EMERGENCE FROM ANESTHESIA IN CHILDREN UNDERGOING AMBULATORY SURGERY- A COMPARISON BETWEEN PROPOFOL AND SEVOFLURANE USING SINGLE ANESTHETIC TECHNIQUE

Anesthetic Technique

Abstract

Objective: To compare emergence from anesthesia using total intravenous anesthesia (TIVA) with propofol and volatile induction maintenance anesthesia (VIMA) with sevoflurane, in children undergoing ambulatory inguinal herniorrhaphy.
Study Design: Randomized, controlled trials.
Place and Duration of Study: Shifa Hospital of Pakistan Navy, from 1st Mar 2005 to 28th Feb 2006.
Patients and Methods: Eighty children, aged 5-10 years of ASA physical status I or II were divided into two groups of 40 each using random numbers table. Group P received propofol 3mg/kg for induction and 100-400 μg/kg/min infusion for maintenance of anesthesia, while group S received sevoflurane 8% (inspired concentration) in 100% oxygen for induction and 2-3 % in oxygen for maintenance of anesthesia. No sedative premedication was given. Analgesia was provided with caudal block using 0.25% bupivacaine. Speed of emergence from anesthesia was assessed by time to extubation, time to eye opening, and time to crying / stating name. A modified aldrete score system was used to evaluate recovery while Pain/Discomfort scale to assess the quality of emergence from anesthesia. These were recorded by a separate consultant anesthetist blind to the anesthetic technique.
Results: Emergence from anesthesia occurred significantly quicker in the S group as compared to P group, as evident by times in minutes (mean ± SD) to extubation: 8.3±6.9 versus 4.7± 2.6(p=0.017), eye opening: 9.1 ± 5.3 vs. 5.6 ± 2.6 (p=0.043) & crying / state name: 14.7 ± 7.2 vs.11.3 ± 4.6(p=0.039). Similarly, more patients in the S group scored maximum points in the modified aldrete score at 10 min: 17 (42.5%) vs.7 (17.5%) (p=0.015), 20 min: 32 (80%) vs.23 (57.5%) (p=0.030). Although, number of patients in the S group compared to P group scoring max points in Pain-discomfort scale at 10 min: 8 (20%) vs4 (10%), p=0.210; 20 min: 6 (15%) vs.2 (5%), p=0.136 & 30 min: 4 (10%) vs. 0, p=0.130 were more, these results were not statistically significant.
Conclusion: VIMA with sevoflurane provided quicker emergence and early recovery compared with TIVA with propofol, in children undergoing ambulatory surgery.