A COMPARISON OF SEVOFLURANE TO HALOTHANE IN PEDIATRIC SURGICAL PATIENTS - RESULTS OF A MULTICENTER INTERNATIONAL STUDY

Induction, emergence and recovery characteristics were compared during sevoflurane or halothane anaesthetic in a large (428) multicentre, in ternational study of children undergoing elective inpatient surgical p rocedures. Two hundred and fourteen children in each group underwent i nhalation induction with nitrous oxide/ oxygen and sevoflurane or halo thane. Incremental doses of either study drug were added until loss of eyelash reflex was achieved. Steady state concentrations of anaesthes ia were maintained until the end of surgery when anaesthetic agents we re terminated simultaneously. Time variables were recorded for inducti on, emergence and the first need for analgesia in the recovery room. L n addition, in 86 of the children in both groups, venous blood samples were drawn for plasma fluoride levels during and after surgery. There was a trend toward smoother induction (induction of anaesthesia witho ut coughing, breath holding, excitement laryngospasm, bronchospasm, in creased secretion, and vomiting) in the sevoflurane group with faster induction (2.1 min vs 2.9 min, P = 0.037) and rapid emergence times (1 0.3 min vs 13.9 min, P = 0.003). Among the children given sevoflurane, 2% developed bradycardia compared with 11% in the halothane group. Po stoperatively, 46% of the children in the halothane group developed na usea and or vomiting versus 31% in the sevoflurane group (P=0.002). Tw o children in the halothane group developed cardiac dysrhythmia and we re dropped from the study. In addition, a child in the halothane group developed malignant hyperthermia, received dantrolene, and had an une ventful recovery. Mean maximum inorganic fluoride concentration was 18 .3 mu M . l(-1). The fluoride concentrations peaked within one h of te rmination of sevoflurane anaesthetic and returned rapidly to baseline within 48 h. This study suggests that sevoflurane may be the drug of c hoice for the anaesthetic management of children.