Intravenous anesthesia with target-controlled infusion of propofol and intravenous infusion of remifentanil in pediatric patients: comparison with combined isoflurane inhalation and propofol infusion anesthesia

Objective To compare a propofol-remifentanil anesthesia with an isoflurane anesthesia with regard to the intraoperative hemodynamics and recovery characteristics in children. Methods Forty children (aged 4-12 years, ASAⅠ-Ⅱ) scheduled for adenotonsillectomy were randomly assigned to receive total intravenous anesthesia (TIVA group, n=20) and combined isoflurane anesthesia(C group, n=20). After standard i.v. induction of anesthesia in both groups, TIVA was maintained with target-controlled infusion of propofol and intravenous remifentanil, while C anesthesia was maintained with isoflurane and intravenous propofol. At the end of surgery, the anesthetics were terminated. SBP, DBP, HR, SpO_2 and ECG were monitored during anesthesia. The recovery of spontaneous breathing, time of extubation, time of eye opening, OAA/S scores, incidence of agitation and incidence of nausea and vomiting, were noted after operation. Results Both anesthesia methods resulted in stable hemodynamics, but in C group, the HR was significantly higher and there was a higher incidence of agitation. The interval between the termination of anesthetics and the full recovery of spontaneous breathing, eye opening and tracheal extubation, did not differ significantly in the two groups.The OAA/S scores at extubation and 1 h later were significantly higher in TIVA group than in C group. Conclusion In children, TIVA with remifentanil and TCI propofol is well tolerated, causing a lower peroperative heart rate and resulting in a better recovery than isoflurane anesthesia.