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A prospective, randomized clinical comparison of sevoflurane and halothane in children
A Villani1, P Zuccoli, C Rovella
1Department of Anaesthesia and Intensive Care, Ospedale del Bambin Gesù, Roma.
Insights
Sevoflurane offers faster recovery and better hemodynamic stability than halothane in pediatric anesthesia. This study suggests sevoflurane as a suitable alternative for halothane in children undergoing surgery.
Area of Science:
- Anesthesiology
- Pediatric Anesthesia
- Pharmacology
Background:
- Halothane has been a standard anesthetic agent in pediatric patients.
- Evaluating newer anesthetic agents like sevoflurane is crucial for improving patient outcomes.
- Multicenter studies are essential for robust comparisons of anesthetic agents.
Purpose of the Study:
- To prospectively compare the induction, maintenance, and recovery characteristics of halothane and sevoflurane in pediatric patients.
- To assess the safety and efficacy of sevoflurane versus halothane in pediatric anesthesia.
- To evaluate postoperative recovery times and hemodynamic stability between the two anesthetic agents.
Main Methods:
- A prospective, randomized multicenter study involving 64 children aged 3-12 years.
- Anesthesia was induced with either sevoflurane or halothane, with N2O in oxygen.
- Key recovery metrics and untoward events were recorded; serum creatinine and BUN were measured pre- and post-operatively.
Main Results:
- No significant differences were found in induction time, extubation time, or postoperative renal function between sevoflurane and halothane groups.
- Children receiving sevoflurane demonstrated significantly shorter times for purposeful movements, emergence from anesthesia, and readiness for discharge.
- Sevoflurane group exhibited more stable heart rates during induction compared to the halothane group.
Conclusions:
- Sevoflurane provides smooth and rapid induction, comparable to halothane.
- Recovery from sevoflurane anesthesia is considerably faster with better hemodynamic tolerance in pediatric patients.
- Sevoflurane presents a potentially useful and advantageous substitute for halothane in pediatric anesthesia.
Background:
The goal of the present multicenter investigation was to compare in a prospective and randomized study the induction, the maintenance and the recovery characteristics of halothane and sevoflurane when used in paediatric patients.
Methods:
With the approval of the Ethical Committee and the parental written informed consent, 64 children aged 3-12 years, receiving general anaesthesia for urological, abdominal, and orthopaedic surgery, were studied. After oral flunitrazepam (0.05 mg kg-1), general anaesthesia was randomly induced by either sevoflurane (start: 1%, maximum: 7%, n = 32) or halothane (start: 0.5%, maximum: 4.5%, n = 32) and a 60% N2O in oxygen mixture until the loss of eyelash reflex (induction time). Then the trachea was intubated (if necessary, a muscle relaxant was administrated), and the concentrations of the anaesthetic vapours were adjusted in order to maintain cardiovascular stability until the end of surgery. The following times were recorded: time of extubation, time for having purposeful movements, time of eyes opening and readiness for discharge from the recovery area, as well as the occurrence of untoward events during either induction of, maintenance of, or recovery from anaesthesia. Before surgery and 24 hr after the procedure, blood was collected in order to measure serum creatinine and BUN.
Results:
No differences in induction time, extubation time, side effects and postoperative renal function were observed between the two groups. Four patients in each group received muscle relaxants to perform intubation (p = NS). When compared to halothane group, children receiving sevoflurane had shorter times of showing purposeful movements (median: 9 min versus 15.5 min, p < 0.005), emergence from anaesthesia (median: 12 min versus 18 min, p < 0.05) and achieving readiness to be discharged (median: 18 min. versus 30 min, p < 0.005). Sevoflurane group also showed a more stable heart rate during the induction period than halothane one (p = 0.05).
Discussion:
Sevoflurane is as effective as halothane in providing smooth and rapid induction of anaesthesia, while recovery is considerably faster and haemodynamic tolerance is better if compared to halothane; this suggests that sevoflurane could be an useful substitute for halothane in pediatric patients.