Sevoflurane in paediatric anaesthesia: a review

Area of Science:

• Anesthesiology
• Pediatric Anesthesia
• Pharmacology

Background:

• Sevoflurane is an ether inhalation anesthetic agent known for low pungency and minimal irritation.
• Its low blood:gas partition coefficient allows for precise control over anesthetic depth and rapid emergence.
• Current anesthetic options for pediatric surgery present varying profiles in terms of induction, recovery, and side effects.

Purpose of the Study:

• To evaluate sevoflurane as an anesthetic agent for induction and maintenance in pediatric surgery.
• To compare sevoflurane's efficacy and safety profile against halothane in pediatric patients.
• To assess sevoflurane's suitability for both ambulatory and non-ambulatory surgical procedures in children.

Main Methods:

• Review of clinical trials and existing literature comparing sevoflurane with halothane in pediatric anesthesia.
• Assessment of induction and emergence characteristics, including time to intubation and laryngeal mask airway insertion.
• Evaluation of patient acceptability, postoperative side effects (nausea, vomiting, excitement), and cardiovascular safety.

Main Results:

• Sevoflurane demonstrates more rapid induction and emergence compared to halothane in pediatric patients.
• Patient acceptability and recovery times are similar or improved with sevoflurane.
• Sevoflurane shows a low potential for arrhythmogenicity and no documented renal or hepatic impairment in clinical trials.

Conclusions:

• Sevoflurane is a preferred anesthetic agent for pediatric anesthesia due to its rapid onset/offset, favorable sensory profile, and cardiovascular stability.
• It is a rational choice for ambulatory and non-ambulatory pediatric surgery, despite the need for further clarification on postoperative excitement.
• Further pharmacoeconomic studies are needed to confirm cost-effectiveness associated with shortened emergence times.