Halothane, enflurane and isoflurane anaesthesia for adenoidectomy in children, using two different premedications

Abstract

In 48 children subjected to adenoidectomy, comparisons of airway problems, heart rates, cardiac arrhythmias, ventilation and stress hormone reactions were studied during halothane, enflurane and isoflurane anaesthesia. Sixteen children were anaesthetized with either of the three agents and eight patients in each group received diazepam 0.25 mg kg-1 and atropine 0.015 mg kg-1 rectally (DA) as premedication and the remainder diazepam 0.5 mg kg-1, morphine 0.15 mg kg-1 and scopolamine 0.01 mg kg-1 (DMS) rectally. All children were intubated and breathing spontaneously. Equianaesthetic inspired concentrations of halothane, enflurane and isoflurane were used. Airway problems were of the same magnitude during halothane and isoflurane anaesthesia but were less frequent with both agents compared with enflurane anaesthesia. DMS reduced the number of airway reactions in all groups. Respiratory rates were uninfluenced by anaesthesia, intubation and surgery during enflurane anaesthesia. Cardiac arrhythmias were less frequent with enflurane and isoflurane than with halothane. Plasma ACTH and cortisol were similar with all three agents. During induction of anaesthesia in the DA-premedicated halothane group, however, plasma catecholamines were higher than in the group which received DMS, in contrast to the findings during enflurane and isoflurane anaesthesia. The DMS premedication decreased the response of plasma ACTH, cortisol and plasma catecholamines to surgery.

Effect of pre-treatment with intravenous atropine or glycopyrrolate on cardiac arrhythmias during halothane anaesthesia for adenoidectomy in children

“…29 With halothane, the incidence of arrhythmias is higher than with enflurane or isoflurane. 19 It has also been shown by Sigurdsson and colleagues that arrhythmias were significantly fewer in children who received halothane anaesthesia for myringotomies compared with adenoidectomy. 29 In their study, there were almost no dysrhythmias in children receiving enflurane.…”

“…18 Johannesson and colleagues showed similar results with diazepam-atropine vs diazepammorphine-scopolamine during adenoidectomy in children. 19 As Sigurdsson and co-workers concluded, 18 more effective sedative premedication reduces the sympathetic and endocrine response to surgery, altering the incidence of arrhythmias. This was probably the case in both of those studies.…”

Effects of halothane and isoflurane anaesthesia on microcirculatory blood flow in musculocutaneous flaps

“…Most general anaesthetics depress the cardiovascular response to stress caused by blood loss or surgical stimuli [17,40], but the literature on the effects of halothane and isoflurane on plasma catecholamines during anaesthesia and surgery is conflicting. During oral surgery in children, halothane-nitrous oxide caused significantly higher plasma concentrations of catecholamines than isoflurane-nitrous oxide anaesthesia [47] and during hypotensive anaesthesia, lower catecholamine concentrations were found in patients given isoflurane than in patients given halothane and sodium nitroprusside [48]. Others have not found any difference in plasma concentrations of catecholamines between the two volatile agents, either during undisturbed anaesthesia or during surgery [49,50].…”