Comparison of low‐fresh gas flow technique to standard technique of sevoflurane induction in children – a randomized controlled trial

Abstract

Background

Although sevoflurane is preferred for inhalational induction in children, financial and environmental costs remain major limitations. The aim of this study was to determine if the use of low‐fresh gas flow during inhalational induction with sevoflurane could significantly reduce agent consumption, without adversely affecting induction conditions.

Methods

After institutional ethical committee approval, 50 children, aged 1–5 years, undergoing ophthalmic procedures under general anesthesia, were randomized into 2 groups – standard induction (Group S) and low‐flow induction (Group L). A pediatric circle system with 1 L reservoir bag was primed with 8% sevoflurane in oxygen at 6 L.min⁻¹ for 30 seconds before beginning induction. In Group S, FGF was maintained at 6 L.min⁻¹ until the end of induction. In Group L, FGF was reduced to 1 L.min⁻¹ after applying facemask (time = T0). In both groups, sevoflurane was reduced to 5% after loss of eyelash reflex (T1). Once adequate depth of anesthesia was achieved (regular respiration, loss of muscle tone and absence of movement to trapezius squeeze), intravenous access was secured (T2), followed by insertion of an appropriately sized LMA‐Classic^™ (T3). Heart rate and end‐tidal sevoflurane concentration were measured at each of the above time points, and at 15 seconds following laryngeal mask airway insertion (T4). The total amount of sevoflurane consumed during induction was recorded.

Results

Sevoflurane consumption was significantly lower in Group L (4.17 ± 0.70 ml) compared to Group S (8.96 ± 1.11 ml) [mean difference 4.79 (95% CI = 4.25 – 5.33) ml; P < 0.001]. Time to successful laryngeal mask airway insertion was similar in both groups. There were no significant differences in heart rate, incidence of reflex tachycardia or need for rescue propofol.

Conclusion

Induction of anesthesia with sevoflurane using low‐fresh gas flow is effective in reducing sevoflurane consumption, without compromising induction time and conditions.

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