Induction of anesthesia with sevoflurane in children: Curiosities and controversies

Paediatr Anaesth. 2022 Oct;32(10):1100-1103. doi: 10.1111/pan.14537. Epub 2022 Aug 4.

Abstract

Inhalational inductions with sevoflurane (up to 8% inspired concentration) have been the standard for inducing anesthesia in children for over three decades. However, when sevoflurane was first introduced, clinicians reported isolated cases of unexpected myoclonic jerking movements during the induction in children without epilepsy. These cases raised concerns regarding the widespread use of sevoflurane particularly after reports of seizures and epileptiform electroencephalographic (EEG) discharges surfaced. The latter reports prompted recommendations to reduce the concentration of sevoflurane during induction of anesthesia. More recently, a shift away from the use of nitrous oxide has prompted some to question whether sevoflurane has a role as an induction agent in children. The preponderance of evidence supports the practice of safely inducing anesthesia with 8% sevoflurane with or without nitrous oxide in children but recommended strategies to mitigate against epileptiform discharges may be more harmful than beneficial.

Keywords: Neurological disease; child; drugs; epilepsy; inhaled agents; sevoflurane.

Publication types

  • Review

MeSH terms

  • Anesthesia, General
  • Anesthesia, Inhalation
  • Anesthetics, Inhalation* / adverse effects
  • Child
  • Exploratory Behavior
  • Humans
  • Methyl Ethers*
  • Nitrous Oxide
  • Sevoflurane

Substances

  • Anesthetics, Inhalation
  • Methyl Ethers
  • Sevoflurane
  • Nitrous Oxide