Detecting wakefulness in anaesthetised children

Purpose

To investigate the suitability of the isolated forearm technique in detecting wakefulness in children aged 5 to 16 yr.

Methods

Forty-one healthy English speaking children were enrolled. Following intravenous induction of anaesthesia with 5–7 mg·kg^?1 thiopentonen. but before administration of 1–1.5 mg·kg^?1 succinylcholine a pneumatic toumiquet was inflated to 50 mmHg above systolic pressure in order to isolate the non-cannulated forearm. Thereafter, anaesthesia was maintained with halothane 1.5–2.5% in nitrous oxide and oxygen. Following the muscle relaxant the patient was instructed to move the unparalyzed arm. Movement was checked at 30 sec intervals and if present on command, identified as wakefulness.

Results

Movement of the isolated forearm to command was observed in 19.5% of children. The youngest child to respond was five years old.

Conclusion

The isolated forearm technique can be used to detect wakefulness during and immediately following tracheal intubation in children from the age of five years.