Comparison of sevoflurane and halothane anesthesia in children undergoing outpatient ear, nose, and throat surgery

Abstract

Study Objective: To compare the induction, maintenance, and recovery characteristics of sevoflurane and halothane in pediatric ambulatory patients undergoing adenoidectomy with or without myringotomies (BMTs). To compare the hemodynamic effects of the two drugs. Design: Open, randomized study. Setting: University-affiliated pediatric hospital. Patients: 39 ASA physical status I children aged 12 months to 12 years undergoing adenoidectomies with or without BMTs. Interventions: Patients were randomized to receive sevoflurane or halothane in 60% nitrous oxide (N 2O)for induction and maintenance of anesthesia. All patients received midazolam 0.5 mg/kg orally as premedication, as well as fentanyl 1 mcg/kg intravenously (IV) immediately following induction. Tracheal intubation was facilitated with mivacurium 0.2 mg/kg IV. Anesthesia was maintained with an end-tidal concentration corresponding to 1 minimum alveolar concentration (MAC) of each drug until the end of surgery, at which time all anesthetic gases were discontinued simultaneously. Emergence (extubation), recovery (Steward score = 6), and discharge times were compared among patients in both groups. Heart rate (HR) and mean arterial pressure were compared at predetermined intervals. Additional fentanyl was administered after full recovery was documented for an objective pain score of at least 6. Measurements and Main Results: Emergence from anesthesia was significantly faster (7.11 ± 3.05 minutes vs. 9.58 ± 5.12 minutes) and recovery (19.89 ± 10.07 minutes vs. 31.08 ± 9.81 minutes) more rapid in the sevoflurane group. However, there was no difference in the time to meet home discharge criteria (184 ± 49 minutes vs. 189 ± 48 minutes). HR was consistently maintained at or above baseline in the sevoflurane group. Blood pressure was significantly more depressed after fentanyl administration in the halothane group. There were no significant differences in the incidence of postoperative vomiting between the two groups. Conclusion: Sevoflurane provides a faster anesthetic emergence and recovery than halothane in premedicated patients but it does not expedite meeting current home discharge criteria.