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British Journal of Anaesthesia 2007 98(1):105-109; doi:10.1093/bja/ael326
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© The Board of Management and Trustees of the British Journal of Anaesthesia 2007. All rights reserved. For Permissions, please e-mail: journals.permissions@oxfordjournals.org

Analgesia with sevoflurane during labour: I. Determination of the optimum concentration{dagger},{ddagger}

S. T. Yeo1,3,*, A. Holdcroft1, S. M. Yentis1 and A. Stewart2

1 Magill Department of Anaesthesia, Imperial College London, Chelsea and Westminster Hospital 369 Fulham Road, London W12 0HS, UK
2 East Surrey Hospital, Canada Avenue Redhill, Surrey RH1 5HR, UK
3 Present address: Hereford Hospitals NHS Trusts Hereford HR1 2ER, UK

*Corresponding author: Anaesthetic Department, The County Hospital Union Walk, Hereford HR1 2ER, UK. E-mail: sengyeo{at}hotmail.com

Background. Sevoflurane has favourable physical qualities for inhaled analgesia during labour pain. The aim of this preliminary study was to identify its optimum concentration.

Methods. In this open-labelled escalating-dose study, 22 parturients in labour self-administered sevoflurane at 10 contractions using an Oxford Miniature Vaporiser. The inspired concentration was increased by 0.2% after each contraction from 0% to 1.4% or decreased if sedation occurred. Visual analogue scores (0–100 mm) for pain intensity, pain relief, sedation, mood and coping were measured after each contraction.

Results. The median (IQR [range]) pain relief and sedation scores increased from 44 (43–56 [4–93]) mm and 55 (43–56 [0–98]) mm at 0.2% sevoflurane, to 74 (72–78 [50–80]) mm and 71 (71–73 [33–97]) mm at 1.2% sevoflurane, respectively. Pain relief scores did not show any significant increase above 0.8% whilst sedation continued to increase, with excessive sedation occurring at 1.2% sevoflurane. No significant changes in other scores were measured.

Conclusions. We concluded that the optimal sevoflurane concentration in labour was 0.8%. This concentration allows a safety margin and balances the risk of sedation with the benefit of pain relief in labour.

{dagger}This research has been presented at the Obstetric Anaesthetists' Association Annual Meeting 2003 and published as the following abstract: ‘Inhalational Analgesia using Sevoflurane: a pilot study’.

{ddagger}This article is accompanied by Editorial I.


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