Quality of recovery in children: sevoflurane versus propofol.
BACKGROUND
Sevoflurane, with its low pungency and low blood and tissue solubility, is an attractive anaesthetic in paediatric outpatient surgery. Propofol-anaesthesia is recognised for its rapid and clear-headed emergence. This study was designed to compare emergence and recovery characteristics of sevoflurane and propofol anaesthesia for tonsillectomy in children.


METHODS
Children aged 3-10 years, undergoing elective tonsillectomy, were randomly assigned to receive propofol (n=25, induction with 3 mg x kg(-1), maintenance with 100-250 microg x kg(-1) min(-1)) or sevoflurane anaesthesia (n=25, induction 7 vol.%, maintenance 2-3 vol.%). Tracheal intubation was performed with alfentanil 20 microg x kg(-1) and atracurium 0.5 mg x kg(-1). Ventilation was controlled to maintain normocapnia and all patients received N2O/O2 (60:40 vol.%) for induction and maintenance of anaesthesia. At the end of surgery infiltration of the operative sites with bupivacaine 2 mg x kg(-1) was provided for postoperative analgesia. Emergence, recovery, discharge times, and incidence of side effects were compared between the two groups.


RESULTS
Time to extubation (14 vs 15 min), time to response to simple verbal command (21 vs 21 min) and time to discharge from the recovery room (45 vs 50 min) were similar in the sevoflurane and propofol groups, respectively. There was a significantly greater incidence of postoperative agitation in the sevoflurane group (46%) compared with the propofol group (9%) (P=0.008). This did not, however, delay discharge from the recovery room. The incidence of nausea and vomiting was not significantly different (8% vs 0%; P=0.49).


CONCLUSIONS
In children, recovery from anaesthesia with sevoflurane results in a higher incidence of agitation compared with propofol.
Picard
V
V
Department of Anaesthesiology, Pharmacology and Surgical Intensive Care, Geneva University Hospital, Switzerland. valerie.picard@hcuge.ch
Dumont
L
L
Pellegrini
M
M
D000777:Anesthetics / Q000494:pharmacology*; D002648:Child; D002675:Child, Preschool; D005260:Female; D006801:Humans; D008297:Male; D008738:Methyl Ethers / Q000009:adverse effects / Q000494:pharmacology*; D015742:Propofol / Q000009:adverse effects / Q000494:pharmacology*; D011595:Psychomotor Agitation / Q000209:etiology; D000077149:Sevoflurane; D013997:Time Factors; D014068:Tonsillectomy
D000777:Anesthetics; D008738:Methyl Ethers; D000077149:Sevoflurane; D015742:Propofol