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Propofol anaesthesia in paediatric ambulatory patients: a comparison with thiopentone and halothane

Canadian Journal of Anaesthesia volume 41, pages 12–18 (1994)Cite this article

Abstract

The purpose of this study was to evaluate the haemodynamic changes during induction, as well as the speed and quality of recovery when propofol (vs thiopentone and/or halothane) was used for induction and maintenance of anaesthesia in paediatric outpatients. One hundred unmedicated children, 3–12-yr-old, scheduled for ambulatory surgery were studied. The most common surgical procedures performed were eye muscle surgery (42%), plastic surgery (21%), dental restoration (15%), and urological procedures (15%). The children were randomized to an anaesthetic regimen for induction/maintenance as follows: propofol/propofol infusion; propofol/halothane; thiopentone/halothane; halothane for both induction and maintenance. Succinylcholine 1.5 mg · kg−1 was used to facilitate tracheal intubation and N2O/O2 were used as the carrier gases in each case. All maintenance drugs were titrated according to the clinical response of the patient to prevent movement and/or maintain BP ± 20% of baseline. Two patients (4%) who received propofol expressed discomfort during injection. The mean propofol dose required to prevent movement was 267 ± 83 μg · kg−1 · min−1. The overall pattern of haemodynamic changes, as well as awakening (extubation) times were not different among the four groups. Children who received propofol recovered faster (22 vs 29–36 min) (P < 0.05), were discharged home sooner (101 vs 127–144 min) (P < 0.05), and had less postoperative vomiting (4 vs 24–48%) (P < 0.05) than all others. There were no serious complications or adverse postoperative sequelae in any of the patients in the study. It is concluded that induction and maintenance of anaesthesia with propofol is a well-tolerated anaesthetic technique in children, and is associated with faster recovery and discharged as well as less vomiting than when halothane is used.

Résumé

L’objet de cette étude est d’évaluer les changements hémodynamiques à l’induction ainsi que la vitesse et la qualité du réveil, lorsque le propofol (versus thiopental et/ou halothane) est utilisé pour l’induction et l’entretien de l’anesthésie d’enfants en ambulatoire. On a étudié 100 enfants dépourvus de traitement, entre 3 et 12 ans, programmés pour une chirurgie ambulatoire. Les chirurgies les plus habituelles sont la cure de strabisme (42%), la chirurgie plastique (21%), la restauration dentaire (15%) et les interventions urologiques (15%). Les enfants sont distribués aléatoirement pour une anesthésie d’induction/entretien comme suit: propofol/infusion de propofol; propofol/ halothane; thiopental/halothane; halothane pour l’induction et l’entretien. On a utilisé la succinylcholine 1,5 mg · kg−1 pour faciliter l’intubation trachéale et le N2O/O2 est utilisé comme véhicule gazeux dans tous les cas. Pour l’entretien de l’anesthésie, les agents sont titrés en fonction de la réponse clinique du patient afin de prévoir les mouvements et/ou de maintenir la pression artérielle à ±20% de la valeur de base. Deux patients (4%) ont manifesté un inconfort pendant l’injection de propofol. La dose moyenne de propofol requise pour prévenir le mouvement est de 267 ± 83 μg · kg−1 · min−1. Autant le profil général des variations hémodynamiques que le moment du réveil (extubation) sont identiques dans les quatre groupes. Les enfants qui reçoivent le propofol se réveillent plus vite (22 secondes versus 29–36 min), (P < 0,05) sont renvoyés plus tôt à la maison (101 versus 127–144 min) (P < 0,05) et ont moins de vomissements post-opératoires (4 versus 24–48%) (P < 0,05). Il n’y a pas eu de complications sérieuses ni de séquelles postopératoires chez aucun des patients de l’étude. On en conclut que l’induction et l’entretien de l’anesthésie avec le propofol est une technique bien tolérée chez l’enfant, associée avec un réveil et un départ plus rapides ainsi que des vomissements moindres que lors de l’utilisation d’halothane.

References

  1. Hannallah RS, Baker SB, Casey W, McGill WA, Broadman LM, Norden JM. Propofol: effective dose and induction characteristics in unpremedicated children. Anesthesiology 1991; 74: 217–9.

    PubMed  CAS  Google Scholar 

  2. Martin TM, Nicolson SC, Bargas MS. Propofol anesthesia reduces emesis and airway obstruction in pediatric out-patients. Anesth Analg 1993; 76: 144–8.

    PubMed  Article  CAS  Google Scholar 

  3. Borgeat A, Popovic V, Meier D, Schwander D. Comparison of propofol and thiopental/halothane for short-duration ENT surgical procedures in children. Anesth Analg 1990; 71: 511–5.

    PubMed  Article  CAS  Google Scholar 

  4. Steward DJ. A simplified scoring system for post-operative recovery room. Can Anaesth Soc J 1975; 22: 111–3.

    PubMed  Article  CAS  Google Scholar 

  5. Hannallah RS, Epstein BS. The pediatric patient.In: Wetchler BV (Ed.). Anesthesia for Ambulatory Surgery, 2nd edition. Philadelphia: JB Lippincott Company, 1991: 184.

    Google Scholar 

  6. Morton NS, Wee M, Christie G, Gray IG, Grant IS. Propofol for induction of anaesthesia in children. A comparison with thiopentone and halothane inhalational induction. Anaesthesia 1988; 43: 350–5.

    PubMed  Article  CAS  Google Scholar 

  7. Reimer EJ, Bevan JC, Montgomery CJ, Merrick P, Blackstock D, Reichert C. Does propofol decrease or merely delay post-strabismus repair vomiting in children? Can J Anaesth 1993; 40: A69.

    Google Scholar 

  8. Watcha MF, Simeon RM, White PF, Stevens JL. Effect of propofol on the incidence of postoperative vomiting after strabismus surgery in pediatric outpatients. Anesthesiology 1991; 75: 204–9.

    PubMed  Article  CAS  Google Scholar 

  9. Weir PM, Munro HM, Reynolds PI, Lewis IH, Wilton NCT. Propofol infusion and the incidence of emesis in pediatric outpatient strabismus surgery. Anesth Analg 1993; 76: 760–4.

    PubMed  Article  CAS  Google Scholar 

  10. White M, Kenny GNC. Intravenous propofol anesthesia using a computerized infusion system. Anaesthesia 1990; 45: 204–9.

    PubMed  Article  CAS  Google Scholar 

  11. March B, White M, Morton N, Kenny GNC. Pharmaco-kinetic model driven infusion of propofol in children. Br J Anaesth 1991; 67: 41–8.

    Article  Google Scholar 

  12. Valtonen M, Iissalo E, Kanto J, Rosenberg P. Propofol as an induction agent in children: pain on injection and phar-macokinetics. Acta Anaesthesiol Scand 1989; 33: 152–5.

    PubMed  CAS  Article  Google Scholar 

  13. Fahy LT, Van Mourik GA, Utting JE. A comparison of the induction characteristics of thiopentone and propofol (2, 6-di-isopropyl phenol). Anaesthesia 1985; 40: 939–44.

    PubMed  Article  CAS  Google Scholar 

  14. Short SM, Aun CST. Haemodynamic effects of propofol in children. Anaesthesia 1991; 46: 783–5.

    PubMed  Article  CAS  Google Scholar 

  15. Herregods L, Rolly G, Versichelen L, Rosseel MT. Propofol combined with nitrous oxide-oxygen for induction and maintenance of anaesthesia. Anaesthesia 1987; 42: 360–5.

    PubMed  Article  CAS  Google Scholar 

  16. Egan TD, Brock-Utne JG. Asystole after anesthesia induction with a fentanyl, propofol, and succinylcholine sequence. Anesth Analg 1991; 73: 818–20.

    PubMed  Article  CAS  Google Scholar 

  17. Bevan DR. Anaesthesia pharmacoeconomics (Editorial). Can J Anaesth 1993; 40: 693–5.

    PubMed  CAS  Google Scholar 

  18. Schreiner MS, Nicolson SC, Martin T, Whitney L. Should children drink before discharge from day surgery? Anesthesiology 1992; 76: 528–33.

    PubMed  CAS  Article  Google Scholar 

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Affiliations

  1. Departments of Anesthesiology and Paediatrics, Children’s National Medical Center and George Washington University Medical Center, Washington, D.C.

    Raafat S. Hannallah, John T. Britton, Patrick G. Schafer, Ramesh I. Patel & Janet M. Norden

Authors
  1. Raafat S. Hannallah
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  2. John T. Britton
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  3. Patrick G. Schafer
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  4. Ramesh I. Patel
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  5. Janet M. Norden
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Supported by a grant from ICI Pharmaceuticals Groups, Inc., Wilmington, Delaware.

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Hannallah, R.S., Britton, J.T., Schafer, P.G. et al. Propofol anaesthesia in paediatric ambulatory patients: a comparison with thiopentone and halothane. Can J Anaesth 41, 12–18 (1994). https://doi.org/10.1007/BF03009654

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Key words

  • Anaesthesia: paediatric
  • Anaesthetics, Intravenous: propofol, thiopentone
  • Aanaesthetics, Inhalational: halothane