Induction, maintenance and recovery characteristics of desflurane in infants and children

Abstract

To determine the induction and recovery characteristics of the new poly-fluorinated anaesthetic desflurane, 78 fasting and unpremedicated neonates, infants and children up to 12 yr of age were studied. Patients were stratified according to age: full-term neonates less than 28 days of age (n = 12), infants 1-6 mth (n = 12) infants 6-12 mth (n = 15), children 1-3 yr (n = 15), 3-5 yr (n = 12), and 5-12 yr (n = 12). After preoxygenation for two minutes and an awake tracheal intubation, neonates were anaesthetized with stepwise increases in the inspired concentration of desflurane in an air/oxygen mixture. Infants 1-12 mth of age and children were anaesthetized with stepwise increases in the inspired concentration of desflurane in oxygen. Their tracheas were intubated under deep desflurane anaesthesia without muscle relaxation. The incidence of airway reflex responses (including breathholding, coughing, laryngospasm, bronchospasm and oropharyngeal secretions), incidence of excitement, minimum arterial oxygen saturation, and times to loss of eyelash reflex and tracheal intubation during induction were recorded. After skin incision, anaesthesia was maintained with desflurane (approximately 1 MAC) in 60% nitrous oxide and oxygen. Heart rate and systolic arterial pressure were recorded awake, at approximately 1 MAC before and after skin incision and throughout surgery. At the completion of surgery, all anaesthetics were discontinued and the lungs were ventilated with 100% oxygen. During emergence, the end-tidal concentration of desflurane was recorded until extubation. The incidence of airway reflex responses and the times to eye opening and extubation after the discontinuation of desflurane were recorded.(ABSTRACT TRUNCATED AT 250 WORDS)