Tracheal Extubation of Deeply Anesthetized Pediatric Patients: A Comparison of Desflurane and Sevoflurane

• Published in: Anesthesia and analgesia Vol. 96; no. 5; pp. 1320 - 1324
• Main Authors: Valley, Robert D, Freid, Eugene B, Bailey, Ann G, Kopp, Vincent J, Georges, Linda S, Fletcher, James, Keifer, Anne
• Format: Journal Article
• Language: English
• Published: Hagerstown, MD International Anesthesia Research Society 01.05.2003; Lippincott
• Subjects: Adolescent; Anesthesia Recovery Period; Anesthesia, Inhalation - adverse effects; Anesthetics, Inhalation - adverse effects; Anesthetics. Neuromuscular blocking agents; Arousal; Biological and medical sciences; Child; Child, Preschool; Desflurane; Female; Humans; Infant; Intubation, Intratracheal - adverse effects; Isoflurane - adverse effects; Isoflurane - analogs & derivatives; Laryngismus - epidemiology; Laryngismus - etiology; Male; Medical sciences; Methyl Ethers - adverse effects; Neuropharmacology; Pharmacology. Drug treatments; Postoperative Nausea and Vomiting - epidemiology; Preanesthetic Medication; Sevoflurane; Human; Volatile compound; Sevoflurane; General anesthetic; Desflurane; General anesthesia; Child; Recovery; Trachea; Comparative study; Extubation; Halogen Organic compounds
• ISSN: 0003-2999; 1526-7598
• DOI: 10.1213/01.ANE.0000058844.77403.16

In this study, we examined the emergence characteristics of children tracheally extubated while deeply anesthetized with desflurane (Group D) or sevoflurane (Group S). Forty-eight children were randomly assigned to one of the two groups. At the end of the operation, all subjects were tracheally extubated while breathing 1.5 times the minimal effective concentration of assigned inhaled anesthetic. Recovery characteristics and complications were noted. Group D patients had higher arousal scores on arrival to the postanesthesia care unit than Group S patients. Later arousal scores were not significantly different. No serious complications occurred in either group. Coughing episodes and the overall incidence of complications after extubation were more frequent in Group D. Readiness for discharge and actual time to discharge were not significantly different between groups. Emergence agitation was common in both groups (33% overall, 46% for Group D, and 21% for Group S). Narcotic administration in the postanesthesia care unit occurred more frequently in Group D (10 of 24 patients) versus Group S (3 of 24 patients). Premedication with oral midazolam resulted in significantly longer emergence times regardless of the potent inhaled anesthetic administered.