A comparison of three general anesthesia techniques in children undergoing adenotonsillectomy

Objective To compare the induction, maintenance and recovery pattern of sevoflurane inhalation, sevoflurane inhalation supplemented with remifentanil infusion and propofol-remifentanil total intravenous anesthesia in children undergoing adenotonsillectomy. Methods Sixty hospitalized children aged 2～12 years undergoing adenoidectomy and (or) tonsillectomy were randomly allocated to 3 groups: In group S, the anesthesia was induced and maintained with sevoflurane; in group SR, the anethesia was induced with propofol and remifentanil, maintained with sevoflurane inhalation supplemented with remifentainl; in group PR, the anesthesia was induced and maintained with continuous intravenous infusion of propofol and remifentanil. All of the patients were administered with optimal doses of relaxtant to facilitate tracheal intubation after disappearance of eye lash reflex. The induction time, tracheal intubation time, extubation time, eyes opening time, consciousness recovery time, hemodynamic characteristics, and adverse events in the three groups were evaluated. Results The induction time in the three group was (90±16)s, (46±22)s and ( 51±14)s, (P﹤0.01) respectively. The time to intubation, extubation, eyes opening, and consciousness recovery were similar in the three groups, (P﹥0.05). Twelve cases (60%) had tachycardia and 1 case had hypertension in the S group, and 2 cases (5%,P﹤0.01 compare to group S)with tachycardia, 4 cases (10%)with bradycardia, and 9 cases (22.5%)with hypotension were found in the SR and PR group during the period of induction and intubation. The mean blood pressure after induction decreased(P﹤0.05), and the heart rate after the beginning of the procedure incrased(P﹤0.01), compared to the base line in all of the three goups with group S varied the most. Emergency agitation were observed in 16 cases (80%), 10 cases (50%), and 6 cases (30%) in group S, SR, and PR respectively, (P﹤0.01). Conclusions The induction and recovery is rapid and smooth in all three groups. Compared with total sevoflurane inhalational anesthesia, sevoflurane inhalation supplemented with remifentanil infusion, and propofol-remifentanil total intravenous anesthesia are associated with more stable hemodynamics, less emergency agitation, so are more suitable for the adenotonsillectomy in children.