Rapid emergence does not explain agitation following sevoflurane anaesthesia in infants and children: a comparison with propofol.
BACKGROUND
Emergence agitation in children is frequently associated with the use of the new highly insoluble volatile anaesthetics. Rapid emergence has been cited as one of the possible causes. Propofol also permits rapid emergence from general anaesthesia but is not associated with agitation.


METHODS
The emergence characteristics of children receiving sevoflurane and propofol anaesthesia were examined. After induction with sevoflurane, 53 children, aged 2-36 months, who were undergoing ambulatory surgery, were randomized to receive maintenance anaesthesia with either sevoflurane or propofol. Introperative analgesia with either 2 micro g x kg-1 of intravenous fentanyl or a caudal block with 0.25% bupivacaine was supplied according to surgical procedure. An observer blinded to anaesthetic technique recorded the time to achieve extubation and recovery and assessed emergence behaviour. Data were analysed using Wilcoxon scores, Kruskal-Wallis test, chi-square and multiple regression analysis.


RESULTS
The results showed that the time to extubation and recovery were similar between the two study groups, but that emergence agitation was significantly higher in the sevoflurane group compared with the propofol group. No relationship between analgesic technique and agitation scores was found.


CONCLUSIONS
Although both sevoflurane and propofol allow for rapid emergence from general anaesthesia, only sevoflurane is associated with a high incidence of emergence agitation in infants and young children. Rapid emergence does not fully explain this phenomena.
Cohen
Ira Todd
IT
Department of Anesthesiology, Children's National Medical Center, Washington, DC 20010, USA. icohen@cnmc.org
Finkel
Julia C
JC
Hannallah
Raafat S
RS
Hummer
Kelly A
KA
Patel
Kantilal M
KM
D000762:Anesthesia Recovery Period; D000768:Anesthesia, General; D018685:Anesthetics, Inhalation / Q000009:adverse effects; D018686:Anesthetics, Intravenous / Q000009:adverse effects; D002675:Child, Preschool; D006801:Humans; D007223:Infant; D008738:Methyl Ethers / Q000009:adverse effects; D015742:Propofol / Q000009:adverse effects; D011595:Psychomotor Agitation / Q000209:etiology*; D000077149:Sevoflurane
D018685:Anesthetics, Inhalation; D018686:Anesthetics, Intravenous; D008738:Methyl Ethers; D000077149:Sevoflurane; D015742:Propofol