SEVOFLURANE VERSUS HALOTHANE FOR GENERAL-ANESTHESIA IN PEDIATRIC-PATIENTS - A COMPARATIVE-STUDY OF VITAL SIGNS, INDUCTION, AND EMERGENCE

Study Objective: To compare vital signs and the speed of induction and emergence with sevoflurane versus halothane in pediatric patients. De sign: Prospective, randomized, open study. Setting: Thomas Jefferson U niversity Hospital. Patients: 40 unpremedicated ASA Physical Status I and II children age 9 months to 16 years undergoing elective inpatient otorhinolaryngologic or orthopedic surgery. Interventions: Standardiz ed induction of anesthesia with sevoflurane (start: 1%, maximum: 7%) o r halothane (start: 0.5%, maximum: 5%) in nitrous oxide/oxygen (N2O/O- 2). Intubation following vecuronium and 4 minutes of controlled ventil ation with 2 minimum alveolar concentration (MAC) drug in O-2; 1.5 MAC drug in N2O/O-2 delivered for 20 minutes; then 0.75 MAC until the end of surgery. Fentanyl 1 mcg/kg was administered 15 minutes before the anticipated end of surgery, at which time anesthetics were stopped and mechanical ventilation continued until eye opening (emergence). Measu rements and Main Results: Blood pressure, heart rate (HR), oxygen satu ration, end-tidal gas concentrations, and temperature were recorded. I nduction and emergence times were measured to the nearest second. Indu ction (loss of eyelash reflex) was faster with sevoflurane (97 +/- 31 sec) than halothane (120 +/- 36 sec; p < 0.05), despite a lower inspir ed sevoflurane MAC. Emergence was faster with sevoflurane (9.9 +/- 2.9 min vs. 12.5 +/- 4.7 min; p ( 0.05), despite a higher MAC multiple of end-tidal sevoflurane concentration at the end of surgery. Following intubation, HR (compared with the preinduction value in the operating room) was significantly higher in the halothane group (136.8% +/- 16.3 % vs. 115.0% +/- 25.6%), as was mean arterial pressure (113.2% +/- 25. 5% vs. 87.8% +/- 22.6%). This finding corresponded with a higher MAC m ultiple of end-tidal concentration in the sevoflurane group than in th e halothane group. Conclusions: Induction of and emergence from anesth esia was faster with sevoflurane than halothane. Airway complications were low in both groups. Vital signs were more stable with sevoflurane during induction through intubation, and were comparable during maint enance. Sevoflurane is an excellent drug for inhalational induction in pediatric patients.