An alternative method for paediatric anaesthetic induction: critical incidents and historical antecedents*

This prospective study was undertaken to examine the safety and to review the historical antecedents of an alternative method of paediatric anaesthetic induction other than halothane by mask. Two-thousand and five ASA I, II and III patients, 1 month-16 years of age initially received 70% N₂O in O₂ via a flavour-scented mask for 1–3 min, until adequate sedation was achieved. Venous cannulation was then undertaken, followed by an intravenous induction with thiopentone, and either atracurium or suxamethonium. The anaesthetist noted the occurrence of specific critical incidents during induction: excitement, coughing, vomiting, airway obstruction, laryngospasm, bradycardia for age, hypotension and/or hypoxaemia. The frequencies of all eight specific critical incidents on induction were extremely low in all ages. The studied alternative method of paediatric anaesthetic induction may be safer and more applicable in diverse clinical settings than a conventional halothane mask induction.