Effects of sevoflurane anaesthesia on recovery in children: a comparison with halothane

Abstract

We prospectively studied one hundred ASA physical status I-II children, ages six months to six years, undergoing myringotomy surgery. Children were randomly assigned to one of four anaesthetic groups receiving either halothane or sevoflurane for anaesthesia and oral midazolam premedication or no premedication. We found that children anaesthetized with sevoflurane had significantly faster recovery times and discharge home times than those who received halothane. Patients given oral midazolam premedication had significantly longer recovery times, but no delay in discharge home compared with those not premedicated. However, children anaesthetized with sevoflurane and no premedication had an unacceptably high incidence (67%) of postoperative agitation. The use of oral midazolam preoperatively did decrease the amount of postoperative agitation seen with sevoflurane. We conclude that although sevoflurane does shorten recovery times, the degree of associated postoperative agitation makes it unacceptable as a sole anaesthetic for myringotomy surgery.

Agitação no despertar da anestesia em crianças: aspectos atuais

“…3 Adding nitrous oxide to anesthesia with sevoflurane reduces the minimum alveolar concentration (MAC) of sevoflurane, meaning that lower concentrations of the anesthetic can be used, thereby reducing the incidence of postoperative agitation. 25 When compared with isoflurane, sevoflurane appears not just to increase the incidence of emergence agitation, but also to prolong the duration of that agitation, which is a problem that was detected in children maintained under anesthesia with sevoflurane, where the occurrence of the complication was 20%, compared with an incidence of 7% when isoflurane was employed.…”

“…Some authors have observed a reduction in preoperative anxiety, have found it easier to separate children from parents and have observed a reduction in agitation when midazolam is used as premedication, followed by sevoflurane as anesthetic. 3 However, some authors have observed that emergence time was prolonged when midazolam was used. 3,33 Combining midazolam with small doses of diazepam, for premedication, improved the quality of recovery, with reduced incidence of agitation after anesthesia with sevoflurane.…”

“…3 However, some authors have observed that emergence time was prolonged when midazolam was used. 3,33 Combining midazolam with small doses of diazepam, for premedication, improved the quality of recovery, with reduced incidence of agitation after anesthesia with sevoflurane. 34 However, other authors have found that children premeditated with midazolam exhibited increased incidence of emergence agitation than children who did not receive these pharmaceuticals , offering the anti-analgesic effects of midazolam as an explanation.…”

“…2 The difficulty with establishing etiology explains the major variation in the prevalence rates reported in the literature, which vary from 10 to 67. [3][4][5] Many studies have used different measurement scales and definitions, making it difficult to compare studies in terms of incidence rates, risk factors and techniques for the control and prevention of postoperative agitation.…”

Ansiedade, a criança e os pais

“…Apesar de alguns estudos registrarem que o midazolam administrado por via oral no pré-operatório não prolonga o tempo de recuperação 38,52,53 , outras pesquisas, envolvendo crianças submetidas à adenoidectomia, mostraram aumento no tempo de despertar e de recuperação 54,55 . Lapin e col. 56 observaram que, apesar do aumento no tempo de recuperação, não houve retardo na alta hospitalar após o uso do midazolam como medicação pré-anestésica em crianças submetidas à amigdalectomia. Vários autores, utilizando doses entre 0,2 e 0,75 mg.kg -1 não encontraram complicações associadas ao uso do midazolam como medicação pré-anestésica 46,53,57,58 .…”