To evaluate the possibility of using sevoflurane for inhalation sedation.
Thirty-five volunteers were divided randomly into two groups: sevoflurane group (n = 20) and nitrous oxide (N2O) group (n = 15). At the beginning of the sedation they all inhaled 100% O2, then a 0.1 minimum alveolar concentration (MAC) of sevoflurane or 10% N2O with oxygen, a 0.2 MAC of sevoflurane or 20% N2O with oxygen, and 0.3 MAC of sevoflurane or 30% N2O with oxygen for 10 minutes each.
The respiratory and cardiovascular functions were stable during inhalation of the gas mixtures. There were five negative comments about breathing N2O, but none about breathing sevoflurane.
All subjects in the sevoflurane group stated they would be willing to submit to the same inhalation procedure again.
"The newer sedative-hypnotic, propofol, is unlike any agent currently available and offers definitive advantages over the more traditional drugs like methohexital [79 – 82]. Newer inhalation agents like sevoflurane and desflurane possess different pharmacokinetic profiles from older agents like isoflurane and halothane, and thus offer advantages in the office setting  . Because airway maintenance and protection is paramount during anesthesia for facial surgery, the laryngeal mask airway is an alternative method of airway maintenance that offers advantages over traditional techniques [85 – 87]. "
[Show abstract][Hide abstract] ABSTRACT: Dr. Leon Goldman's classic advice, "If you don't need a laser, don't use one," is well worth repeating at this point . However, in the authors' opinion, the pulsed CO2 laser with computer pattern generator remains the gold standard for the treatment of facial photo-damage with dyschromias and facial rhytids - especially those with a fine, cross-hatched pattern (Figs. 9, 10). These high-energy pulsed lasers have been shown to be an excellent modality for the safe and precise removal of dermatologic defects and facial rhytids. The action of the laser removes the epidermis, stimulates collagen formation, shortens collagen strands, and welds collagen fragments. The result is rejuvenated, tightened skin, a satisfied patient, and a gratified surgeon.
Oral and Maxillofacial Surgery Clinics of North America 06/2004; 16(2):215-30. DOI:10.1016/j.coms.2004.02.005 · 0.58 Impact Factor
[Show abstract][Hide abstract] ABSTRACT: The physical and physiological characteristics and efficacy and adverse effects of sevoflurane and desflurane are reviewed. A lower blood-gas solubility of both drugs affords a greater degree of control of anaesthetic levels and a more rapid immediate recovery from anaesthesia than is achieved with older inhaled agents. However, this rapid recovery may result in emergence agitation for both agents, probably related to rapid awakening to postoperative pain. The cost efficacy of both agents will depend upon their ability to reduce the personnel and time costs of surgery through this rapid emergence, and this aspect needs to be studied further.Sevoflurane is currently in widespread clinical use in Japan and parts of Europe and the Americas. Compared with desflurane, it has the additional advantage of being nonirritating to the airway; inhalational induction of anaesthesia with sevoflurane is achieved rapidly and easily. The instability of sevoflurane with carbon dioxide absorbents and its in vivo biotransformation produce potentially toxic by-products. These by-products, including Compound A [pentafluoroisopropenyl fluoromethyl ether (PIFE)] and fluoride, have been extensively studied, and although there is a possibility of iatrogenic sequelae from sevoflurane, the likelihood of long term toxicity appears to be quite low. Phase IV studies are indicated to determine the safety of administering sevoflurane: (i) to renally impaired patients, and (ii) to any patient when fresh gas flows of <2 L/min are used. Sevoflurane is otherwise very well tolerated and appears to offer the advantage of rapid and smooth induction and emergence from general anaesthesia, with excellent haemodynamic characteristics.Desflurane is currently in widespread use in the US and does not possess the in vitro and in vivo stability concerns of sevoflurane, with the exception of carbon monoxide production from dry carbon dioxide absorbents. Because of its significant pungency, desflurane is not approved for use in inhalational inductions. In addition, its transient activation of the sympathetic nervous system produces hypertension and tachycardia, probably from stimulation of airway receptors. Desflurane is also otherwise well tolerated and provides very rapid emergence from general anaesthesia.
[Show abstract][Hide abstract] ABSTRACT: This study attempted to determine if sevoflurane in oxygen inhaled via a nasal hood as a sole sedative agent would provide an appropriate level of deep sedation for outpatient third molar surgery. Twenty-four patients scheduled for third molar removal were randomly assigned to receive either nasal hood inhalation sevoflurane or an intravenous deep sedation using midazolam and fentanyl followed by a propofol infusion. In addition to measuring patient, surgeon, and dentist anesthesiologist subjective satisfaction with the technique, physiological parameters, amnesia, and psychomotor recovery were also assessed. No statistically significant difference was found between the sevoflurane and midazolam-fentanyl-propofol sedative groups in physiological parameters, degree of amnesia, reported quality of sedation, or patient willingness to again undergo a similar deep sedation. A trend toward earlier recovery in the sevoflurane group was identified. Sevoflurane can be successfully employed as a deep sedative rather than a general anesthetic for extraction of third molars in healthy subjects.
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