Two different techniques of facial mask induction of anesthesia in children provide identical intubation conditions despite different anesthetic depth. Hallet C., Venneman I., Hans G., & Bonhomme V. 2016. ![Two different techniques of facial mask induction of anesthesia in children provide identical intubation conditions despite different anesthetic depth [link]](https://bibbase.org/img/filetypes/link.svg "link")
Paper abstract bibtex Background: Sevoflurane induction in children is performed using different techniques. Constricted, centered, and symmetrical pupils (CCSP) are classically the endpoint to be achieved before laryngoscopy is performed. Objectives: We investigated whether two different inhalation induction techniques with the same clinical end-point provided similar intubating conditions and comparable depth of anesthesia as assessed by the Bispectral Index (BIS). Methods: Following IRB approval, and informed parental consent, 20 children were recruited. They were scheduled for general anesthesia with tracheal intubation, and randomly assigned to Group 1, where the practitioner used 6% inspired sevoflurane in 50% O2/N2O, and no manually assisted ventilation, or Group 2, where inspired sevoflurane was 8% in 50% O2/N2O, and ventilation was manually supported upon loss of consciousness. BIS values were blinded. Laryngoscopy was performed after CCSP. Intubation conditions scoring was based on jaw relaxation (mobile = 1, partially mobile = 2, fixed = 3), position of vocal cords (open = 1, half-closed = 2, closed = 3), and cough (no cough = 1,1 or 2 coughing efforts = 2, persistent coughing = 3). A total score \textgreater3 corresponded to non-optimal conditions. Results: Upon CCSP, BIS values were significantly lower in Group 1 [mean (SD): 30 (8) - 48 (18), p \textless 0.001], despite significantly higher end-tidal sevoflurane concentration in Group 2 [mean (SD): 5.0 (0.7) - 6.2 (0.5); p \textless 0.001]. Time to CCSP was slightly shorter in Group 2. Intubation conditions were always optimal except for one patient of Group 1. Discussion: Both induction techniques achieve good intubating conditions. Possible explanations for the between-group BIS difference include variable appreciation of the CCSP endpoint, different induction lengths or sevoflurane equilibration times, or sevoflurane-induced increase in electroencephalogram power. A better indicator of the best time to intubate is needed to avoid too deep anesthesia in children. Copyright © Ada Anaesthesiologica Belgica, 2016.
@misc{hallet_c._two_2016,
title = {Two different techniques of facial mask induction of anesthesia in children provide identical intubation conditions despite different anesthetic depth},
url = {http://www.arsmb-kvbmg.be/ramsb/contact.html},
abstract = {Background: Sevoflurane induction in children is performed using different techniques. Constricted, centered, and symmetrical pupils (CCSP) are classically the endpoint to be achieved before laryngoscopy is performed. Objectives: We investigated whether two different inhalation induction techniques with the same clinical end-point provided similar intubating conditions and comparable depth of anesthesia as assessed by the Bispectral Index (BIS). Methods: Following IRB approval, and informed parental consent, 20 children were recruited. They were scheduled for general anesthesia with tracheal intubation, and randomly assigned to Group 1, where the practitioner used 6\% inspired sevoflurane in 50\% O2/N2O, and no manually assisted ventilation, or Group 2, where inspired sevoflurane was 8\% in 50\% O2/N2O, and ventilation was manually supported upon loss of consciousness. BIS values were blinded. Laryngoscopy was performed after CCSP. Intubation conditions scoring was based on jaw relaxation (mobile = 1, partially mobile = 2, fixed = 3), position of vocal cords (open = 1, half-closed = 2, closed = 3), and cough (no cough = 1,1 or 2 coughing efforts = 2, persistent coughing = 3). A total score {\textgreater}3 corresponded to non-optimal conditions. Results: Upon CCSP, BIS values were significantly lower in Group 1 [mean (SD): 30 (8) - 48 (18), p {\textless} 0.001], despite significantly higher end-tidal sevoflurane concentration in Group 2 [mean (SD): 5.0 (0.7) - 6.2 (0.5); p {\textless} 0.001]. Time to CCSP was slightly shorter in Group 2. Intubation conditions were always optimal except for one patient of Group 1. Discussion: Both induction techniques achieve good intubating conditions. Possible explanations for the between-group BIS difference include variable appreciation of the CCSP endpoint, different induction lengths or sevoflurane equilibration times, or sevoflurane-induced increase in electroencephalogram power. A better indicator of the best time to intubate is needed to avoid too deep anesthesia in children. Copyright © Ada Anaesthesiologica Belgica, 2016.},
journal = {Acta Anaesthesiologica Belgica},
author = {{Hallet C.} and {Venneman I.} and {Hans G.} and {Bonhomme V.}},
year = {2016},
keywords = {*anesthesia induction, *anesthesia level, *bispectral index, *endotracheal intubation, *face, *pediatric face mask, *pediatric face mask/ct [Clinical Trial], *sevoflurane, Child, anesthesiology monitoring device, article, assisted ventilation, bispectral index, clinical article, clinical trial, controlled clinical trial, controlled study, coughing, double blind procedure, endotracheal tube cuff, exposure, general anesthesia, human, intermethod comparison, jaw, laryngoscopy, leisure, manual ventilation, mechanical ventilator, oxygen, parental consent, physician, prospective study, randomized controlled trial, rebreathing device, sevoflurane/ih [Inhalational Drug Administration], single blind procedure, unconsciousness, vocal cord}
}
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Constricted, centered, and symmetrical pupils (CCSP) are classically the endpoint to be achieved before laryngoscopy is performed. Objectives: We investigated whether two different inhalation induction techniques with the same clinical end-point provided similar intubating conditions and comparable depth of anesthesia as assessed by the Bispectral Index (BIS). Methods: Following IRB approval, and informed parental consent, 20 children were recruited. They were scheduled for general anesthesia with tracheal intubation, and randomly assigned to Group 1, where the practitioner used 6% inspired sevoflurane in 50% O2/N2O, and no manually assisted ventilation, or Group 2, where inspired sevoflurane was 8% in 50% O2/N2O, and ventilation was manually supported upon loss of consciousness. BIS values were blinded. Laryngoscopy was performed after CCSP. Intubation conditions scoring was based on jaw relaxation (mobile = 1, partially mobile = 2, fixed = 3), position of vocal cords (open = 1, half-closed = 2, closed = 3), and cough (no cough = 1,1 or 2 coughing efforts = 2, persistent coughing = 3). A total score \\textgreater3 corresponded to non-optimal conditions. Results: Upon CCSP, BIS values were significantly lower in Group 1 [mean (SD): 30 (8) - 48 (18), p \\textless 0.001], despite significantly higher end-tidal sevoflurane concentration in Group 2 [mean (SD): 5.0 (0.7) - 6.2 (0.5); p \\textless 0.001]. Time to CCSP was slightly shorter in Group 2. Intubation conditions were always optimal except for one patient of Group 1. Discussion: Both induction techniques achieve good intubating conditions. Possible explanations for the between-group BIS difference include variable appreciation of the CCSP endpoint, different induction lengths or sevoflurane equilibration times, or sevoflurane-induced increase in electroencephalogram power. A better indicator of the best time to intubate is needed to avoid too deep anesthesia in children. Copyright © Ada Anaesthesiologica Belgica, 2016.","journal":"Acta Anaesthesiologica Belgica","author":[{"firstnames":[],"propositions":[],"lastnames":["Hallet C."],"suffixes":[]},{"firstnames":[],"propositions":[],"lastnames":["Venneman I."],"suffixes":[]},{"firstnames":[],"propositions":[],"lastnames":["Hans G."],"suffixes":[]},{"firstnames":[],"propositions":[],"lastnames":["Bonhomme V."],"suffixes":[]}],"year":"2016","keywords":"*anesthesia induction, *anesthesia level, *bispectral index, *endotracheal intubation, *face, *pediatric face mask, *pediatric face mask/ct [Clinical Trial], *sevoflurane, Child, anesthesiology monitoring device, article, assisted ventilation, bispectral index, clinical article, clinical trial, controlled clinical trial, controlled study, coughing, double blind procedure, endotracheal tube cuff, exposure, general anesthesia, human, intermethod comparison, jaw, laryngoscopy, leisure, manual ventilation, mechanical ventilator, oxygen, parental consent, physician, prospective study, randomized controlled trial, rebreathing device, sevoflurane/ih [Inhalational Drug Administration], single blind procedure, unconsciousness, vocal cord","bibtex":"@misc{hallet_c._two_2016,\n\ttitle = {Two different techniques of facial mask induction of anesthesia in children provide identical intubation conditions despite different anesthetic depth},\n\turl = {http://www.arsmb-kvbmg.be/ramsb/contact.html},\n\tabstract = {Background: Sevoflurane induction in children is performed using different techniques. Constricted, centered, and symmetrical pupils (CCSP) are classically the endpoint to be achieved before laryngoscopy is performed. Objectives: We investigated whether two different inhalation induction techniques with the same clinical end-point provided similar intubating conditions and comparable depth of anesthesia as assessed by the Bispectral Index (BIS). Methods: Following IRB approval, and informed parental consent, 20 children were recruited. They were scheduled for general anesthesia with tracheal intubation, and randomly assigned to Group 1, where the practitioner used 6\\% inspired sevoflurane in 50\\% O2/N2O, and no manually assisted ventilation, or Group 2, where inspired sevoflurane was 8\\% in 50\\% O2/N2O, and ventilation was manually supported upon loss of consciousness. BIS values were blinded. Laryngoscopy was performed after CCSP. Intubation conditions scoring was based on jaw relaxation (mobile = 1, partially mobile = 2, fixed = 3), position of vocal cords (open = 1, half-closed = 2, closed = 3), and cough (no cough = 1,1 or 2 coughing efforts = 2, persistent coughing = 3). A total score {\\textgreater}3 corresponded to non-optimal conditions. Results: Upon CCSP, BIS values were significantly lower in Group 1 [mean (SD): 30 (8) - 48 (18), p {\\textless} 0.001], despite significantly higher end-tidal sevoflurane concentration in Group 2 [mean (SD): 5.0 (0.7) - 6.2 (0.5); p {\\textless} 0.001]. Time to CCSP was slightly shorter in Group 2. Intubation conditions were always optimal except for one patient of Group 1. Discussion: Both induction techniques achieve good intubating conditions. Possible explanations for the between-group BIS difference include variable appreciation of the CCSP endpoint, different induction lengths or sevoflurane equilibration times, or sevoflurane-induced increase in electroencephalogram power. A better indicator of the best time to intubate is needed to avoid too deep anesthesia in children. 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