Comparison of Sevoflurane Induction Time between Pediatric Circle and Jackson-Rees System in Pediatric Patients

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Akkharawat Sinkueakunkit


Background: A Jackson Rees (JR), compared with a
pediatric circle (PC), system has lower capacity and time
constant leading to shorter induction time, thus making it
circuit of choice for induction. However, during maintenance
using low flow anesthesia, a JR is inappropriate due to the
need of very high fresh gas flow. At Srinagarind Hospital,
sevoflurane induction in pediatric patient without
premedication and intravenous access is usually
performed using a JR system and then switch to a PC
system during maintenance. This switching procedure
increases risk of error; so some anesthesiologists prefer
using a PC system solely to prevent error.
Objectives: To compare sevoflurane induction time
between a PC system and JR system.
Methods: Fifty-six pediatric patients without premedication
and intravenous access were randomized and allocated
into 2 groups; PC group (28 patients) and JR group
(28 patients). Both systems were primed with 8%
sevoflurane with 67% nitrous oxide in oxygen with a total
flow rate of 6 LPM before starting induction. Time to loss
of eyelash reflex, intravenous cannulation, central pupils,
as well as patients’ movement during intravenous
cannulation and adverse effects were recorded and
compared.Results: Time to loss of eyelash reflex of PC group was
significantly longer than JR group (69.14±27.36 vs.
51.03±12.30 sec, respectively; p<0.05). No statistical
difference was found in time to intravenous cannulation,
central pupils, as well as patients’ movement during
intravenous cannulation and adverse effects between both
Conclusion: Sevoflurane induction time using PC system
was significantly, slightly longer than JR system (mean
difference 18.1 sec; 95% CI = 6.63-29.59 sec.). There is
no significant difference in time to intravenous cannulation
as well as patients’ movement during intravenous
cannulation and adverse effects. So clinical implement is

Article Details

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