREE OF MD IN ANAESTHESIOLOGY FOR THE YEAR 2009-2012 UTKAL UNIVERSITY

TITLE OF THE PAPER

COMPARATIVE EVALATION OF SEVOFLURANE AND HALOTHANE INDUCTION OF ANAESTHESIA IN PADIATRIC PATIENT.

: DR. PRATIVA PANDA ASSOCIATE PROFESSOR, DEPARTMENT OF ANAESTHESIOLOGY SCB MEDICAL COLLEGE, CUTTACK. DR.S.S.ROUTRAY ASSISTANT PROFESSOR SCB MEDICAL COLLEGE , CUTTACK PROF (DR) RAMESH CH. SAMANTARAY PROFESSOR & HEAD, DEPARTMENT OF ANAESTHESIOLOGY S.C.B MEDICAL COLLEGE, CUTTACK DR. JAYANTI SINGH POST GRADUATE STUDENT, DEPARTMENT OF ANAESTHESIOLOGY SCB MEDICAL COLLEGE, CUTTACK. DEPARTMENT OF NAESTHESIOLOGY SCB MEDICAL COLLEGE, CUTTACK. 2009 -2010

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NAME OF CANDIDATE

PLACE OF STUDY

PERIOD OF STUDY

NAME OF UNIVERSITY

UTKAL UNIVERSITY

INTRODUCTION
In paediatric patient induction can be done by intravenous tech., inhalational tech. , intramuscular tech. , But If no IV is present, then inhalational induction is the gentle, pleasant best technique, allowing the anesthesiologist to practice .

Inhalational anesthesia is the preferred technique of induction in the paediatric age group in routine case. Halothane with its negligible pungency and minimal effects on airway reactivity has been the cornerstone of paediatric inhalational induction despite its propensity to cause bradycardia, hypotension and arrhythmias. However, loss of consciousness is often associated with transient reduction or cessation of breathing, interfering with the process of anaesthetic uptake and prolonging induction . To overcome this problem Continued research to manufacture an inhalational agent which would match the induction properties of halothane, but having minimal cardiac and hepatic side effects and requiring lesser time for induction and emergence led to the introduction of sevoflurane Sevoflurane, with low blood gas solubility allows rapid induction and early emergence. Due to its pleasant odour, it is non irritant to the airway which makes it an attractive alternative for inhalational induction in children.. This study was undertaken to compare the induction characteristics of sevoflurane and halothane and ease of endotracheal tube insertion .

AIM S AND OBJECTIVES :

1. To evaluate Time interval during induction with halothane 2. To evaluate time internal during induction with sevoflurane

3. To compare the time of induction with halothane and sevoflurane in the paediatric patient .

REVIEW OF LITERATURE :
Literature pertaining to the study were and will be r eviewed and in depth with reference from the published data in various journals and books

MATERIALS AND METHODS :

Selection of patients The present study was conducted on 60 padiatric Grade 1 or 2 patients with age between 1-12 years and weighing between 10-30 kg, undergoing short, general surgical and genitourinary surgeries were enrolled for the study at s.c.b.medical college .cuttack.

Exclusion criteria
 have a difficult airway or ASA grade 3 and above .  children with cardiac disease ,hepatic ,CNS, renal ,respiratory disease are excluded  child with previous h/o of any adverse reaction to volatile anesthetic was excluded

Preanesthetic preparation
A detailed preanesthetic checkup was done in all the patients. A detailed history was taken and thorough physical examination done. The following investigations were carried out in all the patients. a. Hemoglobin estimation b. Total leucocyte count c. Differential leucocyte count

An informed consent was taken from all the parents. The patients were asked to restrict oral intake overnight or at least 6 hours before surgery
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Allocation of the groups

1. In group I, inspired concentration of halothane was set at 0.5% initially, followed by stepwise increase of 0.5% every 3 - 4 breaths until the loss of eyelash reflex. 2. In group II, sevoflurane was set at 1% initially and increased stepwise by 1%. Until the loss of eye lash reflex .

Anesthetic procedure
With preoperative preparation, patients were kept overnight fasting .all patients were premedication with midazolam 0.5mg/kg and inj.atropine 0.02mg/kg IM. were given and a parent was encourage to present during induction . All children underwent routine monitoring, which consisted of y y y y electrocardiogram, automatic blood pressure pulse oximetery recording . Temp.monitoring

The anesthetic was delivered by mapleson F breathing ciruit with holding appropriate facemask as close to child face as could be tolerated. Induction with halothane was started at 0.5% and increased stepwise by 0.5% every 3-4 breaths to a maximum of 3.5% in 50% nitrous oxide and 50% oxygen, while sevoflurane was started at 1% and increased gradually by 1% to a maximum of 6%.

So we observed....

Time interval during induction

1. Start of induction to onset of regular respiration

2. Start of induction to loss of eyelash reflex 3. Start of induction to jaw relaxation 4. Start of induction to centralization of eyeballs

Struggling score was note

0 1 2 3 No movement, Head movement, Head and Limb movement, severe struggle 1. 2. 3. 4. Laryngoscopy Vocal cord Jaw relaxation Limb movement

Scoring system for intubating condition

DISCUSSION :
All the observations discussed with reference to currently available literature.

CONCLUSION :
After reviewing the literature pertaining to the study, conclusion will be discussed in the final dissertation

BIBLIOGRAPHY :
1. Lerman Jerrold, Nancy Sikich, Sam Kleinman, Steve Yentis. The pharmacology of sevoflurane in infants and children. Anesthesiology 1994; 80: 814-824. 2. Black A, Sury MRJ, Haemington L, Howard RFI, Mackerise AM, Hatch DJ. A comparison of the induction characteristics of sevoflurane and halothane in children. Anaesthesia 1996;5 1: 539-542.

3. Sigston PE, Jenkin AMC, Jackson CA, Sury MRJ, Mackerise AM, Hatch DJ. Rapid inhalation induction in children: 8% sevoflurane compared with 5% halothane. Br J Anaesth 1997; 78: 362-365 4. Naito Y, Tamai S, Shingu K, Fujimori R, Mori K. Comparison between sevoflurane and halothane for paediatric ambulatory anesthesia. Br J Anaesth 1991; 67: 387-389. 5. Piat Veronique, Marie-Claude Dubois, Stanislaus Johanet, Isabelle Murat. Induction and recovery characteristics and hemodynamic responses to sevoflurane and halothane in children. Anaesth Analg 1994; 79: 840-844. 6. Katoh T, Ikeda K. Minimum alveolar concentration of sevoflurane in children. Br J Anaesth 1992; 68: 139-141. 7. Hall JE, Jim Stewart, Harmer M. Single-breath inhalation induction of sevoflurane anesthesia with and without nitrous oxide: a feasibility study in adults and comparison with an intravenous bolus of propofol. Anaesthesia 1997; 52: 410-415. 8. Koprulu AS, Dogruer K, Karpat H. Sevoflurane versus halothane for Laryngeal Mask Airway (LMA) insertion. Br J Anaesth 1997; 78: 8. 9. .Johannesson GP, Floren M Lindahl. Sevoflurane for ENT-surgery in children: A comparison with halothane. Acta Anaesthesiologica Scandinavica 1995; 39: 546-550. 10. Lerman J, Davis PJ, Welborn LG et al. Induction recovery and safety characteristics of sevoflurane in children undergoing ambulatory surgery: A comparison with halothane. Anesthesiology 1996; 84: 1332-1340. 11. Wodey E, Pladys P, Copin C et al . Comparative hemodynamic depression of sevoflurane versus halothane in infants: An echocardiographic study. Anesthesiology 1997; 87: 795-800.

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