A Comparison of the Sevoflurane and Total Intravenous Anesthesia on the Quality of Recovery in 2 to 10-Year-Old Children

Abstract

Background: Inhalant anesthesia is one of the mainstays of pediatric anesthesia, and it is considered by the majority of pediatric anesthetists worldwide as the gold standard. On the other hand, total intravenous anesthesia (TIVA) is a very popular choice for routine pediatric anesthesia practice. Therefore, utilization of TIVA compared to the volatile anesthesia is still a topic of debate in successful anesthesia management. Objectives: To compare TIVA vs sevoflurane-based anesthesia on the quality of recovery in children aged 2 to 10 years who had outpatient surgery. Methods: Eighty children, aged 2 to 10 years old undergoing outpatient surgery, were randomly divided into two groups (40 patients each). The TIVA group with propofol (T) received general anesthesia induced with midazolam 0.03 - 0.05 mg/kg, fentanyl 1 mcg/kg, propofol 3 - 5 mg/kg, 0.1 mg/kg lidocaine and maintenance with propofol 100 to 250 μg/kg.min and remifantanil 0.1 mcg/kg. The sevoflurane (S) group received general anesthesia induced with midazolam 0.03 - 0.05 mg/kg, fentanyl 1 mcg/kg, O2/sevoflurane 8 vol%, maintenance with 2 - 3 vol%. Demographic characteristics, awakening quality in recovery, hemodynamic status, and other complications such as patient agitation, pain, nausea, and vomiting were evaluated in both groups. Results: Patients did not differ significantly in terms of demographic characteristics. The incidence of postoperative agitation was 62% higher in the sevoflurane group than the TIVA group (5%, P < 0.001). The highest percentage of pain was obtained as 52.5% in the sevoflurane group. Postoperative nausea and vomiting did not differ significantly among groups, and there was a significant decrease in the heart rate of the subjects in the T group as one of the hemodynamic variables (P = 0.01). Conclusions: Inhalation anesthesia with sevoflurane led to more rapid recovery from anesthesia, and TIVA with propofol injection reduced post-operative pain and agitation compared to patients receiving sevoflurane. Therefore, TIVA with propofol infusion is probably an effective technique to maintain general anesthesia in pediatric outpatient surgery and to increase parental satisfaction, and to reduce the workload of recovery room staff.