Orhon Zeynep Nur, Orhon Cem
Istanbul Medeniyet University, Faculty of Medicine, Goztepe Training and Research Hospital, Department of Anesthesiology and Reanimation, Istanbul, Turkey.
Private Yuzyıl Hospital, Department of Neurosurgery, Istanbul, Turkey.
Medeni Med J. 2020;35(2):85-90. doi: 10.5222/MMJ.2020.22309. Epub 2020 Jun 30.
Anesthesia induction is usually achieved with sevoflurane for pediatric patients without vascular access. The aim of this study was to investigate the optimum intravenous access time and to evaluate the corresponding bispectral index (BIS) value in pediatric patients after sevoflurane induction.
This prospective study included 100 children enrolled between January 1, 2017 and January 1, 2018 at Istanbul Medeniyet University Goztepe Training and Research Hospital. Anesthesia was induced with 8% sevoflurane and oxygen. Measurements included mask adaptation time, time to loss of the ciliary reflex, time to recovery of regular breathing, and optimal timing of intravenous access time with the corresponding BIS values, as well as the time elapsed for the BIS value to fall below 60.
The mean mask adaptation time was 27.8±28.4 s, time to loss of the ciliary reflex was 39.7±10.3 s, and time to reach regular respiration was 88.5±116.9 s, with mean BIS value of 80.4±16.9, 70.2±10.4, and 52.4±12.1, respectively. The mean time for BIS to fall below 60 was 72.54±24.41 s. The mean time required for the the iniation of optimal intravenous access was 104.92±36.45 s, with a mean BIS value of 30±10.1.
Following anesthesia induction with sevoflurane in children, the BIS value below 60 which is the upper limit for surgical anesthesia, was found to be insufficient for intravenous intervention. For pediatric patients undergoing sevoflurane induction it has been concluded that, the BIS value below 30 or an average waiting time of 104.9 s is ideal for initiation of optimal intravenous access.
对于没有血管通路的儿科患者，麻醉诱导通常采用七氟醚。本研究的目的是调查最佳静脉穿刺时间，并评估七氟醚诱导后儿科患者相应的脑电双频指数（BIS）值。
这项前瞻性研究纳入了2017年1月1日至2018年1月1日期间在伊斯坦布尔梅迪尼耶特大学戈兹泰佩培训与研究医院登记的100名儿童。用8%的七氟醚和氧气进行麻醉诱导。测量指标包括面罩适应时间、睫状反射消失时间、恢复正常呼吸的时间、最佳静脉穿刺时间及相应的BIS值，以及BIS值降至60以下所用的时间。
平均面罩适应时间为27.8±28.4秒，睫状反射消失时间为39.7±10.3秒，恢复正常呼吸的时间为88.5±116.9秒，相应的平均BIS值分别为80.4±16.9、70.2±10.4和52.4±12.1。BIS值降至60以下的平均时间为72.54±24.41秒。开始最佳静脉穿刺所需的平均时间为104.92±36.45秒，平均BIS值为30±10.1。
在儿童七氟醚麻醉诱导后，发现手术麻醉上限的BIS值低于60时进行静脉干预是不够的。对于接受七氟醚诱导的儿科患者，得出的结论是，BIS值低于30或平均等待时间104.9秒是开始最佳静脉穿刺的理想时机。
