Quality of recovery in children: sevoflurane versus propofol

Background: Sevoflurane, with its low pungency and low blood and tissue sol ubility, is an attractive anaesthetic in paediatric outpatient surgery. Pro pofol-anaesthesia is recognised for its rapid and clear-headed emergence. T his study was designed to compare emergence and recovery characteristics of sevoflurane and propofol anaesthesia for tonsillectomy in children. Methods: Children aged 3-10 years, undergoing elective tonsillectomy, were randomly assigned to receive propofol (n=25, induction with 3 mg . kg(-1), maintenance with 100-250 mu g . kg(-1) . min(-1)) or sevoflurane anaesthesi a (n=25, induction 7 vol.%, maintenance 2-3 vol.%). Tracheal intubation was per formed with alfentanil 20 mu g . kg(-1) and atracurium 0.5 mg . kg(-1) . Ventilation was controlled to maintain normocapnia and all patients recei ved N2O/O-2 (60:40 vol.%) for induction and maintenance of anaesthesia. At the end of surgery infiltration of the operative sites with bupivacaine 2 m g . kg(-1) was provided for postoperative analgesia. Emergence, recovery, d ischarge times, and incidence of side effects were compared between the two groups. Results: Time to extubation (14 vs 15 min), time to response to simple verb al command (21 vs 21 min) and time to discharge from the recovery room (45 vs 50 min) were similar in the sevoflurane and propofol groups, respectivel y. There was a significantly greater incidence of postoperative agitation i n the sevoflurane group (46%) compared with the propofol group (9%) (P=0.00 8). This did not, however, delay discharge from the recovery room. The inci dence of nausea and vomiting was not significantly different (8% vs 0%; P=0 .49). Conclusion: In children, recovery from anaesthesia with sevoflurane results in a higher incidence of agitation compared with propofol.