Complications of sevoflurane-fentanyl versus midazolam-fentanyl anesthesia in pediatric cleft lip and palate surgery: a randomized comparison study.
Careful choice of anesthetic agents in pediatric patients reduces the frequency of anesthesia-related complications. The frequency and type of intraoperative and postoperative complications of sevoflurane-fentanyl versus midazolam-fentanyl anesthesia were compared in 140 consecutive children (aged 3 months to 10 years) undergoing cleft lip and palate repair. Midazolam-fentanyl anesthesia was induced with midazolam (0.05 mg/kg), fentanyl (0.005 mg/kg) and vecuronium (0.1mg/kg), and maintained with the same agents according to the defined parametars. Sevoflurane-fentanyl anesthesia was induced and maintained with sevoflurane (5-8 vol% and 0.8-1 vol%, respectively) in an oxygen/air mixture and supplemented with fentanyl (0.005 mg/kg). Both groups were comparable in basic demographic data, hemodynamic and respiratory parameters. Difficult intubation occurred in 6 of 76 children (midazolam-fentanyl group) and 4 of 64 children (sevoflurane-fentanyl group) (P=0.754). Ventricular extrasystole and bronchospasm occurred in one patient each in the sevoflurane-fentanyl group. Postoperatively, emergence agitation was observed in the sevoflurane-fentanyl group (17 cases; P<0.001); postoperative nausea and vomiting occurred in 2 children (midazolam-fentanyl group) and 3 children (sevoflurane-fentanyl group) (P=0.660). Midazolam-based anesthesia in children is safer than sevoflurane-based anesthesia regarding occurrence of emergence agitation.
Milić
M
M
Department of Anesthesiology, Reanimatology and Intensive Care Medicine, Dubrava University Hospital, Zagreb, Croatia.
Goranović
T
T
Knezević
P
P
D000762:Anesthesia Recovery Period; D019162:Anesthetics, Combined / Q000008:administration & dosage*; D018685:Anesthetics, Inhalation / Q000008:administration & dosage*; D018686:Anesthetics, Intravenous / Q000008:administration & dosage*; D001986:Bronchial Spasm / Q000209:etiology; D002648:Child; D002675:Child, Preschool; D002971:Cleft Lip / Q000601:surgery*; D002972:Cleft Palate / Q000601:surgery*; D005260:Female; D005283:Fentanyl / Q000008:administration & dosage*; D006801:Humans; D006993:Hypnotics and Sedatives / Q000008:administration & dosage; D007223:Infant; D007431:Intraoperative Complications; D007442:Intubation, Intratracheal; D008297:Male; D008738:Methyl Ethers / Q000008:administration & dosage*; D008874:Midazolam / Q000008:administration & dosage*; D003473:Neuromuscular Nondepolarizing Agents / Q000008:administration & dosage; D010149:Postoperative Pain / Q000209:etiology; D020250:Postoperative Nausea and Vomiting / Q000209:etiology; D011229:Preanesthetic Medication; D011595:Psychomotor Agitation / Q000209:etiology; D000077149:Sevoflurane; D013997:Time Factors; D014673:Vecuronium Bromide / Q000008:administration & dosage; D018879:Ventricular Premature Complexes / Q000209:etiology
D019162:Anesthetics, Combined; D018685:Anesthetics, Inhalation; D018686:Anesthetics, Intravenous; D006993:Hypnotics and Sedatives; D008738:Methyl Ethers; D003473:Neuromuscular Nondepolarizing Agents; D000077149:Sevoflurane; D014673:Vecuronium Bromide; D008874:Midazolam; D005283:Fentanyl