Der Anaesthesist
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Review Comparative Study
[Sevoflurane in pediatric anesthesia. Malignant hyperthermia].
Inhalational anaesthesia is the most common anaesthesia technique in paediatric anaesthesia worldwide. Up to now the standard anaesthetic used is halothane. Because halothane is tolerated in the upper airways without side effects it is well suited for the inhalational induction of anaesthesia. ⋯ However, shorter recovery times lead to earlier perception of postoperative pain, requiring adequate pain management. (4) The hemodynamic stability after administration of sevoflurane is favourable to that after halothane in paediatric patients, leading to significantly less bradycardia. (5) In paediatric patients no negative effects on kidney function have been observed after administration of sevoflurane. There is no scientific basis for organotoxic effects, thus sevoflurane is suitable for low-flow and minimal-flow anaesthesia. (6) The duration of the action of muscle relaxants is increased to a greater extent in presence of sevoflurane compared to halothane. Consequently, the total dose of muscle relaxants can be reduced using sevoflurane. (7) Similar to the established inhalational anaesthetics sevoflurane triggers malignant hyperthermia (MH) and must not be used in patients in which MH is suspected or in which a predisposition for MH is known.
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An ideal anaesthetic should allow rapid, pleasant, and predictable induction, maintenance and emergence from anaesthesia. Little information is available about sevoflurane use in elderly patients. The pharmacological profile of sevoflurane may be advantageous in geriatric patients because low solubility in the blood is a prerequisite for rapid changes in anaesthetic depth. ⋯ However, there is still controversy if the occurrence of postoperative cognitive and mental impairment is reduced in elderly patients if drugs with fast elimination characteristics are use. Few data are available on the use of sevoflurane in geriatric patients with renal impairment. Further studies are needed to clarify if the administration of sevoflurane is safe in this population of patients.
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Echocardiography is a noninvasive method for cardiac evaluation. A review of the current literature shows that the routine use of echocardiography for assessing perioperative cardiac risk in patients undergoing noncardiac surgery can not be supported. ⋯ However, because of the high financial and personal implications it should be reserved to those patients who are not able to perform a normal stress test. Besides in patients in whom transthoracic echocardiography doesn't offer sufficient information or is not possible transesophageal echocardiography plays only a minor role in preoperative cardiac evaluation.