Sevoflurane in paediatric anaesthesia: a review

Sevoflurane is an ether inhalation anaesthetic agent with low pungency, a non-irritant odour and a low blood: gas partition coefficient. It can be rapidly and conveniently administered without discomfort, and its low solubility facilitates precise control over the depth of anaesthesia and a rapid and smooth induction of, and emergence from, general anaesthesia. As an induction and maintenance agent for ambulatory and nonambulatory surgery in children, sevoflurane provides more rapid induction of, and emergence from, anaesthesia than halothane, and has similar or better patient acceptability. Time to discharge from the recovery area is usually at least as fast with sevoflurane as with halothane. While rapid emergence from sevoflurane lessens the time spent under anaesthesia, postoperative pain may be more intense and occur earlier than during more gradual emergence. Sevoflurane has been used successfully as an induction agent for tracheal intubation and laryngeal mask airway (LMA) insertion: time to LMA insertion is faster with sevoflurane than halothane, but the 2 drugs provide similar conditions for tracheal intubation. The pattern and incidence of induction and emergence events such as cough, laryngospasm and agitation/excitement is similar with sevoflurane and halothane; however, sevoflurane may cause less postoperative nausea and vomiting. At present, differences have not been consistently shown between the 2 drugs in their propensity to cause postoperative excitement or agitation. Compared with halothane, sevoflurane has low potential for arrhythmogenicity. Clinical experience does not substantiate concerns over the potential nephrotoxicity of the sevoflurane byproducts pentafluoroisopropenyl fluoromethyl ether ('Compound A') and plasma F- ions; no renal impairment has been documented in children receiving sevoflurane in clinical trials. The potential for sevoflurane hepatotoxicity also appears negligible. There are few trials comparing sevoflurane with agents other than halothane in paediatric anaesthesia. As well, pharmacoeconomic analyses are scarce and incompletely published; further studies are needed to determine whether shortened times to emergence will translate into cost savings.

Sevoflurane is a preferred anaesthetic agent for induction and maintenance of paediatric anaesthesia because of its rapid induction and recovery characteristics, lack of pungency and agreeable odour, and acceptable cardiovascular profile. Although the issue of postoperative excitement requires clarification, sevoflurane anaesthesia can be considered a rational choice for ambulatory and nonambulatory surgery in children.