Propofol en perfusion à débit continu versus enflurane chez l'enfant opéré de strabisme. Comparaison de la qualité de l'anesthésie et du réveil

Abstract

In children, the use of a continuous infusion of propofol has not yet been reported. A study was therefore designed to compare the characteristics of anaesthesia and recovery when either propofol or enflurance was used as the main anaesthetic agent. All 42 children (14 girls, 28 boys), ASA I and scheduled for corrective squint surgery under general anaesthesia, received 350 μg · kg −1 midazolam and 40 μg · kg −1 atropine intrarectally 20 min before induction, which was carried out with 3 mg · kg −1 propofol intravenously in 20 s. The patients were then randomly assigned to two groups, according to the drug used for maintenance : group P (n = 21) received a continuous intravenous infusion of propofol, 18 mg · kg −1 · h −1 for the first 30 min and 15 mg · kg −1 · h −1 thereafter ; group E (n = 21) received 2.5 %, then, after 30 min, 2 % enflurane. Both groups were given 15 μg · kg −1 dextromoramide and 0.09 mg · kg −1 vecuronium. During anaesthesia, the following parameters were monitored : systolic (Pa sys), diastolic (Pa dia) and mean arterial (P̄a) pressures, heart rate (f c), the presence or not of an oculocardiac reflex with or without a 20 % fall in f c which responded to 10–15 μg · kg −1 atropine, the appearance of a cardiac dysrhythmia, duration of anaesthesia and the delay before extubation. Recovery was assessed 1, 2, 4 and 6 h postoperatively by using both clinical and psychomotor criteria, the latter being adapted to children having one or both eyes occluded. The quality of anaesthesia was satisfactory in both groups, although a greater number of oculocardiac reflexes were seen in group P (9/21) than in group E (3/21) (p < 0.05). All the children were extubated within 20 min after stopping anaesthesia. One hour after extubation, recovery was of better quality in group P, being quieter and more complete. In fact, 10 min after extubation, the children who had been given propofol were already able to answer questions and correctly carry out psychomotor tests. Anaesthesia with a continuous infusion of propofol was therefore an excellent alternative to enflurane for surgery lasting less than 1 h.