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Sevoflurane Induction of Anaesthesia in Critically ill Patients Undergoing Emergency Laparotomy
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Why is it important?
Sevoflurane has characteristics of rapid inhalational induction of anaesthesia in 60 secs while maintaining spontaneous respiration, bronchodilatation, haemodynamic stability with rapid recovery in elective scenario. This retrospective study analysed 40 (n=40) critically ill patients undergoing induction of anaesthesia with sevoflurane in emergency laparotomy. Standard methods and techniques were used in patient induction and management. Patients were optimized prior to sevoflurane induction were in ASA-III E (72.5%) and ASA-IV E (27.5%) status. Clinical outcome of sevoflurane anaesthesia induction analysed in terms of any airway managment complication and haemodynamic stability. Statistical analysis of haemodynamics done by ANOVA (analysis of variance). Incidence of airway complication such as laryngospasm, aspiration were nil and none of patient required abandoning or modification in induction process. Patients Spo2 improved postinduction (only 2.5% SpO2 between 85%-90%) even in comorbid COPD and smoker patients showing beneficial effects of sevoflurane induction. Induction of anaesthesia with sevoflurane is associated with significant changes (p < .05) in MAP and pulse peaking at 3 minutes postinduction as sevoflurane induction unable to attenuate intubation response on haemodynamics. None of the patient had bradycardia (HR < 60 bpm), hypotension (MAP < 60 mmHg) and arryythemias or required additional vasopressor support post induction and throughout perioperative period. None of patient required postoperative ventilation due to delayed recovery. Study concludes sevoflurane induction is without airway complications and haemodynamic unstability is suitable induction agent in emergency laparotomy in optimized critically ill patients while taking measure to prevent aspiration though unable to inhibit adrenergic endotracheal intubation responses.
Perspectives
Sevoflurane has characteristics of rapid inhalational induction of anaesthesia in 60 secs while maintaining spontaneous respiration, bronchodilatation, haemodynamic stability with rapid recovery in elective scenario. This retrospective study analysed 40 (n=40) critically ill patients undergoing induction of anaesthesia with sevoflurane in emergency laparotomy. Standard methods and techniques were used in patient induction and management. Patients were optimized prior to sevoflurane induction were in ASA-III E (72.5%) and ASA-IV E (27.5%) status. Clinical outcome of sevoflurane anaesthesia induction analysed in terms of any airway managment complication and haemodynamic stability. Statistical analysis of haemodynamics done by ANOVA (analysis of variance). Incidence of airway complication such as laryngospasm, aspiration were nil and none of patient required abandoning or modification in induction process. Patients Spo2 improved postinduction (only 2.5% SpO2 between 85%-90%) even in comorbid COPD and smoker patients showing beneficial effects of sevoflurane induction. Induction of anaesthesia with sevoflurane is associated with significant changes (p < .05) in MAP and pulse peaking at 3 minutes postinduction as sevoflurane induction unable to attenuate intubation response on haemodynamics. None of the patient had bradycardia (HR < 60 bpm), hypotension (MAP < 60 mmHg) and arryythemias or required additional vasopressor support post induction and throughout perioperative period. None of patient required postoperative ventilation due to delayed recovery. Study concludes sevoflurane induction is without airway complications and haemodynamic unstability is suitable induction agent in emergency laparotomy in optimized critically ill patients while taking measure to prevent aspiration though unable to inhibit adrenergic endotracheal intubation responses.
Red Flower Publication Publications
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This page is a summary of: Sevoflurane Induction of Anaesthesia in Critically ill Patients Undergoing Emergency Laparotomy, Indian Journal of Anaesthesia and Analgesia, January 2019, Red Flower Publication Private, Ltd.,
DOI: 10.21088/ijaa.2349.8471.6119.1.
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