Sevoflurane is associated with a higher incidence of complications than propofol in paediatric patients undergoing sedation (13.46% vs 7.03%), according to results of a cohort review presented at the 2014 Annual Meeting of the American Society of Anesthesiologists (ASA).
While procedure and recovery times were similar for both the sevoflurane and propofol groups, the duration of anaesthesia time was significantly shorter in the propofol group (56.6 ± 41.6 vs 45.59 ± 27.85 minutes), explained lead author Navneet Kaur, MD, University of Minnesota, Minneapolis, Minnesota.
Dr. Kaur and colleagues collected data from the medical records of 761 children (50.6% male; mean age 4.48 years; mean weight 39.36 kg) who underwent sedation in their hospital sedation unit over a period of 7 months. In all, 52 patients (6.83%) were induced with sevoflurane, while 709 patients (92.17%) were induced with propofol (of these 709, there were 199 patients for comparison who underwent similar procedures).
The team recorded data about patient demographics, admission and discharge, diagnoses, procedures, type of sedation, anaesthesia and analgaesic medication, duration in the sedation unit, and complications (for propofol: nausea, flushing, desaturation, apnoea, anxiety, and airway obstruction; for sevoflurane: nausea, agitation, laryngospasm, and headache).
Children induced with propofol were older than those induced with sevoflurane (6.41 ± 5.20 vs 4.6 ± 4.02 years), and were heavier (36.59 ± 32.74 vs 26.6 ± 26 kg).
The researchers concluded that, in their sedation unit, children were less likely to be induced with sevoflurane. The incidence of complications was higher with sevoflurane when compared to propofol in this group of children.
Propofol is commonly used in a sedation unit during diagnostic and therapeutic procedures in the paediatric population. An intravenous (IV) line can be established in most children with the support of child life services and distraction methods. The administration of sevoflurane by mask for induction, followed by IV line placement, represents an alternate approach, especially in uncooperative children.