Isoflurane is associated with a similar incidence of emergence agitation/delirium as sevoflurane in young children – a randomized controlled study

Abstract

Children may be agitated or even delirious especially when recovering from general anesthesia using volatile anesthetics. Many trials have focused on the newer agents sevoflurane and desflurane but for the widely used isoflurane little is known about its potential to generate agitation. We investigated the emergence characteristics of small children after sevoflurane or isoflurane with caudal anesthesia for postoperative pain control. After institutional approval and parental consent, anesthesia was randomly performed with sevoflurane (n = 30) or isoflurane (n = 29) in children at the age of 3.8 +/- 1.8 years during surgical interventions on the lower part of the body. After induction, all children received caudal anesthesia with bupivacaine (0.25%, 0.8 ml x kg(-1)). Postoperatively, the incidences of emergence agitation (EA) and emergence delirium (ED) were measured by a blinded observer using a ten point scale (TPS; EA = TPS > 5 ED = TPS > 7) as well as vigilance, nausea/vomiting and shivering. The two groups were comparable with respect to demographic data, duration of surgery and duration of anesthesia. There were also no differences in the period of time from the end of surgery until extubation, duration of stay in the PACU, postoperative vigilance and vegetative parameters. Incidence of EA was 30% (9/30) for sevoflurane and 34% (10/29) for isoflurane during the first 60 min in the PACU (P = 0.785). Likewise, the incidence of ED was not different between the groups (20% and 24%, respectively). In our randomized controlled study, we found no difference in the incidence of EA or ED between sevoflurane and isoflurane. Therefore, the decision to use one or the other should not be based upon the incidence of EA or ED.