Intravenous Anesthesia vs Inhalation in high risk Children

Perioperative respiratory adverse events are experienced by approximately 15% of children undergoing anesthesia with rates as high as 50% reported during some common surgical procedures. The incidence of perioperative respiratory adverse events is associated with increased airway reactivity and this association is strongest in individuals with asthma, eczema, a recent upper respiratory tract infection or passive smoke exposure

Anop Ramgolam and his associates conducted a study to assess whether IV induction with propofol or inhalation induction with sevoflurane influenced the likelihood of perioperative respiratory adverse events in high-risk infants and children undergoing minor elective surgery.

The trial was a single-center open-label randomized controlled which included
300 Children up to 8 years old with at least two clinically relevant risk factors for perioperative respiratory adverse events and deemed suitable for either technique of anesthesia induction and randomly assigned to either intravenous propofol or inhalational sevoflurane. The primary outcome was the difference in the rate of occurrence of perioperative respiratory adverse events between children receiving intravenous induction and those receiving inhalation induction of anesthesia.

The study found that children with at least two risk factors for perioperative respiratory adverse events, having an inhalational induction of anesthesia with sevoflurane, were significantly more likely to experience perioperative respiratory adverse events than when IV propofol was used.

The secondary outcomes showed that both serious and minor perioperative respiratory adverse events were more likely to occur over the perioperative period with an inhalational induction rather than an IV induction. Moreover, while the likelihood of perioperative respiratory adverse events was independent of the type of anesthesia induction in children without respiratory symptoms, they were more likely to occur with an inhalational induction than an IV induction in those with respiratory symptoms

The study concluded that the results provide initial evidence as to the benefits of using an IV induction with propofol to minimize the occurrence of perioperative respiratory adverse events in high-risk children, especially in those with respiratory symptoms when compared with inhalational induction with sevoflurane.

The study was published in the journal Anesthesiology.

For more reference log on to 10.1097/ALN.0000000000002152