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Published on: January 18, 2011
[Does propofol have advantages over isoflurane for sufentanil supplemented anesthesia in children for strabismus
Insights
Total intravenous anesthesia with propofol and sufentanil in children undergoing strabismus surgery led to fewer instances of postoperative nausea and vomiting compared to isoflurane anesthesia. However, propofol anesthesia was associated with a higher incidence of bradycardia, particularly in younger children.
Area of Science:
- Anesthesiology
- Pediatric Surgery
- Pharmacology
Background:
- Strabismus surgery in children necessitates careful anesthetic management.
- Propofol and isoflurane are common anesthetic agents with distinct side effect profiles.
- Sufentanil is often used as an adjunct analgesic in pediatric anesthesia.
Purpose of the Study:
- To compare the efficacy and side effects of propofol-based total intravenous anesthesia (TIVA) versus isoflurane anesthesia supplemented with sufentanil in pediatric strabismus surgery.
- To evaluate the incidence of adverse events, including bradycardia, oculocardiac reflex (OCR), and postoperative nausea and vomiting (PONV).
Main Methods:
- A randomized study of 130 children (aged 3-11, ASA I-II) undergoing elective strabismus surgery.
- Four groups were established: two with propofol TIVA (with O2/air or N2O) and two with isoflurane/N2O anesthesia (induced with propofol or thiopentone).
- All patients received premedication and a single dose of sufentanil and atracurium; hemodynamic parameters and adverse events were monitored.
Main Results:
- Propofol TIVA resulted in decreased heart rate and a higher frequency of OCR compared to thiopentone/isoflurane, with increased sensitivity in children younger than 6 years.
- No significant differences were observed in extubation times between the groups.
- The incidence of postoperative nausea and vomiting was significantly lower in the propofol TIVA groups (Groups 1 and 2) compared to the isoflurane groups (Groups 3 and 4).
Conclusions:
- Propofol as an induction agent for balanced anesthesia did not demonstrate advantages over thiopentone.
- Total intravenous anesthesia with propofol increases the risk of bradycardia, especially in younger pediatric patients.
- The significantly lower incidence of postoperative nausea and vomiting with propofol and sufentanil TIVA offers a potential advantage over isoflurane anesthesia in pediatric strabismus surgery.
Objective:
The present study investigates the effectivity and the incidence of side effects of sufentanil-supplemented propofol versus isoflurane anaesthesia in children undergoing elective strabismus surgery.
Methods:
130 children (aged 3-11; ASA I-II) were randomly allocated to one of four groups. In group 1 and 2, anaesthesia was induced with 2 mg/kg propofol and maintained with 15-20 mg/kg x h propofol and 30% O2 in air (group 1) or 10-15 mg/kg x h propofol in N2O (group 2). After induction with either 2 mg/kg propofol (group 3) or 5 mg/kg thiopentone (group 4), anaesthesia was maintained with 0.8-1.5 Vol% isoflurane and N2O in 30% O2 in these groups. All children were orally premedicated with midazolam and atropine and received a single dose of intravenous sufentanil (0.5 micrograms/kg) and atracurium (0.5 mg/kg) prior to intubation. Heart rate, mean arterial blood pressure and pulse oximetry were registered 5 min prior and after intubation as well as 10 min before and 5 min after extubation. The incidence of pain and involuntary movements during injection, oculocardiac reflex (OCR), laryngospasm and postoperative shivering were as well registered as the duration of the operation and the time of extubation. Episodes of nausea and vomiting were documented during 24 hours postoperatively.
Results:
TIVA with Propofol resulted in a decreased heart rate (p = 0.002) and a higher frequency of OCR (p = 0.01) than thiopentone/isoflurane anaesthesia with a higher sensitivity of children younger than 6 years (p = 0.007) in all groups. There were no differences in extubation time between groups. The overall incidence of nausea (p = 0.002) and vomiting (p = 0.007) was lower in group 1 and 2 when compared to group 3 and 4.
Conclusion:
Propofol as an induction agent of balanced anaesthesia fails to show advantages over thiopentone. During total intravenous anaesthesia propofol increases the risk of bradycardia especially in younger children. However, a significantly lower incidence of postoperative nausea and vomiting after TIVA with propofol and sufentanil, irrespective of N2O administration, may be an advantage over isoflurane anaesthesia in paediatric patients after strabismus surgery.
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