Emergence characteristics of sevoflurane compared to halothane in pediatric patients undergoing bilateral pressure equalization tube insertion.
OBJECTIVE
To compare the emergence characteristics of sevoflurane with halothane in pediatric patients having bilateral myringotomy and pressure equalization tube insertion using a highly standardized and common anesthetic technique.


METHODS
Prospective, randomized, double-blind study.


METHODS
University hospital.


METHODS
43 ASA physical status I and II healthy pediatric outpatients scheduled for initial ear tube placement by one surgeon.


METHODS
Patients were randomized to receive either halothane or sevoflurane as their sole anesthetic drug for ear tube insertion. All patients as well as the research nurse grading emergence agitation were blinded to group assignment. No premedication was administered, and all patients received a standard dose of rectal acetaminophen for postoperative pain control.


RESULTS
The primary outcome was the percentage of patients with emergence agitation, defined as thrashing behavior requiring physical restraint for greater than three minutes. Time to discharge from the postanesthesia care unit (PACU) and from the hospital were also compared. Sevoflurane patients had a greater incidence of emergence delirium: 57% versus 27% [95% CI (1.7%-58.1%) p = 0.047]. Time to discharge from the PACU and the hospital were longer for patients who received sevoflurane: 62 versus 50 min [95% CI (1.4-23.6) p = 0.02] and 102 versus 79 mins [95% CI (9.6-37.1) p = 0.003].


CONCLUSIONS
In our institution there is a trend toward greater emergence agitation in ear tube placement patients given sevoflurane versus halothane anesthesia. Further, (with our discharge criteria) patients are actually discharged from the PACU and the hospital faster when given halothane as a sole anesthetic when compared to sevoflurane.
Cravero
J P
JP
Dartmouth Hitchcock Medical Center, Department of Anesthesia, Lebanon, NH 03756, USA.
Beach
M
M
Dodge
C P
CP
Whalen
K
K
D000769:Anesthesia, Inhalation; D018685:Anesthetics, Inhalation; D002675:Child, Preschool; D004311:Double-Blind Method; D005260:Female; D006221:Halothane; D006439:Hemodynamics; D006801:Humans; D017214:Laryngeal Masks; D008297:Male; D008738:Methyl Ethers; D009225:Myringoplasty; D011183:Postoperative Complications / Q000139:chemically induced / Q000523:psychology; D020250:Postoperative Nausea and Vomiting / Q000139:chemically induced; D011312:Pressure; D011595:Psychomotor Agitation; D012044:Regression Analysis; D000077149:Sevoflurane; D014432:Tympanic Membrane / Q000601:surgery
D018685:Anesthetics, Inhalation; D008738:Methyl Ethers; D000077149:Sevoflurane; D006221:Halothane