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Cardiac arrhythmias in children during outpatient general anaesthesia for dentistry: a prospective randomised trial
M R Blayney1, A F Malins, G M Cooper
1Featherstone Department of Anaesthesia and Intensive Care, Queen Elizabeth Hospital, Edgbaston, Birmingham, UK.
Insights
Halothane anesthesia in children undergoing dental procedures is linked to dangerous ventricular arrhythmias. Sevoflurane is a safer alternative, potentially reducing deaths associated with dental anesthesia.
Area of Science:
- Pediatric Anesthesiology
- Cardiovascular Safety in Children
- Dental Anesthesia Research
Background:
- Outpatient general dental anesthesia in children has been linked to cardiovascular collapse.
- Ventricular arrhythmias are suspected as a cause of sudden deaths.
- A potential link between halothane anesthesia and these events has been proposed.
Purpose of the Study:
- To compare the frequency and type of cardiac arrhythmias during dental anesthesia.
- To investigate the safety of halothane versus sevoflurane in pediatric dental procedures.
Main Methods:
- A prospective, randomized trial involving 150 children aged 3-15 years undergoing dental extraction.
- Children were assigned to receive either halothane or sevoflurane with nitrous oxide and spontaneous ventilation.
- Different administration protocols for sevoflurane were used and compared.
Main Results:
- 48% of children receiving halothane experienced arrhythmias, primarily ventricular.
- Only 8% of children receiving incremental sevoflurane had arrhythmias, mainly supraventricular.
- Ventricular tachycardia occurred in 12% of the halothane group.
Conclusions:
- Halothane is strongly associated with ventricular arrhythmias, including ventricular tachycardia, in children during dental anesthesia.
- Sevoflurane appears to be a safer anesthetic agent in this context.
- Switching to sevoflurane could decrease complications and mortality in pediatric dental anesthesia.
Background:
Deaths in children associated with outpatient general dental anaesthesia may be attributable to sudden cardiovascular collapse precipitated by ventricular arrhythmias. A causal link between halothane anaesthesia, ventricular arrhythmias, and deaths has been suggested. We did a prospective, randomised trial to investigate the frequency and character of arrhythmias during anaesthesia with halothane and the alternative anaesthetic agent, sevoflurane.
Methods:
150 children, aged 3-15 years, who needed dental extraction under general anaesthesia were randomly assigned sevoflurane or halothane supplementation of 66% nitrous oxide in oxygen with spontaneous ventilation. The halothane group (n=50) received halothane introduced in 0.75% increments, every two to three breaths, to a maximum of 3.0%, with maintenance at 1.5%. The incremental sevoflurane group (n=50) received sevoflurane introduced in 2% increments increased to a maximum of 8%, with maintenance at 4%. The 8% sevoflurane group (n=50) received sevoflurane introduced at 8%, with maintenance at 4%.
Findings:
24 (48%) children receiving halothane had arrhythmias compared with four (8%) receiving incremental sevoflurane (difference 40% [95% Ci for differences 24-56] p<0.0001), and eight (16%) receiving 8% sevoflurane (difference 32% [15-50] p=0.0013). Halothane-associated arrhythmias occurred during dental extraction or emergence and were mainly ventricular. Six (12%) children in the halothane group had ventricular tachycardia. The methods of sevoflurane administration did not differ significantly for the frequency of arrhythmias (p=0.357). Sevoflurane-associated arrhythmias were mainly single supraventricular ectopic beats.
Interpretation:
There was a strong association between halothane and ventricular arrhythmias, especially ventricular tachycardia. The use of sevoflurane in preference to halothane could contribute to a decline in morbidity and mortality associated with dental anaesthesia.
