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British Journal of Anaesthesia, Vol 82, Issue 1 20-24, Copyright © 1999 by The Board of Management and Trustees of the British Journal of Anaesthesia

CLINICAL INVESTIGATIONS

Effect of sevoflurane concentration on inhalation induction of anaesthesia in the elderly

R. Walpole and M. Logan
Western General Hospital, Crewe Road South, Edinburgh, EH4 2XU and Princess Margaret Rose Orthopaedic Hospital, 41-43 Frogston Road West, Edinburhg EH10 7ED, UK; Present address: Department of Anaesthesia, Royal Infirmary of Edinburgh, Lauriston Place, Edinburgh EH3 9Y2, UK

We have conducted a randomized, double-blind comparison of 4% and 8% sevoflurane for induction of anaesthesia in unpremedicated patients aged more than 60 yr. Sevoflurane was inhaled in 50% nitrous oxide using a vital capacity breath technique, and mean, systolic and diastolic arterial pressures and heart rate were monitored continuously using a Finapres cuff. In the 8% sevoflurane group, time to successful laryngeal mask insertion was significantly shorter (mean 168 (SD 34) s vs 226 (62) s; P < 0.01) and achieved more often at the first attempt than in the 4% sevoflurane group. Arterial pressures were lower in the 8% group, but this was not significant. No patient had apnoea lasting longer than 1 min. A total of 69% of patients described induction as pleasant and 85% would choose to have it again. We conclude that compared with 8% sevoflurane, the use of 4% sevoflurane in the elderly resulted in greater cardiovascular stability but at the cost of prolonged and occasionally unsuccessful induction.
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