Recovery with Propofol Anesthesia in Children Undergoing Cleft Palate Repair Compared with Sevoflurane Anesthesia

Abstract

Background Nowadays, propofol total intravenous anesthesia (propofol TIVA) is a very attractive choice for routine pediatric anesthesia practice. Objectives To compare propofol- vs. sevoflurane-based anesthesia for pediatrics undergoing cleft palate repair in emergence characteristics and respiratory adverse effects. Methods Eighty infants, aged from six months to one year, scheduled for cleft palate repair surgery, were randomly divided into two groups (40 patients each). The group I received general anesthesia induced with intravenous propofol 2.5 mg/kg, 0.1 mg/kg of lidocaine, fentanyl one µg/kg and cisatracurium 0.15 mg/kg, and maintained by a continuous infusion of propofol 9 mg/kg/hr and cisatracurium 3 µg/kg/hr. While in the group II, general anesthesia induced by O 2 /sevoflurane, intravenous fentanyl one µg/kg and cisatracurium 0.15 mg/kg then the maintenance was carried out by O 2 /air, sevoflurane 2 MAC, and cisatracurium three µg/kg/hr. Postoperative FLACC behavioral pain assessment Scale, modified Hannallah score, postoperative laryngeal spasm incidence, the recovery time, time to extubation, and postoperative complication were recorded. Results The quality of emergence was assessed by modified Hannallah score, there was a significant decrease in the number of patients developed agitation after propofol TIVA in comparison to sevoflurane anesthesia (P < 0.001) with a significant decrease in the number of patients developed postoperative laryngeal spasm (P < 0.047). On the other hand, a significantly prolonged time of extubation was observed in the propofol TIVA group (P < 0.001). Conclusions Propofol TIVA regimen was the more peaceful recovery approach with less perioperative respiratory complications than sevoflurane-based anesthesia in infants undergoing cleft palate repair surgery.

A novel balanced anesthesia shortens time to emergence in patients undergoing modified radical mastectomy: a randomized prospective trial

“…Propofol is currently the most frequently used intravenous anesthetic on account of its rapid recovery profile. However, after prolonged high-dose propofol infusion, the plasma level of propofol may decrease slowly and its half time may increase more (5,18). Furthermore, compared with sevoflurane, propofol is metabolized dependent of liver and renal function; therefore, it is less controllable.…”

“…Traditionally, propofol has been used in combination with volatile anesthetics for "balanced anesthesia" regimen (4). Practitioners have been using propofol at induction and during maintenance of anesthesia or in a "sandwich" technique (at induction and again during the last 30 min before the end of surgery) to reduce postoperative complications, but it may delay emergence and decrease bed turnover rate in post-anesthesia care unit (PACU) (5)(6)(7)(8). Previous studies have demonstrated an unpredictable interindividual variability of propofol pharmacokinetics and pharmacodynamics with clinically relevant adverse outcomes (9).…”

Anesthetic Management of a Pediatric Patient with Emanuel Syndrome

“…Hiperventilasyondan kaçınmak ve dikkatli soluk-sonu karbon dioksit takibi gereklidir (7) . Çocuklarda total intravenöz anestezi (TIVA) kullanımı, daha iyi bir derlenme sağlaması ve daha az solunum yolu komplikasyonuna neden olması dolayısıyla da avantajlıdır (9) . Biz de güvenli tarafta kalmak ve Emanuel sendromuna eşlik eden iskelet anomalileri nedeniyle malign hipertermi riskini en aza indirmek adına ilk tercih olarak TIVA uyguladık.…”

Inhaled Anesthetics: Environmental Role, Occupational Risk, and Clinical Use

“…Other potential benefits of inhalational anesthesia, such as cardioprotection in adults have not been confirmed in a pediatric population [ 158 ]. On the other hand, the use of TIVA has been associated with reduced complications such as lower incidence of delirium, lower incidence of bronchospasm, and a more peaceful recovery [ 159 , 160 , 161 ]. Furthermore, volatile anesthesia was more associated with the risk of PONV, whereas different studies have shown a potential antiemetic property of propofol, which is currently considered in guidelines as the indicated anesthesia technique to minimize the risk of PONV [ 162 , 163 , 164 ].…”