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PEDIATRIC ANESTHESIA

Desflurane Anesthesia After Sevoflurane Inhaled Induction Reduces Severity of Emergence Agitation in Children Undergoing Minor Ear-Nose-Throat Surgery Compared with Sevoflurane Induction and Maintenance

Jochen Mayer, MD^*, Joachim Boldt, MD^*, Kerstin D. Röhm, MD^*, Klaus Scheuermann, MD, and Stefan W. Suttner, MD^*

Department of *Anesthesia and Intensive Care Medicine and ENT Department, Klinikum Ludwigshafen, Ludwigshafen, Germany

Address correspondence and reprint requests to Jochen Mayer, Department of Anesthesia and Intensive Care Medicine, Klinikum Ludwigshafen, Bremserstr. 79, 67063 Ludwigshafen, Germany. Address e-mail to j-mayer{at}gmx.de.

Emergence agitation may occur after general anesthesia with volatile anesthetics in children. We designed this study to examine the emergence behavior of children undergoing ear-nose-throat surgery after sevoflurane induction and desflurane maintenance versus both sevoflurane induction and maintenance using a recently published Pediatric Anesthesia Emergence Delirium (PAED) scale. In 38 premedicated children aged 12 mo to 7 yr mask induction with sevoflurane was performed and they were randomly assigned to receive either sevoflurane (n = 19) or desflurane (n = 19) for maintenance of general anesthesia. Time to tracheal extubation, modified Aldrete score, emergence behavior, recovery complications, and pain scores were assessed. The PAED scale showed a significant advantage for desflurane (6 [0–15] versus 12 [2–20], maximum total score of 20 for severe agitation). Time to extubation was significantly shorter with desflurane than with sevoflurane (5.4 ± 1.4 versus 13.4 ± 1.8 min). The modified Aldrete score on arrival in the postanesthesia care unit (PACU) was significantly lower in children receiving sevoflurane for maintenance. Time to discharge from PACU to normal ward and the incidence of adverse effects were not significantly different between the groups. In conclusion, the use of desflurane for maintenance of anesthesia after sevoflurane induction in children is associated with less severe emergence agitation and faster emergence times.

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Anesthesia & Analgesia® is published for the International Anesthesia Research Society® by Lippincott Williams & Wilkins with the assistance of Stanford University Libraries' HighWire Press®. Copyright 2006 by the International Anesthesia Research Society. Online ISSN: 1526-7598   Print ISSN: 0003-2999