A comparison of sevoflurane to halothane in paediatric surgical patients: results of a multicentre international study

Abstract

Induction, emergence and recovery characteristics were compared during sevoflurane or halothane anaesthetic in a large (428) multicentre, international study of children undergoing elective inpatient surgical procedures. Two hundred and fourteen children in each group underwent inhalation induction with nitrous oxide/oxygen and sevoflurane or halothane. Incremental doses of either study drug were added until loss of eyelash reflex was achieved. Steady state concentrations of anaesthesia were maintained until the end of surgery when anaesthetic agents were terminated simultaneously. Time variables were recorded for induction, emergence and the first need for analgesia in the recovery room. In addition, in 86 of the children in both groups, venous blood samples were drawn for plasma fluoride levels during and after surgery. There was a trend toward smoother induction (induction of anaesthesia without coughing, breath holding, excitement laryngospasm, bronchospasm, increased secretion, and vomiting) in the sevoflurane group with faster induction (2.1 min vs 2.9 min, P = 0.037) and rapid emergence times (10.3 min vs 13.9 min, P = 0.003). Among the children given sevoflurane, 2% developed bradycardia compared with 11% in the halothane group. Postoperatively, 46% of the children in the halothane group developed nausea and or vomiting versus 31% in the sevoflurane group (P = 0.002). Two children in the halothane group developed cardiac dysrhythmia and were dropped from the study. In addition, a child in the halothane group developed malignant hyperthermia, received dantrolene, and had an uneventful recovery. Mean maximum inorganic fluoride concentration was 18.3 microM.l-1. The fluoride concentrations peaked within one h of termination of sevoflurane anaesthetic and returned rapidly to baseline within 48 h. This study suggests that sevoflurane may be the drug of choice for the anaesthetic management of children.

Dental Treatment under General Anesthesia in Healthy and Medically Compromised/Developmentally Disabled Children: A Comparative Study

“…Recovery time was similar for both groups, means being 11 and 12 minutes for each group respectively. This finding is similar to several reports of general anesthesia procedures in different medical specialties where the combination propofol-sevoflurane is used for GA. 31 The results of this study showed that 80% of the total sample of healthy children required greater than 120 minutes to complete the dental procedures, whereas most (67.5%) of the MCDD children required less than 120 minutes of DGA. It is important to note that there was not a statistical difference when comparing the number of teeth extracted in both groups.…”

Sevoflurane induction in cyanotic and acyanotic children with congenital heart disease

“…4 Studies of sevoflurane in adults and healthy children suggest that it may have significant advantages over halothane in children and infants with heart disease. [5][6][7] Russell and colleagues 3 demonstrated that sevoflurane may have haemodynamic advantages over halothane during the induction and maintenance of anaesthesia in infants and children with congeni- They observed a 25% decrease in systolic blood pressure in the halothane group versus a 15% decrease in the sevoflurane group and a 60% incidence of dysrhythmias in the halothane group versus none in the sevoflurane group. In our study the blood pressure and heart rate findings revealed no significant differences between the control group and either the acyanotic or cyanotic groups.…”

Anions and the anaesthetist

“…hexafluoroisopropanol (HFIP) [33], or changes in renal plasma flow. More recently, it has been observed that maximum fluoride concentrations do not exceed 20 mmol.l 21 in children undergoing sevoflurane anaesthesia and they are therefore unlikely to be at risk from renal toxicity [34,35]. Despite some early misgivings [33], sevoflurane is now well established as the agent of choice for inhalational induction in both adults and children.…”