Duration of Anaesthesia Induction in Paediatric Patients: Prospective Observational Trial
Condition: Anaesthesia Induction
Study type: Observational

Summary: 
      Intravenous anaesthesia induction is nowadays considered as gold standard, mainly because of
      the possibility of the rapid therapeutic intervention while having secured i.v. line.

      In the paediatric patients, apart from intravenous induction, it is also possible to use in
      the specific situations inhalation anaesthesia induction with sevoflurane (in the mixture
      with O2 + air, or O2 + N2O) and secure the i.v. line afterwards in the inhalation
      anaesthesia. This method is in the paediatric population currently preferred, mainly because
      of possible fear of the painful venipuncture.

      Inhalation anaesthesia induction is possible only in patients without the risk of
      aspiration/regurgitation of stomach content and in patients without predicted difficult
      airway. Even if sedative premedication is used, during the inhalation induction excitation
      stage of the general anaesthesia variably appears, during which hemodynamic sympathoadrenal
      response and involuntary limbs movement might occur. When deepening inhalation anaesthesia,
      progression to surgical stage and automatic breathing onset appears. This subsequently
      facilitates to secure the venous access, without which is is not possible to secure the
      airway (in exception of the emergency situations - resuscitation).
    

Detailed description: 
      The aim of this prospective observational trial is to compare the duration of inhalation and
      intravenous anaesthesia induction in paediatric patients, who undergo elective surgical or
      diagnostic procedures. After the approval of the study by the Ethics Committee of the
      University hospital Brno and registration of the protocol at clinicaltrials.gov, the duration
      of inhalation and intravenous anaesthesia induction in the patients undergoing general
      anaesthesia in the Departement of paediatric anaesthesia and intensive care unit, University
      Hospital Brno in the term from 1.9.2020 until 30.6.2021 will be measured. Measurement will be
      done in all patients in the given time period, who will undergo elective surgical or
      diagnostic procedure. The measurement will begin after the patient's arrival at the operating
      theatre, after the control of the documentation and beginning of the vital signs monitoring.
      The measurement will be terminated at the occurence of the first end-tidal carbon dioxide
      (ETCO2) wave, after securing the airway with laryngeal mask or orotracheal intubation

      For the inhalation induction sevoflurane will be used (in the mixture with O2 + air, or O2 +
      N2O), for the intravenous induction, commonly used induction anaesthetics will be used
      (propofol, etomidate, ketamine, midazolam).

      The type and the dose of the induction anaesthetic agent will be recorded (in the case of
      inhalation induction the dose of inhalation anaesthetic set on the vaporizer, in the case of
      intravenous induction the dose in mg/kg body weight).

      The type and dose of the sedative premedication will be recorded, the number of attempts
      needed to secure i.v. line, success rate of securing the i.v. line while using Eutectic
      Mixture of Local Anesthetics (EMLA) patch and/or Buzzy (vibration device for patient
      distraction), the number of attempts needed to secure the airway, incidence of adverse events
      which might occur during anaesthesia induction (tachycardia, bradycardia, bronchospasm,
      laryngospasm).
    

Intervention name(s): Inhalation induction; Intravenous induction
Intervention type(s): Procedure; Procedure
Intervention description(s): For the inhalation induction sevoflurane will be used (in the mixture with O2 + air, or O2 + N2O).; For the intravenous induction, commonly used induction anaesthetics will be used (propofol, etomidate, ketamine, midazolam).
Other intervention name(s): Anaesthesia inhalation induction; Anaesthesia intravenous induction
Intervention MeSH terms: Anesthetics
Observational model: Cohort
Time perspective: Prospective
Sampling method: Non-Probability Sample
Study population: 
        Pediatric patients scheduled for elective surgical or diagnostic procedure in the term from
        10.9.2020 until 30.6.2021.
      
Keywords: Anaesthesia; Paediatric; Inhalation; Intravenous