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Comparative Effects of Total Intravenous Anesthesia with Propofol and Remifentanil Versus Inhalational Sevoflurane
Mohamed E Oriby1,2, Ayman Elrashidy3
1Department of Anesthesia and Surgical Intensive Care, Tanta University, Tanta, Egypt.
Insights
Emergence delirium (ED) was reduced with both sevoflurane and dexmedetomidine (DEX) or total intravenous anesthesia (TIVA) with remifentanil. TIVA with remifentanil showed lower postoperative nausea and vomiting (PONV) rates.
Area of Science:
- Anesthesiology
- Pediatric Surgery
Background:
- Emergence delirium (ED) is a frequent complication following strabismus surgery in children.
- Factors contributing to ED include visual disturbances, vomiting, and pain.
- Total intravenous anesthesia (TIVA) offers benefits such as smoother emergence, reduced postoperative nausea and vomiting (PONV), and improved analgesia.
Purpose of the Study:
- To compare the incidence of ED in pediatric patients undergoing strabismus surgery.
- To evaluate inhalational sevoflurane with dexmedetomidine (DEX) versus TIVA with remifentanil for ED prevention.
Main Methods:
- Eighty-four pediatric patients (3-11 years) were randomized into two groups.
- Group I received sevoflurane and DEX; Group II received TIVA with propofol and remifentanil.
- Hemodynamic parameters, pediatric anesthesia emergence delirium (PAED) scores, PONV, and recovery time were monitored.
Main Results:
- Dexmedetomidine infusion in Group I led to significant decreases in heart rate (HR) and mean arterial pressure (MAP).
- Group II (TIVA with remifentanil) exhibited a significantly lower incidence of PONV.
- Both anesthetic techniques resulted in a decreased incidence of emergence delirium, with Group I showing a shorter recovery time.
Conclusions:
- Both TIVA with propofol/remifentanil and sevoflurane/DEX anesthesia effectively reduce emergence delirium in pediatric strabismus surgery.
- Dexmedetomidine was associated with hypotension, bradycardia, and PONV.
- TIVA with remifentanil demonstrated a lower incidence of PONV compared to sevoflurane with DEX.
Background:
Emergence delirium (ED) is common after strabismus surgery due to postoperative visual disturbance, vomiting, and pain. Total intravenous anesthesia (TIVA) has many advantages like smooth emergence from anesthesia, decreased incidence of postoperative nausea and vomiting (PONV), and postoperative analgesia.
Objectives:
Our study aimed to compare the incidence of ED using inhalational sevoflurane with dexmedetomidine (DEX) versus TIVA with remifentanil.
Methods:
Eighty-four patients aged 3 - 11 years scheduled for strabismus surgery under general anesthesia were randomly allocated into two groups. Patients in group I received sevoflurane and DEX (group I, n = 42), while group II patients received TIVA with propofol and remifentanil infusion (group II, n = 42). Mean arterial pressure (MAP), heart rate (HR), and pulse oximetry (SpO2) were monitored before induction, at induction, and every 10 minutes during the surgery. In the postanesthetic care unit (PACU), pediatric anesthesia emergence delirium (PAED), face, legs, activity, cry, and consolability (FLACC), need for rescue analgesics, recovery time, level of parents' satisfaction, and PONV were recorded.
Results:
Based on the results, HR and MAP significantly decreased 10 and 20 min after induction compared to baseline in group I after infusion of DEX. The incidence of PONV was significantly lower in group II than in group I, while the recovery time was significantly shorter in group I. The incidence of emergence delirium decreased in both groups.
Conclusions:
The use of either total intravenous anesthesia with propofol and remifentanil or sevoflurane inhalational anesthesia with dexmedetomidine resulted in a lower incidence of emergence delirium, although dexmedetomidine resulted in hypotension, bradycardia, and PONV.
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