Impact of high concentrations of sevoflurane on laryngeal reflex responses

• Published in: Pediatric anesthesia Vol. 27; no. 3; pp. 282 - 289
• Main Authors: Erb, Thomas O., Ungern‐Sternberg, Britta S., Moll, Jens, Frei, Franz J., Lerman, Jerrold
• Format: Journal Article
• Language: English
• Published: France Wiley Subscription Services, Inc 01.03.2017
• Subjects: anesthesia; Anesthetics, Inhalation - pharmacology; Child; Child, Preschool; Dose-Response Relationship, Drug; Female; Humans; Hypotheses; laryngeal reflexes; Laryngismus - prevention & control; laryngospasm; Larynx - drug effects; Larynx - physiopathology; Male; Methyl Ethers - pharmacology; Prospective Studies; Reflex - drug effects; respiratory adverse events; sevoflurane; laryngospasm; sevoflurane; laryngeal reflexes; respiratory adverse events; anesthesia; child
• ISSN: 1155-5645; 1460-9592
• DOI: 10.1111/pan.13062

Summary Background Exaggerated defensive upper airway reflexes, particularly laryngospasm, may cause hypoxemic damage, especially in children. General clinical experience suggests that laryngeal reflex responses are more common under light levels of anesthesia, and previous clinical studies have shown an inverse correlation between laryngeal responsiveness and depth of hypnosis. However, this seems to be less obvious in children anesthetized with sevoflurane. The aim of this study was to assess the impact of high concentrations of sevoflurane on laryngeal and respiratory reflex responses in spontaneously breathing children. Accordingly, we tested the hypothesis that laryngeal and respiratory reflex responses were completely suppressed in spontaneously breathing children when anesthetized with sevoflurane 4.7% (=MACED95Intubation) as compared with sevoflurane 2.5% (=1 MAC). Methods In this prospective observational study, we tested the hypothesis that the incidence of laryngospasm evoked by laryngeal stimulation is diminished under high concentrations of sevoflurane. Following Ethics approval, trial registration, and informed consent, 40 children (3–7 years) scheduled for elective surgery participated in the trial. All children received sevoflurane 2.5% (1 MAC) and 4.7% (ED95Intubation) in random order with 5‐min equilibration between the states. Under both conditions, distilled water was sprayed under bronchoscopic view onto the larynx. Potential laryngeal and respiratory reflex responses were assessed offline by a blinded reviewer. Results Laryngospasm (episodes lasting >10 s) occurred in 12/38 (32%) of the patients anesthetized with sevoflurane 2.5%, vs 7/38 (18%) in those anesthetized with sevoflurane 4.7% (difference: OR 3.5; 95% CI [0.72–16.84], P = 0.18). All other reflex responses (coughing, expiration reflexes, and spasmodic panting) were infrequent and were similar among the examined concentrations. Conclusion Against our hypothesis, laryngospasm could still be observed in 18% of children under the higher concentration of sevoflurane (4.7%, ED95Intubation).