Comparison of Emergence and Recovery Characteristics of Sevoflurane, Desflurane, and Halothane in Pediatric Ambulatory Patients

Abstract

This study compares the emergence and recovery characteristics of sevoflurane, desflurane, and halothane in children undergoing adenoidectomy with bilateral myringotomy and the insertion of tubes. Eighty children 1-7 yr of age were studied. Thirty minutes prior to the induction of anesthesia, all patients received 0.5 mg/kg midazolam orally. Patients were randomly assigned to one of four groups: Group 1, sevoflurane induction and maintenance (S:S); Group 2, halothane induction and sevoflurane maintenance (H:S); Group 3, halothane induction and maintenance (H:H); or Group 4, halothane induction and desflurane maintenance (H:D). Tracheal intubation was facilitated with the use of a single dose of 0.2 mg/kg mivacurium. A Mapelson D circuit was used, and all patients received N2O:O2 60:40 for induction and maintenance at standardized appropriate fresh gas flow. Ventilation was controlled to maintain normocapnia. End-tidal concentration of anesthetics was maintained at approximately 1.3 minimum alveolar anesthetic concentration (MAC) (halothane: 0.56; sevoflurane: 2.6; desflurane: 8.3) until the end of surgery when all anesthetics were discontinued. Emergence (extubation), recovery (Steward score 6), and discharge times were compared among patients in the four groups using analysis of variance and Newman-Keuls tests P < 0.05 was considered significant. There were no significant differences among the four groups with respect to age, weight, duration of surgery, or duration of anesthesia. Emergence and recovery from anesthesia were significantly faster in the desflurane group (Group 4) compared with the sevoflurane and halothane groups (Groups 1, 2, and 3) (5 +/- 1.6 min vs 11 +/- 3.7, 11 +/- 4.0, 10 +/- 4.0 min and 11 +/- 3.9 min vs 17 +/- 5.5, 19 +/- 7.1, 21 +/- 8.5 min, respectively). There was a significantly greater incidence of postoperative agitation and excitement in patients who received desflurane (55%) versus sevoflurane (10%) and halothane (25%). There were no significant differences among the four groups with respect to the time to meet home discharge criteria (134 +/- 36.9, 129 +/- 53.3, 117 +/- 64.6, 137 +/- 22.6 in Groups 1, 2, 3, and 4, respectively), in the time to drink oral fluids (139 +/- 31.6, 136 +/- 53.8, 123 +/- 65.0, 142 +/- 29.4 min, respectively), or in the incidence of postoperative vomiting. It is concluded that, although desflurane resulted in the fastest early emergence from anesthesia, it was associated with a greater incidence of postoperative agitation. Sevoflurane resulted in similar emergence and recovery compared with halothane. Desflurane and sevoflurane did not result in faster discharge times than halothane in this patient population.

Fentanyl-induced rigidity during emergence from general anesthesia potentiated by venlafexine

“…Desflurane has been associated with agitation upon emergence, significantly more so than sevoflurane, halothane, or propofol-remifentanil anesthesia. 6,7 Reported cases of agitation with desflurane have shown clear signs of emergence prior to agitation. Interestingly iv fentanyl 2.5 µg·kg -1 may prevent desflurane-induced agitation.…”

Agitação no despertar da anestesia em crianças: aspectos atuais

“…26 One of the hypotheses offered to explain this increased incidence of emergence agitation when sevoflurane is used, is the low solubility of this agent in blood, when compared with halothane, promoting earlier emergence from anesthesia and emergence agitation. 4,17 However, anesthesia with propofol also favors rapid emergence, but with lower agitation incidence rates than those observed with sevoflurane. 27 Furthermore, gradually reducing the concentration of sevoflurane, resulting in more prolonged emergence, did not result in a reduction in the incidence of agitation associated with this agent.…”

“…2 The difficulty with establishing etiology explains the major variation in the prevalence rates reported in the literature, which vary from 10 to 67. [3][4][5] Many studies have used different measurement scales and definitions, making it difficult to compare studies in terms of incidence rates, risk factors and techniques for the control and prevention of postoperative agitation.…”

Hyperpolarization-Activated Cyclic Nucleotide-Gated Channel Blocker ZD7288 Prevents Sevoflurane-Induced Hyperactivity in A Novel Mice Behavioral Model

“…Unfortunately, like other general anesthetics, sevoflurane, could also cause some side effects. Exciting behavior is a common side effect during sevoflurane induction and recovery, including epileptiform electroencephalographic activity and seizure like movements (1)(2)(3)(4)(5)(6)(7)(8). Some patients are also observed convulsions without epileptogenic EEG during sevoflurane induction (9).…”