Comparison of cardiovascular changes during anaesthesia and recovery from propofol-alfentanil-nitrous oxide and thiopentone-halothane-nitrous oxide anaesthesia in children undergoing otolaryngological surgery.
Propofol/alfentanil anaesthesia was compared with thiopentone/halothane anaesthesia in 86 midazolam-atropine premedicated children undergoing minor otolaryngological surgery. The study was randomised, and evaluation of recovery from anaesthesia was double-blind. The children were divided into two age groups: 1-3 years and 4 years and older. Particular attention was paid to ECG changes during anaesthesia and to the rapidity of recovery. One minute after alfentanil 15 micrograms.kg-1, the children in the propofol group received propofol 2.0-3.0 mg.kg-1 followed by propofol infusion 15 mg.kg-1.h-1. In addition, 0.1% suxamethonium 6 mg.kg-1.h-1 was infused during operation. The other children received thiopentone 5-7 mg.kg-1 followed by halothane (0.5-2%) immediately after endotracheal intubation. Junctional rhythm occurred in 5-35% of the children independent of anaesthesia method, and ventricular ectopic beats were seen in 20% of the older children during halothane anaesthesia. Recovery with respect to times to eye opening or response to verbal contact was significantly faster after propofol/alfentanil anaesthesia than after thiopentone/halothane anaesthesia in the older but not in the younger age group. Furthermore, in the younger age group significantly more crying occurred after propofol/alfentanil than after thiopentone/halothane anaesthesia. On the basis of this study, thiopentone/halothane anaesthesia is recommended for children aged 1-3 years and propofol/alfentanil anaesthesia for older children undergoing adenoidectomy and/or tonsillectomy.
Hiller
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Department of Anaesthesia, Otolaryngological Hospital, Helsinki, Finland.
D015760:Alfentanil; D000758:Anesthesia; D001794:Blood Pressure / Q000502:physiology; D002648:Child; D002675:Child, Preschool; D004311:Double-Blind Method; D004562:Electrocardiography; D006221:Halothane; D006339:Heart Rate / Q000502:physiology; D006801:Humans; D007223:Infant; D009609:Nitrous Oxide; D010038:Otorhinolaryngologic Diseases / Q000453:epidemiology / Q000503:physiopathology / Q000601:surgery*; D015742:Propofol; D013874:Thiopental
D015760:Alfentanil; D013874:Thiopental; D009609:Nitrous Oxide; D006221:Halothane; D015742:Propofol