title: Awakening properties of isoflurane, sevoflurane, and desflurane in pediatric patients after craniotomy for supratentorial tumours.
abstract: BACKGROUND
  The aim of this prospective, comparative, randomized study was to compare the inhalational anesthetics isoflurane, sevoflurane, and desflurane in pediatric patients undergoing craniotomy for excision of supratentorial tumors. We assessed early postoperative recovery outcome, intraoperative hemodynamics, and degree of brain swelling, as well as postoperative vomiting and shivering.
  
  
  METHODS
  Sixty patients scheduled for supratentorial brain tumor excision, were randomly allocated into 1 of 3 groups (20 patients each); isoflurane, sevoflurane, and desflurane group. After IV induction of anesthesia, maintenance was achieved using the inhalational anesthetic according to the allocated group. Tracheal extubation time was the primary endpoint. The secondary endpoints included: emergence time and the interval time needed to reach Aldrete score ≥9, intraoperative degree of brain swelling, intraoperative heart rate and mean arterial blood pressure, as well as postoperative vomiting and shivering.
  
  
  RESULTS
  The mean emergence time, extubation time, and the interval required to reach Aldrete score 9 were significantly shorter in the desflurane and sevoflurane groups than the isoflurane group. No statistically significant changes in the 3 groups regarding intraoperative brain swelling, hemodynamics, and postoperative shivering or vomiting were noted.
  
  
  CONCLUSIONS
  Desflurane and sevoflurane can be used to facilitate early emergence from anesthesia in neurosurgical pediatric patients. Emergence times are shorter with desflurane or sevoflurane than with isoflurane. The patients who received desflurane or sevoflurane have similar intraoperative and postoperative incidence of adverse effects compared with those who received isoflurane. Thus, desflurane and sevoflurane can be considered as suitable for emergence in pediatric neurosurgical anesthesia.
authors.affiliation: *Department of Anesthesia and Pain Management, National Cancer Institute †Department of Neurosurgery, Faculty of Medicine, Cairo University, Cairo, Egypt.
authors.forename: Ayman A
authors.initials: AA
authors.lastname: Ghoneim
authors.forename: Magda S
authors.initials: MS
authors.lastname: Azer
authors.forename: Hossam Z
authors.initials: HZ
authors.lastname: Ghobrial
authors.forename: Mohammed A
authors.initials: MA
authors.lastname: El Beltagy
mesh_terms: D000328:Adult; D000577:Amides / Q000493:pharmacokinetics; D000768:Anesthesia, General; D000772:Anesthesia, Local / Q000379:methods*; D018685:Anesthetics, Inhalation / Q000493:pharmacokinetics; D000779:Anesthetics, Local / Q000493:pharmacokinetics; D001794:Blood Pressure / Q000187:drug effects; D003399:Craniotomy / Q000379:methods*; D000077335:Desflurane; D004338:Drug Combinations; D005260:Female; D006339:Heart Rate / Q000187:drug effects; D006801:Humans; D007530:Isoflurane / Q000031:analogs & derivatives* / Q000493:pharmacokinetics; D008012:Lidocaine / Q000493:pharmacokinetics; D008297:Male; D008738:Methyl Ethers / Q000493:pharmacokinetics; D008875:Middle Aged; D009407:Nerve Block / Q000379:methods*; D010149:Postoperative Pain / Q000453:epidemiology; D000077212:Ropivacaine; D012535:Scalp; D000077149:Sevoflurane; D014851:Wakefulness
chemical_list: D000577:Amides; D018685:Anesthetics, Inhalation; D000779:Anesthetics, Local; D004338:Drug Combinations; D008738:Methyl Ethers; D000077149:Sevoflurane; D000077212:Ropivacaine; D008012:Lidocaine; D000077335:Desflurane; D007530:Isoflurane