Comment gérer une induction inhalatoire chez l'enfant ?

Inhalation of anaesthetic agents is commonly used for anaesthetic induction in children. Sevoflurane has become the gold standard for anaesthetic induction in that setting. Premedication by midazolam or clonidine facilitates the acceptance of facial mask. Inhalation of high concentrations of sevoflurane permits a rapid loss of consciousness with a good respiratory and haemodynamic tolerance. A mixture of nitrous oxide in oxygen speeds loss of consciousness. However, epileptogenic effects of sevoflurane have been documented further to the administration of thigh concentrations. Consequently, guidelines recommend to use sevoflurane concentrations <6 % for induction and to reduce time spent at alveolar concentrations >1.5 MAC during maintenance of anaesthesia. Pressure support ventilation during inhalation induction allows to maintain normocapnia and to monitor FeSevo. Adding intravenous adjuvants may improve tracheal quality of tracheal intubation.