Emergence characteristics of sevoflurane compared to halothane in pediatric patients undergoing bilateral pressure equalization tube insertion

Study Objective: To compare the emergence characteristics of sevoflurane wi th halothane in pediatric patients having bilateral myringotomy and pressur e equalization tube insertion using a highly standardized and common anesth etic technique. Design: Prospective randomized double-blind study. Setting: University hospital. Patients: 43 ASA physical status I and II healthy pediatric outpatients sch eduled for initial ear tube placement by one surgeon. Interventions: Patients were randomized to receive either halothane or sevo flurane as their sole anesthetic drug for ear tube insertion. All patients as well as the research nurse grading emergence agitation were blinded to g roup assignment. No premedication was administered, and all patients receiv ed a standard dose of rectal acetaminophen for postoperative pain control. Measurement and Main Results: The primary outcome was the percentage of pat ients with emergence agitation, defined as thrashing behavior requiring phy sical restraint for greater than three minutes. Time to discharge from the postanesthesia care unit (PACU) and from the hospital were also compared. S evoflurane patients had a greater incidence of emergence delirium: 57% vers us 27% [95% CI (1.7%-58.1%) p = 0.047]. Time to discharge from the PACU and the hospital were longer for patients who received sevoflurane: 62 versus 50 min [95% CI (1.4-23.6) p = 0.02] and 102 versus 79 mins [95% CI (9.6-37. 1) p = 0.003]. Conclusion: In our institution there is a trend toward greater emergence ag itation in ear tube placement patients given sevoflurane versus halothane a nesthesia. Further, (with our discharge criteria) patients are actually dis charged from the PACU and the hospital faster when given halothane as a sol e anesthetic when compared to sevoflurane. (C) 2000 by Elsevier Science Inc .