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Complications of sevoflurane-fentanyl versus midazolam-fentanyl anesthesia in pediatric cleft lip and palate surgery:

M Milić1, T Goranović, P Knezević

  • 1Department of Anesthesiology, Reanimatology and Intensive Care Medicine, Dubrava University Hospital, Zagreb, Croatia.

International Journal of Oral and Maxillofacial Surgery
|October 27, 2009
PubMed

Insights

Midazolam-fentanyl anesthesia is safer for pediatric cleft lip and palate repair than sevoflurane-fentanyl anesthesia, significantly reducing emergence agitation in children. This finding aids in selecting optimal anesthetic agents for pediatric surgical procedures.

Area of Science:

  • Pediatric Anesthesiology
  • Surgical Complication Reduction

Background:

  • Anesthetic agent selection is crucial for minimizing anesthesia-related complications in pediatric patients.
  • Cleft lip and palate repair surgeries require careful anesthetic management in children.

Purpose of the Study:

  • To compare intraoperative and postoperative complications between sevoflurane-fentanyl and midazolam-fentanyl anesthesia in pediatric patients undergoing cleft lip and palate repair.
  • To determine the safer anesthetic approach regarding specific complications like emergence agitation.

Main Methods:

  • A comparative study involving 140 pediatric patients (3 months to 10 years) undergoing cleft lip and palate repair.
  • Two anesthesia regimens were used: midazolam-fentanyl and sevoflurane-fentanyl, with detailed protocols for induction and maintenance.
  • Complications including difficult intubation, arrhythmias, bronchospasm, emergence agitation, and postoperative nausea/vomiting were recorded and compared.

Main Results:

  • No significant difference was found in difficult intubation rates between the two groups (P=0.754).
  • The sevoflurane-fentanyl group experienced isolated cases of ventricular extrasystole and bronchospasm.
  • Emergence agitation was significantly more frequent in the sevoflurane-fentanyl group (17 cases) compared to the midazolam-fentanyl group (P<0.001).

Conclusions:

  • Midazolam-based anesthesia demonstrated a superior safety profile compared to sevoflurane-based anesthesia in pediatric patients undergoing cleft lip and palate repair, specifically concerning emergence agitation.
  • The choice of anesthetic agent can significantly impact postoperative recovery, highlighting the importance of agent selection in pediatric anesthesia.

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