Sevoflurane in child anaesthesia. Malignant hyperthermia

Inhalational anaesthesia is the most common anaesthesia technique in paedia tric anaesthesia worldwide. Up to now the standard anaesthetic used is halo thane. Because halothane is tolerated in the upper airways without side eff ects it is well suited for the inhalational induction of anaesthesia. Howev er, halothane exerts side effects on the hepatic and the cardiovascular sys tem. This review focuses on the replacement of halothane by sevoflurane in paediatric anaesthesia. Apart from its favorable pharmacological properties sevoflurane is also superior because of economical considerations,The foll owing conclusions are drawn:(1) Halothane and sevoflurane do not cause irri tations of the airways and are thus suitable for an inhalational induction. Sevoflurane should be administered in oxygen/nitrous oxide during inductio n of anaesthesia to reduce excitation.(2) The MAC values of sevoflurane are age dependent. In contrast to adult patients the MAC values of sevoflurane are only decreased by 20 to 25% in paediatric patients. The end-tidal conc entration of sevoflurane necessary for intubation or insertion of a larynge al mask is 2 to 4 Vol.%.(3) The blood/gas partition coefficient of sevoflur ane is low, resulting in shorter induction times with sevoflurane compared to halothane. The so called priming technique with 8 Vol.% of sevoflurane r esults in shorter induction times. Consequently, times to recovery and psyc he-motor functions are favourable for sevoflurane compared to halothane in paediatric patients. However, shorter recovery times lead to earlier percep tion of postoperative pain, requiring adequate pain management.(4) The hemo dynamic stability after administration of sevoflurane is favourable to that after halothane in paediatric patients, leading to significantly less brad ycardia.(5) In paediatric patients no negative effects on kidney function h ave been observed after administration of sevoflurane. There is no scientif ic basis for organotoxic effects,thus sevoflurane is suitable for low-flow and minimal-flow anaesthesia. (6) The duration of the action of muscle rela xants is increased to a greater extent in presence of sevoflurane compared to halothane. Consequently, the total dose of muscle relaxants can be reduc ed using sevoflurane. (7) Similar to the established inhalational anaesthet ics sevoflurane triggers malignant hyperthermia (MH) and must not be used i n patients in which MH is suspected or in which a predisposition for MH is known.