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Sevoflurane causes more postoperative agitation in children than does halothane
1Department of Anesthesia and Intensive Care, University Hospital, Lund, Sweden.
Insights
Sevoflurane anesthesia resulted in faster recovery than halothane in children. However, sevoflurane was associated with increased agitation, particularly in younger children, though pain was not correlated.
Area of Science:
- Anesthesiology
- Pediatric Anesthesia
Background:
- Post-anesthesia agitated recovery is a concern in pediatric patients.
- Inhalation anesthesia quality varies between agents.
Purpose of the Study:
- To compare recovery quality after mask anesthesia using halothane versus sevoflurane in children.
- To assess agitation, pain, and vomiting incidence post-anesthesia.
Main Methods:
- Sixty-two pediatric patients (8 months-18 years) received halothane or sevoflurane via face mask.
- Recovery was evaluated by a blinded observer using a postanesthetic recovery score.
- Agitation and pain were measured using visual analog scales; vomiting and hospital stay were noted.
Main Results:
- Recovery was significantly faster with sevoflurane (25 min to eye opening) compared to halothane (48 min).
- Agitation occurred more frequently with sevoflurane (P < 0.05), especially in younger children, but pain incidence was similar.
- No differences were observed in surgery duration, gas exposure, or hospital stay.
Conclusions:
- Sevoflurane facilitates faster early postanesthetic recovery compared to halothane in pediatric mask anesthesia.
- Increased agitation post-sevoflurane anesthesia is noted, particularly in younger children, independent of pain levels.
Background:
An agitated recovery may occur after inhalation anesthesia. The aim of the present study was to assess the recovery quality after mask anesthesia with either halothane or sevoflurane in children.
Methods:
Sixty-two children, 8 months to 18 years of age, scheduled for minor surgery, were randomly assigned to receive either halothane or sevoflurane. The patients were premedicated with midazolam and anesthesia was induced i.v. with propofol or by inhalation and maintained with halothane or sevoflurane in N2O/O2 via face mask. Recovery was assessed by a "blinded" observer using a postanesthetic recovery score. Agitation and pain were judged using a visual analog scale. The incidence of vomiting was noted. The day after anesthesia older children and parents of younger children were interviewed about their experience of the anesthesia and recovery period.
Results:
There were no differences between groups in respect of age, weight, length, or duration of surgery or inhalational gas exposure. Median time from end of administration of inhalational agent to spontaneous eye opening was less after sevoflurane (25 min) than after halothane (48 min), (P < 0.01). Likewise, recovery was faster after sevoflurane anesthesia (P < 0.05). Agitation, but not pain, occurred more frequently after sevoflurane than after halothane (P < 0.05) and agitation was significantly more common in younger children. There was no difference in duration of hospital stay between day-care patients in the two groups.
Conclusion:
Early postanesthetic agitation and recovery was faster after mask anesthesia with sevoflurane than after halothane. There was a higher incidence of agitation in younger children, without correlation to pain.