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Respiratory reflex responses of the larynx differ between sevoflurane and propofol in pediatric patients

Christine Oberer1, Britta S von Ungern-Sternberg, Franz J Frei

  • 1Division of Anesthesiology, University Children's Hospital beider Basel, 8 Roemergasse, CH-4058 Basel, Switzerland.

Anesthesiology
|November 25, 2005
PubMed

Insights

Sevoflurane anesthesia in children aged 2-6 years led to more frequent apnea with laryngospasm compared to propofol. Laryngeal reflex responses differed between the two anesthetics, regardless of hypnosis level.

Area of Science:

  • Anesthesiology
  • Pediatric Anesthesia
  • Airway Management

Background:

  • Airway protective reflexes in children under anesthesia are not well understood.
  • Comparing sevoflurane and propofol effects on laryngeal reflexes is crucial for pediatric anesthesia.
  • Hypnosis levels, measured by Bispectral Index (BIS), may influence these reflexes.

Purpose of the Study:

  • To compare laryngeal reflex responses in children receiving sevoflurane versus propofol.
  • To investigate the impact of two hypnosis levels (BIS 40-50 and BIS 60-70) on these reflexes.
  • To determine if anesthetic choice affects apnea and laryngospasm incidence.

Main Methods:

  • Seventy children (2-6 years) undergoing elective surgery were studied.
  • Random allocation to sevoflurane or propofol anesthesia while breathing spontaneously.
  • Laryngeal stimulation with water spray assessed reflex responses, with outcomes evaluated by a blinded reviewer.

Main Results:

  • Apnea with laryngospasm was significantly more frequent with sevoflurane than propofol (P < 0.04 at BIS 40, P < 0.01 at BIS 60).
  • Cough and expiration reflexes were more frequent with propofol.
  • These differences were independent of the hypnosis levels achieved (BIS 40-50 vs. 60-70).

Conclusions:

  • Sevoflurane and propofol induce different laryngeal and respiratory reflex responses in young children.
  • Anesthetic choice impacts airway protective reflexes in pediatric patients.
  • Hypnosis level did not alter the observed differences in reflex responses between sevoflurane and propofol.
Abstract

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