Sevoflurane-maintained anesthesia induced with propofol or sevoflurane in small children: induction and recovery characteristics.

Objective: To compare the induction and recovery characteristics of sevoflurane anesthesia induced with either propofol or sevoflurane in pediatric outpatients.

Methods: Fifty-two children, aged 1-3 yr, presenting for ambulatory adenoidectomy were randomly allocated to receive 3 mg.kg-1 propofol i.v. or sevoflurane 8% inspired concentration for induction of anesthesia. Tracheal intubation was facilitated with 0.2 mg.kg-1 mivacurium. Anesthesia was maintained with nitrous oxide/oxygen (FiO2 0.3) and sevoflurane approximately 3-5% inspired concentration with controlled ventilation. Intubation was assessed by an anesthetist blinded to the induction method. Recovery characteristics were compared using the modified Aldrete scoring system, the Pain/Discomfort scale and measuring specific recovery times. A postoperative questionnaire was used to evaluate the children's well-being at home.

Results: Intubating conditions were similar in both groups. Emergence from anesthesia occurred earlier with sevoflurane for induction than with propofol (11 +/- 4 vs 17 +/- 7 min (mean +/- SD), P = 0.0002). More children in the sevoflurane group achieved full points on the modified Aldrete scoring system during the first 20 min after anesthesia (P < 0.05). However, children in the sevoflurane group scored higher in the Pain/Discomfort scale at 10 min after anesthesia (P = 0.04) and were given postoperative analgesics earlier than children in the propofol group (13 +/- 5 min vs 18 +/- 11 min, P = 0.03). The time to meet discharge criteria and recovery at home were similar.

Conclusions: Induction of sevoflurane anesthesia with propofol for day-case adenoidectomy results in longer, but more calm, early recovery but does not delay discharge or affect recovery at home.