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Recovery after propofol infusion anaesthesia in children: comparison with propofol, thiopentone or halothane
C S Aun1, T G Short, M E O'Meara
1Department of Anaesthesia and Intensive Care, Faculty of Medicine, Chinese University of Hong Kong, Shatin.
Insights
Propofol infusion resulted in slower recovery for Chinese children after general anesthesia compared to bolus propofol, thiopentone, or halothane. The choice among the latter three anesthetic techniques did not significantly impact recovery times.
Area of Science:
- Anesthesiology
- Pediatric Surgery
- Pharmacology
Background:
- General anesthesia is commonly used for minor surgical procedures in children.
- Choosing the optimal anesthetic agent and technique is crucial for ensuring rapid and safe recovery.
- Previous studies have yielded mixed results regarding the recovery profiles of different anesthetic agents in pediatric populations.
Purpose of the Study:
- To compare the recovery profiles of four different anesthetic techniques in healthy Chinese children undergoing minor surgery.
- To evaluate the time to achieve specific recovery milestones, including full Steward score, eye opening, orientation, and puzzle completion.
Main Methods:
- A randomized controlled trial involving 163 healthy Chinese children.
- Four anesthetic groups: propofol infusion, propofol bolus, thiopentone, and halothane.
- All patients received nitrous oxide/oxygen mixture, laryngeal mask airway, and regional anesthetic block.
- Recovery assessed by time to full Steward score, eye opening on command, orientation, and simple puzzle completion.
Main Results:
- Propofol infusion resulted in significantly slower recovery (mean 39.8 min to eye opening) compared to other techniques.
- Recovery times for propofol bolus (21.9 min), thiopentone (23.4 min), and halothane (20.1 min) were significantly shorter.
- No significant difference in recovery profiles was observed among propofol bolus, thiopentone, and halothane groups.
Conclusions:
- Propofol infusion, when used for induction and maintenance guided by pharmacokinetic modeling, leads to delayed recovery in pediatric patients.
- Bolus propofol, thiopentone, and halothane offer comparable and faster recovery profiles for minor pediatric surgical procedures.
- Anesthesiologists can consider bolus propofol, thiopentone, or halothane for faster recovery in this patient group.
Abstract:
We have compared the recovery profiles of 163 healthy Chinese children after general anaesthesia for minor surgical procedures. Patients were allocated randomly to receive one of four anaesthetic techniques: propofol infusion for induction and maintenance using a pharmacokinetic model-controlled syringe pump set initially at a target concentration of 8 micrograms ml-1 and then adjusted according to clinical requirements; propofol 2.5-3.5 mg kg-1, thiopentone 4-5 mg kg-1 or 2-3% halothane for induction of anaesthesia followed by 1-2% halothane for maintenance of anaesthesia. All patients breathed a mixture of 70% nitrous oxide in oxygen through a laryngeal mask airway and received an appropriate regional anaesthetic block. Recovery was assessed using the time to achieve full Steward score, open eyes on command, orientation and the time required to complete a simple puzzle. Recovery was slowest with the propofol infusion (mean 39.8 (SD 12.9) min when eyes opened on command). The recovery times were significantly shorter with the three other techniques (propofol bolus 21.9 (9.9) min, thiopentone 23.4 (11.3) min, halothane 20.1 (8.9) min), and the choice among these three methods had no significant influence on the recovery profile.