Immediate 8% Sevoflurane Induction in Children: A Comparison with Incremental Sevoflurane and Incremental Halothane

We compared the efficacy and tolerance of pediatric inductions with immediate 8% sevoflurane in 70% nitrous oxide with either incremental sevoflurane or incremental halothane in 70% nitrous oxide.Forty-six unpremedicated children had anesthesia induced by immediate 8% sevoflurane (high sevoflurane [HS]; circuit primed with 70% N2 O and 8% sevoflurane before application of the face mask), gradual sevoflurane (GS; primed with 70% N2 O with increments of sevoflurane), and gradual halothane (HAL; 70% N2 O with incremental halothane). Blind video recordings were made, and each childʼs distress was rated prior to mask application, during mask application, and every 10 s thereafter using a behavioral rating scale. There were no complications. Of those subjects not quiet and cooperative throughout, times to complete quiet were significantly different (P = 0.001)HS 19.8 +/- 8 s (range 9-34); GS 52 +/- 17 s (range 8-73); HAL 43 +/- 22 s (range 13-73). Times to eye closure were also significantly different (P < 0.001)HS 37 +/- 10 s (range 15-56); GS 70 +/- 18 s (range 35-114); HAL 81 +/- 34 s (range 55-140). Distress scale scores showed more rapid decrement with HS than with GS or HAL. We conclude that 1) immediate 8% sevoflurane/N2 O results in a significantly faster induction than GS or HAL; 2) in children, HS in N2 O will not result in a single-breath induction under the conditions of this study; 3) in this small group, HS was extremely well tolerated in ASA class I and II patients.(Anesth Analg 1997;85:313-6)