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Emergence characteristics of sevoflurane compared to halothane in pediatric patients undergoing bilateral pressure
J P Cravero1, M Beach, C P Dodge
1Dartmouth Hitchcock Medical Center, Department of Anesthesia, Lebanon, NH 03756, USA.
Study Objective:
To compare the emergence characteristics of sevoflurane with halothane in pediatric patients having bilateral myringotomy and pressure equalization tube insertion using a highly standardized and common anesthetic technique.
Design:
Prospective, randomized, double-blind study.
Setting:
University hospital.
Patients:
43 ASA physical status I and II healthy pediatric outpatients scheduled for initial ear tube placement by one surgeon.
Interventions:
Patients were randomized to receive either halothane or sevoflurane as their sole anesthetic drug for ear tube insertion. All patients as well as the research nurse grading emergence agitation were blinded to group assignment. No premedication was administered, and all patients received a standard dose of rectal acetaminophen for postoperative pain control.
Measurement And Main Results:
The primary outcome was the percentage of patients with emergence agitation, defined as thrashing behavior requiring physical restraint for greater than three minutes. Time to discharge from the postanesthesia care unit (PACU) and from the hospital were also compared. Sevoflurane patients had a greater incidence of emergence delirium: 57% versus 27% [95% CI (1.7%-58.1%) p = 0.047]. Time to discharge from the PACU and the hospital were longer for patients who received sevoflurane: 62 versus 50 min [95% CI (1.4-23.6) p = 0.02] and 102 versus 79 mins [95% CI (9.6-37.1) p = 0.003].
Conclusion:
In our institution there is a trend toward greater emergence agitation in ear tube placement patients given sevoflurane versus halothane anesthesia. Further, (with our discharge criteria) patients are actually discharged from the PACU and the hospital faster when given halothane as a sole anesthetic when compared to sevoflurane.