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Halothane, enflurane and isoflurane anaesthesia for adenoidectomy in children, using two different premedications
Insights
Comparing anesthetic agents in children undergoing adenoidectomy, enflurane caused more airway issues than halothane or isoflurane. Diazepam, morphine, and scopolamine (DMS) premedication reduced airway reactions and stress hormone responses.
Area of Science:
- Pediatric Anesthesiology
- Pharmacology
Background:
- Adenoidectomy is a common pediatric surgical procedure.
- Anesthetic agents and premedication can influence patient outcomes.
Purpose of the Study:
- To compare airway issues, cardiovascular responses, and stress hormone reactions during halothane, enflurane, and isoflurane anesthesia in children undergoing adenoidectomy.
- To evaluate the effect of two different rectal premedication regimens on these parameters.
Main Methods:
- 48 children undergoing adenoidectomy were divided into groups receiving halothane, enflurane, or isoflurane.
- Two premedication regimens were used: diazepam and atropine (DA), or diazepam, morphine, and scopolamine (DMS).
- Airway events, heart rate, cardiac arrhythmias, ventilation, plasma ACTH, cortisol, and catecholamines were monitored.
Main Results:
- Enflurane was associated with more frequent airway problems compared to halothane and isoflurane.
- DMS premedication reduced airway reactions and stress hormone responses (ACTH, cortisol, catecholamines) across all anesthetic agents.
- Cardiac arrhythmias were less frequent with enflurane and isoflurane than with halothane.
Conclusions:
- Enflurane may lead to more airway complications in pediatric adenoidectomy compared to halothane and isoflurane.
- DMS premedication offers benefits in reducing airway reactivity and surgical stress response in pediatric anesthesia.
- Enflurane and isoflurane appear to have a more favorable cardiac arrhythmia profile than halothane in this context.
Abstract:
In 48 children subjected to adenoidectomy, comparisons of airway problems, heart rates, cardiac arrhythmias, ventilation and stress hormone reactions were studied during halothane, enflurane and isoflurane anaesthesia. Sixteen children were anaesthetized with either of the three agents and eight patients in each group received diazepam 0.25 mg kg-1 and atropine 0.015 mg kg-1 rectally (DA) as premedication and the remainder diazepam 0.5 mg kg-1, morphine 0.15 mg kg-1 and scopolamine 0.01 mg kg-1 (DMS) rectally. All children were intubated and breathing spontaneously. Equianaesthetic inspired concentrations of halothane, enflurane and isoflurane were used. Airway problems were of the same magnitude during halothane and isoflurane anaesthesia but were less frequent with both agents compared with enflurane anaesthesia. DMS reduced the number of airway reactions in all groups. Respiratory rates were uninfluenced by anaesthesia, intubation and surgery during enflurane anaesthesia. Cardiac arrhythmias were less frequent with enflurane and isoflurane than with halothane. Plasma ACTH and cortisol were similar with all three agents. During induction of anaesthesia in the DA-premedicated halothane group, however, plasma catecholamines were higher than in the group which received DMS, in contrast to the findings during enflurane and isoflurane anaesthesia. The DMS premedication decreased the response of plasma ACTH, cortisol and plasma catecholamines to surgery.