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BJA Advance Access published online on April 28, 2006
British Journal of Anaesthesia, doi:10.1093/bja/ael100
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© The Board of Management and Trustees of the British Journal of Anaesthesia 2006. All rights reserved. For Permissions, please e-mail: journals.permissions@oxfordjournals.org
Accepted March 20, 2006

Clinical Investigation

Prospective comparison of sevoflurane and desflurane in formerly premature infants undergoing inguinal herniotomy

S. M. Sale 1 *, J. A. Read 1, P. A. Stoddart 1, and A. R. Wolf 1

1 Department of Anaesthesia, Bristol Royal Hospital for Children, Upper Maudlin Street, Bristol BS2 8BJ, UK

* To whom correspondence should be addressed.
S. M. Sale, E-mail: steven.sale{at}mac.com


  Abstract

Background. Formerly premature infants having inguinal herniotomy have been at a high risk of postoperative apnoea, newer less soluble anaesthetic agents may reduce this risk.

Methods. Thirty infants, under 37 weeks gestation and under 47 weeks post-conceptional age, undergoing inguinal herniotomy had an inhalational induction with sevoflurane and were randomly allocated to sevoflurane (group S) or desflurane (group D) for maintenance. All infants received i.v. atracurium 0.5 mg kg-1, rectal acetaminophen 20 mg kg-1 and caudal bupivacaine 0.25% 1 ml kg-1. Infants were monitored for apnoeas (using nasal thermistry and impedance), haemoglobin oxygen desaturations and bradycardias for 12 h before and after operation with an Alice® 4 polysomnograph. Emergence timings were recorded.

Results. There was no difference between pre- and postoperative incidence of apnoeas in either group, and no group difference between desflurane and sevoflurane in terms of pre- and postoperative ventilatory events or in the number of apnoeas in the postoperative period (nine patients in group D and five patients in group S had apnoeas). Median times to first movement, tracheal extubation, eye opening and first cry were all faster with group D (group D: 3.0, 10.0, 9.0 and 11.0 min and group S: 7.0, 15.1, 13.5 and 16.1 min, respectively). No infant had problems with airway irritation on emergence and no infant required airway intervention for apnoea.

Conclusions. Infants wake faster from general anaesthesia when maintained with desflurane as compared with sevoflurane, but no difference in postoperative respiratory events was demonstrated between the groups.

Keywords: anaesthesia, paediatric, newborn; anaesthesia, paediatric, premature; anaesthetics volatile, desflurane; anaesthetics volatile, sevoflurane.
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