Maintenance and recovery characteristics after sevoflurane or propofol during ambulatory surgery in children with epidural blockade

Abstract

Mark Levine MB FRCPCPurpose: To compare the maintenance and recovery characteristics after sevoflurane with those after propofol in children with epidural blockade. Methods: F~cy unpremedicated, children ASA I-II, 2 -8 yr of age, scheduled for elective urological surgery as outpatients, were randomly allocated to receive either: I) sevoflurane for induction and maintenance of anaesthesia or 2) propofol for induction (2-3 mgkg -~ iv) and for maintenance (5-I0 mg-kg -t-hr -l iv). All children received N20 70% in oxygen before induction and throughout the anaesthetic, rocuronium for neuromuscular blockade and a lumbar or caudal epidural block before incision. Heart rate (HR), systolic blood pressure (SBP), recovery times and all side effects during maintenance and recovery were recorded by a blinded observer. Adverse events during the first 24 hr were also recorded. Results: Mean HR increased 5-10% after induction in both groups reaching a maximum by five minutes. Heart rate returned to baseline by skin incision in the sevoflurane group and by I0 min after induction in the propofol group. During maintenance, HR decreased by 10-20% below baseline values by 20 min in the propofol group only, where it remained for the remainder of the anaesthetic. Similarly, SBP increased by 10% after induction of anaesthesia in both groups, but returned to baseline by I 0 min. Light anaesthesia occurred in four (16%) children, all in the propofol group. Emergence and recovery indices were similar in the two groups. Discussion: Sevoflurane and propofol exhibit similar maintenance and recovery profiles when combined with epidural analgesia in children undergoing ambulatory surgery. Objectif : Comparer les caract~ristiques du maintien et de la r&up~ration de l'anesth&ie apt& l'administration de s~voflurane avec celles de l'anesth&ie apr~s le propofol chez des enfants qui ont subi un blocage p~ridural. M~thode : Cinquante enfants ASA I-II, ~g~s de 2 ~ 8 ans, qui n'ont re~u aucune premeditation, devaient subir une chirurgie urologique ~lective ambulatoire et ont ~t~ r~partis au hasard pour recevoir soit : I) du s~voflurane pour rinduction et le maintien de l'anesth&ie, ou 2) du propofol pour rinduction (2-3 mg'kg "~ iv) et de I'anesth&~e, du rocuronrum pour le blocage neuromuscula~re et une anestheste p~ndurale Iomba~re ou caudale avant rincision. La fr~quence cardiaque (FC), la tension art&ielle systolique (TAS), le moment de la r&up&ation et tousles effets secondaires pendant le maintien et la r&up~ration de I'anesth&ie ont ~t~ enregistr& par un observateur impartial. On a aussi not~ les &~nements ind~sirables pendant les 24 prerni~res h. R6,sultats : La FC moyenne a augment~ de 5-I 0 % apr& I'induction de I'anesth&ie dans les deux groupes eta atteint sa valeur maximale en cinq minutes. Elle est revenue ~ sa valeur de base Iors de rincision cutan& darts le groupe s~voflurane et en dix minutes apr& rinduction darts le groupe propofol. Pendant le maintien de ranesth&ie, la FC a diminu~ de 10-20 % sous sa valeur de base en 20 min dans le...

Rapid emergence does not explain agitation following sevoflurane anaesthesia in infants and children: a comparison with propofol

“…Significantly higher subjective and observational pain scores in children receiving sevoflurane have been reported in numerous studies. This has been observed in children who have had regional block (2,3,20,21) and in those who have undergone noninvasive procedures (12). This may reflect the effect of severe agitation on scoring pain on a behaviour pain scale.…”

Sevoflurane in Paediatric Anaesthesia

“…Data from 2 small studies (1 published only as an abstract) indicate similar times to recovery from anaesthesia for sevoflurane compared with intravenous propofol in children undergoing tonsillectomy [78] or urological surgery [77] (table III) [quantitative data on induction were not reported]. …”

Respiratory and hemodynamic perioperative adverse events in intravenous versus inhalational induction in pediatric anesthesia: A systematic review and meta‐analysis

“…In the study by Guard et al, 11 when comparing the sevoflurane group (both for induction and maintenance) and propofol group (induction and maintenance), no significant difference in coughing was found (RR 0.92, 95% CI 0.50‐1.67). Laryngospasm occurred twice in the sevoflurane group but did not occur in the propofol group; therefore, the relative risk could not be calculated.…”

“…The study results are outlined in Table 3. Two studies showed no significant difference in hemodynamic or respiratory adverse events 9,11 . Hasani et al 9 showed no difference between groups in coughing, hypotension, bradycardia, and laryngospasm.…”

“…No relevant manuscripts were found through reference checking. Five RCT's were included in the critical appraisal 2,8‐11 . Table S3 shows the articles excluded after full‐text screening.…”