Comparison of the effects of desflurane and isoflurane anaesthesia on hepatocellular function assessed by alpha glutathione S-transferase

The purpose of this study was to investigate the influence of isoflurane and desflurane on hepatocellular function. Twenty male patients undergoing elective surgery were randomly assigned to receive either isoflurane or desflurane anaesthesia. Alpha glutathione S-transferase concentrations and aminotransferase activities were measured at induction of anaesthesia (t0), 15 min (t1), 90 min after induction (t2), end of surgery (t3) and 2 h thereafter (t4). A significant increase in alpha glutathione S-transferase concentration was observed only in the isoflurane group. Alpha glutathione S-transferase levels increased significantly from 2.3 microg.l-1 at t0 to 6.1 (1.9) microg.l-1 at t2 and to 7.8 (2.1) microg.l-1 at t3. A significant difference in alpha glutathione S-transferase concentration between the two groups was found at t2 and t3. The significant increases in alpha glutathione S-transferase concentrations in patients receiving isoflurane suggest a transient disturbance of hepatocellular function.     

Emergence agitation in paediatric patients after sevoflurane anaesthesia and no surgery: a comparison with halothane

This study was designed to compare the emergence characteristics of sevoflurane with halothane anaesthesia in paediatric patients having no surgical intervention. We randomized 32 ASA I or II paediatric outpatients scheduled for magnetic resonance imaging scans to receive either halothane or sevoflurane anaesthesia. The primary outcome measure was the percentage of patients with emergence agitation, as defined by two different criteria. Time to discharge from the postanaesthesia care unit (PACU) and the secondary recovery unit (SRU) were compared. Sevoflurane patients had a greater incidence of emergence delirium when a high threshold for agitation was defined (33% vs. 0%, P = 0.010) and a lower threshold for agitation was applied (80% vs. 12%, P<0.0001). Discharge times from the PACU and the SRU were not different. We conclude that there is an increased incidence of emergence agitation with sevoflurane anaesthesia compared to halothane independent of any painful stimulus.     

Serum glutathione S-transferase concentrations and creatinine clearance after sevoflurane anaesthesia

The effects of sevoflurane and isoflurane on serum glutathione S-transferase concentrations and creatinine clearance were compared in 50 ASA I–III patients aged over 18 years undergoing body surface surgery of 1–3 h predicted duration. Patients randomly received sevoflurane ( n  = 24) or isoflurane ( n  = 26) in nitrous oxide and oxygen ( F IO ₂ = 0.4) via a nonrebreathing system. Fluids were standardised and patient's lungs ventilated to normocapnia. Expired concentration of anaesthetic agent was adjusted to maintain systolic arterial pressure between 70 and 100% of baseline. Patients received significantly less (p < 0.05) sevoflurane (1.0 MAC-h) than isoflurane (1.5 MAC-h). Using serum glutathione S-transferase concentrations and creatinine clearance as markers of hepatic and renal function respectively, no statistically significant differences were identified between the groups.     

Comparison of plasma α glutathione S-transferase concentrations during and after low-flow sevoflurane or isoflurane anaesthesia

BACKGROUND: We evaluated the effect of low-flow sevoflurane anaesthesia, in which compound A is generated, and isoflurane anaesthesia, in which compound A is not generated (n=13 in each group), on hepatocellular integrity using alpha glutathione S-transferase (GST). Alpha GST is a more sensitive and specific marker of hepatocellular damage than is aminotransferase activity and correlates better with hepatic histology. METHODS: Sevoflurane or isoflurane were delivered without nitrous oxide with a fresh gas flow of 1 l/min. Concentrations of compound A in the circuit were measured hourly, and plasma alpha GST concentrations were measured perioperatively. RESULTS: Mean duration of anaesthesia was 338+/-92 min in the sevoflurane group and 320+/-63 min in the isoflurane group. Mean compound A concentration in the sevoflurane group was 28.6+/-9.0 ppm. There was no significant difference in alpha GST concentrations between the sevoflurane and isoflurane groups during or after anaesthesia. CONCLUSION: These results indicate that low-flow sevoflurane and isoflurane anaesthesia have the same effect on hepatic function, as assessed by plasma alpha GST concentrations.     

Effects of halothane and sevoflurane on QT dispersion in paediatric patients

BACKGROUND: The QT dispersion (QTd) of the ECG is an indirect measure of heterogeneity of ventricular repolarization which may contribute to complex ventricular arrhythmias. We compared the effects of halothane and sevoflurane on QTd, and heart-rate corrected QT dispersion (QTcd). METHODS: Fifty ASA physical status I patients, aged 5-15 years, undergoing general anaesthesia were studied. A control ECG recording was printed before induction of anaesthesia. In the halothane group, anaesthesia was induced with halothane 4% in 2 : 1 ratio of air : O2 mixture and in the sevoflurane group with sevoflurane 8% in 2 : 1 ratio of air : O2 mixture. The ECG was recorded 1 and 3 min after induction of anaesthesia, 1 and 3 min after the administration of vecuronium 0.08 m.kg(-1) intravenous and 1 and 3 min after the tracheal intubation. All ECGs were analysed by two cardiologists blinded to the anaesthetic. RESULTS: Although QTd increased in both groups following intubation, this difference was not statistically significant when compared with control values. Following intubation five patients in the halothane group had ventricular arrhythmias of short duration, whereas no arrhythmias were recorded in the sevoflurane group (P = 0.052). Following intubation, QTd (45 +/- 15 ms vs 40 +/- 14 ms) and QTcd (60 +/- 17 ms vs 55 +/- 16 ms) values in the halothane group were significantly greater than the sevoflurane group (P < 0.05). CONCLUSION: Neither sevoflurane nor halothane caused a significant increase in QTd compared with control values before induction. Only QTd following intubation was significantly greater in the halothane group than the sevoflurane group.     

A comparison of sevoflurane to halothane in paediatric surgical patients: results of a multicentre international study

Induction, emergence and recovery characteristics were compared during sevoflurane or halothane anaesthetic in a large (428) multicentre, international study of children undergoing elective inpatient surgical procedures. Two hundred and fourteen children in each group underwent inhalation induction with nitrous oxide/oxygen and sevoflurane or halothane. Incremental doses of either study drug were added until loss of eyelash reflex was achieved. Steady state concentrations of anaesthesia were maintained until the end of surgery when anaesthetic agents were terminated simultaneously. Time variables were recorded for induction, emergence and the first need for analgesia in the recovery room. In addition, in 86 of the children in both groups, venous blood samples were drawn for plasma fluoride levels during and after surgery. There was a trend toward smoother induction (induction of anaesthesia without coughing, breath holding, excitement laryngospasm, bronchospasm, increased secretion, and vomiting) in the sevoflurane group with faster induction (2.1 min vs 2.9 min, P= 0.037) and rapid emergence times (10.3 min vs 13.9 min, P= 0.003). Among the children given sevoflurane, 2% developed bradycardia compared with 11% in the halothane group. Postoperatively, 46% of the children in the halothane group developed nausea and or vomiting versus 31% in the sevoflurane group (P= 0.002). Two children in the halothane group developed cardiac dysrhythmia and were dropped from the study. In addition, a child in the halothane group developed malignant hyperthermia, received dantrolene, and had an uneventful recovery. Mean maximum inorganic fluoride concentration was 18.3 μM˙l^?1. The fluoride concentrations peaked within one h of termination of sevoflurane anaesthetic and returned rapidly to baseline within 48 h. This study suggests that sevoflurane may be the drug of choice for the anaesthetic management of children.     

Propofol as a sole agent for paediatric day care diagnostic ophthalmic procedures: comparison with halothane anaesthesia

BACKGROUND: Our aim was to study the feasibility of total intravenous anaesthesia with propofol in spontaneously breathing children undergoing ophthalmic procedures. METHODS: Fifty-five children (aged 6 months to 5 years) were randomly allocated to receive either propofol bolus (until loss of eyelash reflex) followed by infusion [group P (n=29)] or halothane 3-4% for induction, followed by 1-2% in 70% nitrous oxide and oxygen via face mask [group H (n=28)]. Dose for induction and maintenance, intraoperative adverse events, time to recovery (on an Observer's Assessment of Alertness/Sedation Scale, 5 at each level) and duration of procedure were recorded. All children in both groups, were anaesthetized successfully. RESULTS: 4.0 +/- 0.7 mg x kg(-1) and 5.1 +/- 1.0 mg x kg(-1) of propofol were required for loss of eyelash reflex and tolerance of the ophthalmic speculum, respectively. An infusion rate of 8.3 +/- 1.7 mg x kg(-1) x h(-1) was needed for maintenance of anaesthesia; 3.4 +/- 0.5%, 3.6 +/- 0.4% and 1.4 +/- 0.4% halothane was needed for induction, tolerance of the eye speculum and maintenance of anaesthesia, respectively. Induction and recovery were significantly faster with halothane compared with propofol [induction - 38.3 +/- 6.6 s (group H)/60.9 +/- 15.2 s (group P) (P < 0.001); recovery 12.8 +/- 4.6 min (group H)/27.0 +/- 23.3 min (group P) (P < 0.001)]. Apnoea, coughing and breath-holding were seen only in group H. Group P had significantly higher incidence of involuntary movements (minor degree) (n=6) (P < 0.01). CONCLUSIONS: Propofol is a feasible option for paediatric diagnostic ophthalmic procedures with the advantage over halothane of providing complete access to the eye.     

The correlation between bispectral index and airway reflexes with sevoflurane and halothane anaesthesia

Background: Unwanted airway reflexes such as laryngospasm are a frequent cause for concern in paediatric anaesthesia. They are more active during light anaesthesia. Bispectral index (BIS) is a recognized measure of anaesthetic effect. Ensuring adequate depth with the BIS may prevent these reflexes. This study investigates the relationship between BIS and a defined measure of airway reactivity. Methods: Sixty‐two children scheduled for direct laryngoscopy and bronchoscopy were enrolled in this prospective nonrandomized blinded study. They were induced and maintained with either sevoflurane or halothane. When depth of anaesthesia was judged deep enough on clinical grounds, the cords were sprayed with 2% lidocaine. Using an A2000 monitor, the BIS was recorded at the moment of spraying the cords. The anaesthetist was blinded to the BIS and noted whether or not spraying resulted in complete closure of the cords. Breath holding, desaturation and coughing were also recorded as secondary endpoints. Results: Using logistic regression there was a significant correlation between BIS and cord closure for halothane but not for sevoflurane (halothane Pseudo r² = 0.5, P = 0.003; sevoflurane Pseudo r² = 0.0004, P = 0.9). Although the study was not specifically designed to test for it, no difference was detected between agents in the incidence of cord closure (halothane 38%, sevoflurane 36%), or secondary endpoints (halothane 29%, sevoflurane 29%). Conclusions: The BIS may be useful to help prevent unwanted airway reflexes when using halothane but not with sevoflurane. The differing sites of anaesthetic action for sevoflurane and halothane may explain this result.     

Propofol and halothane versus sevoflurane in paediatric day-case surgery: induction and recovery characteristics

Background. The aim of this study was to compare the inductionand recovery characteristics associated with propofol inductionand halothane maintenance with sevoflurane anaesthesia in paediatricday surgery. Methods. In total, 322 children were assigned randomly to i.v.propofol induction and halothane/nitrous oxide maintenance orsevoflurane/nitrous oxide alone. The patients’ age, sex,and type of surgery were recorded, as were the times requiredfor anaesthetic induction, maintenance, recovery and time todischarge home. Postoperative nausea and vomiting, and the incidenceof adverse events during induction and recovery were also noted. Results. No significant differences were detected in age, sex,type of surgery performed or intraoperative opioid administration.Excitatory movement was more common during induction with sevoflurane.The mean time required for induction with propofol was 3.1 mincompared with 5 min in the sevoflurane group (P<0.001). Therecovery time was shorter in the sevoflurane group comparedwith propofol/halothane (23.2 vs 26.4 min, P<0.002). Theincidence of delirium in recovery was greater in the sevofluranegroup (P<0.001). There was no difference between groups inthe time spent on the postoperative ward before discharge home.On the postoperative ward the incidence of both nausea and vomitingwas significantly higher in the sevoflurane group (P=0.034).Five children were admitted to hospital overnight, none foranaesthetic reasons. Conclusions. The increased incidence of adverse events duringinduction, postoperative nausea and vomiting and postoperativedelirium in the sevoflurane group suggests that sevofluraneis not ideal as a sole agent for paediatric day case anaesthesia. Br J Anaesth 2003; 90: 461–6     

Haemodynamic responses to sevoflurane compared with halothane during inhalational induction in children

We studied the haemodynamic changes during induction of anaesthesia in 50 ASA I and II children (1–12 yrs) undergoing minor elective surgery. The patients were randomly divided into two groups to receive either halothane (n=25) or sevoflurane (n=25) in a mixture of O₂ and N₂O (40:60) for mask induction of anaesthesia. Induction of anaesthesia was performed with an overpressure technique by administering rapid increases of gas concentrations, in increments of 1% up to 7% for sevoflurane and of 0.5% up to 3% for halothane. Induction was smooth and rapid in both groups but characterized by increases in heart rate and systolic blood pressure up to 20% especially in the sevoflurane group (P<0.05); these increases in the latter group were significant compared with baseline and the halothane group (P<0.05). No serious complications were observed. The authors conclude that more children experienced heart rate and blood pressure increases during the early stage of inhalational induction with sevoflurane compared with halothane.     

Recovery of psychomotor function following general anaesthesia in children: a comparison of propofol and thiopentone/halothane

The present study was undertaken to compare immediate recovery and recovery of complex psychomotor function in 20 children (aged 6–12 years) following general anaesthesia with either thiopentone/halothane or propofol. Early recovery of psychomotor skills was significantly faster in the propofol group than in the thiopentone/halothane group. Compared to preanaesthesia baseline the sedation and cooperation scores, the reaction time to visual and auditory stimuli as well as the postbox test and the flicker fusion frequency were less impaired after propofol than after thiopentone/halothane anaesthesia up to 120 min postoperatively. In the propofol group most tests reached preanaesthesia levels after 120 min, while in the thiopentone/halothane group these levels were not reattained throughout the entire study period. The results indicate that the recovery of psychomotor function in paediatric patients following general anaesthesia with propofol is significantly faster than with thiopentone/halothane. This has important implications for parental satisfaction, the time over which patients need to be monitored in the recovery room and for the discharge criteria after daycase surgery.     

Alterations in the biochemical markers of renal function after sevoflurane anaesthesia

AIM: This study has been carried out to see whether renal function is acutely altered in patients undergoing sevoflurane anaesthesia. For this purpose, the urinary levels of markers of renal tubular function, namely leucine amino peptidase (LAP), gamma-glutamyl transferase (GGT), alkaline phosphatase (ALP), lactate dehydrogenase (LDH) and beta-2 microglobulin (beta-2M), and urinary albumin as a predictor of renal glomerular function were measured before and after sevoflurane anaesthesia. METHODS: This study was comprised of 20 patients (11 males and nine females) aged 18-55, who underwent various elective surgical procedures under general anaesthesia. Urine samples of all patients were collected before and 1, 2 and 8 h after the anaesthesia. The levels of LAP, GGT, beta-2M, and albumin were then expressed as factored by urinary creatinine. In all patients, the anaesthesia was maintained with sevoflurane (2% end-tidal) at a high flow-rate (6 L/min). RESULTS: Urinary beta-2M and LAP levels after anaesthesia were unchanged (P > 0.05). While urinary GGT and ALP levels were found elevated in the first hour, LDH levels were higher in the second hour (P < 0.05). They returned to normal levels in the later periods after the anaesthesia. Urinary albumin excretion (UAE) was significantly elevated in the second hour after the anaesthesia (P < 0.001). Although UAE was decreased in the eighth hour after the anaesthesia, it still remained higher than the pre-anaesthesia level (P < 0.001). CONCLUSIONS: These results suggest that a 2% end-tidal concentration of sevoflurane at a high flow-rate (6 L/min) acutely alters renal glomerular function but does not have a significant acute effect on biochemical markers of renal tubular damage.     

Effects of halothane and sevoflurane on the paediatric respiratory pattern

Using a respiratory inductive plethysmograph, we investigated the effects of halothane and sevoflurane on the paediatric respiratory pattern under spontaneous breathing. We measured tidal volume per weight, respiratory rate, partial pressure of end-expiratory carbon dioxide (Pet_CO2), rib cage contribution to ventilation (%RC) and phase shift between rib cage and abdominal movements at 0.5, 1.0 and 1.5 MAC of these inhalational anaesthetics in oxygen. Both of these anaesthetics increased Pet_CO2 significantly with increase in depth of anaesthesia; sevoflurane produced more profound respiratory depression than halothane at high MAC. Both agents decreased %RC significantly with increase in depth of anaesthesia; paradoxical respiration occurred in the halothane group at high MAC. The profound respiratory depression of sevoflurane is due to both decreased tidal volume and decreased respiratory rate. The paradoxical respiration under halothane may be attributed to the potent suppression of intercostal muscle function and may be partly due to compensatory sparing effect on respiratory rate, which leads to the increase in airway flow and airway resistance.     

Occupational exposure to sevoflurane, halothane and nitrous oxide during paediatric anaesthesia Waste gas exposure during paediatric anaesthesia

We report the findings of a study on exposure of operating room staff to sevoflurane, halothane and nitrous oxide during induction and maintenance of anaesthesia in children. Concentrations of anaesthetic agents in the operating theatre were measured directly by highly sensitive, photoacoustic infrared spectrometer during 20 anaesthetics. Samples were taken from the breathing zones of the anaesthetist and the circulating nurse. The operating theatre was of modern design with an air conditioning system providing 20 changes of air each hour. The threshold values of 100 ppm N₂O, 50 ppm isoflurane and 10 ppm halothane recommended by the United Kingdom Committee for Occupational Safety and Health (COSH) were exceeded in several cases for a short time during mask induction. After tracheal intubation, trace concentrations of sevoflurane, halothane and N₂O were mostly under the recommended levels and comparable to levels measured during adult anaesthesia.     

Recovery characteristics of sevoflurane or halothane for day-case anaesthesia in children aged 1-3 years

BACKGROUND: Our objective was to compare the recovery characteristics of sevoflurane and halothane for short day-case anaesthesia in a specifically limited age group of children 1-3 yr. METHODS: Eighty unpremedicated children undergoing day-case adenoidectomy were randomly assigned to receive inhalational induction with either sevoflurane 8% or halothane 5% and nitrous oxide in oxygen (70/30) via a face mask. Tracheal intubation was performed without a muscle relaxant. Anaesthesia was continued with the volatile anaesthetic, adjusted to maintain heart rate and blood pressure within +/-20% of initial values. Recovery was evaluated using a modified Aldrete score, a Pain/Discomfort scale and by measuring recovery end-points. A postoperative questionnaire was used to determine the well-being of the child at home until 24 h after discharge. RESULTS: Emergence and interaction occurred significantly earlier after sevoflurane than halothane but discharge times were similar. More children in the sevoflurane group achieved full Aldrete scores within the first 30 min after anaesthesia, although this group suffered more discomfort during the first 10 min. The amount of postoperative analgesic administered was higher and the first dose given earlier in the sevoflurane group. Postoperative vomiting was more common with halothane, but side-effects in the two groups were otherwise similar in the recovery room and at home. CONCLUSIONS: In children 1-3 yr, sevoflurane provided more rapid early recovery but not discharge after anaesthesia of <30-min duration. Apart from more vomiting with halothane and more discomfort during the first 10 min after awakening with sevoflurane, the quality of recovery was similar with the two anaesthestics.