Tracheal extubation of deeply anesthetized pediatric patients: A comparison of isoflurane and sevoflurane

We studied the emergence characteristics of unpremedicated children trachea lly extubated while deeply anesthetized ("deep extubation") with isoflurane or sevoflurane. Forty children were assigned to one of two groups, Group I or Group S. At the end of the operation, Group I patients were extubated w hile breathing 1.5 times the minimum alveolar anesthetic concentration (MAC ) of isoflurane. Group S patients were tracheally extubated while breathing 1.5 times the MAC of sevoflurane. Recovery characteristics and complicatio ns were noted. Group S patients were arousable sooner than Group I patients (10.1 + 6.5 vs 16.3 + 9.9 min). Later arousal scores and times to discharg e were the same. There were no serious complications in either group. Breat h-holding was more common in Group I. We conclude that the overall incidenc e of airway problems and desaturation episodes was similar between groups. Emergency delirium was common in both groups (32% overall: 40% for Group I, 25% for Group S). Implications: Deep extubation of children can be safely performed with either isoflurane or sevoflurane. After deep tracheal extuba tion, airway problems occur but are easily managed. Return to an arousable state occurred more quickly with sevoflurane, although time to meeting disc harge criteria was not different between the two groups. Emergence delirium occurs frequently with either technique.