Inhalation agents in pediatric anaesthesia - an update.

PURPOSE OF REVIEW: To present the most recent publications on inhaled agents in children and their implications for clinical care. RECENT
FINDINGS: The roles of clonidine, dexmedetomidine, ketamine and nalbuphine in the treatment of emergence delirium after sevoflurane and desflurane are discussed. Bispectral index monitoring has generated several curious findings in children. Halothane consistently produced higher Bispectral index readings than equi-minimum-alveolar-concentration multiples of ether anesthetics. Bispectral index readings increased as the sevoflurane concentration increased beyond 3%. Inhalation agents may cause two serious complications when administered to children with Duchenne's muscular dystrophy: hyperkalemia in younger children and myocardial depression in adolescents. Recovery after desflurane anesthesia is more rapid than with the other ether anesthetics in infants and children. Single-breath inductions are of interest in children >6 years for rapid anesthesia induction.
SUMMARY: Sevoflurane and desflurane continue to challenge our abilities to anesthetize children safely and efficiently. Although transient emergence delirium after insoluble agents is a problem, several medications may be used to attenuate it. Inhaled agents must be used with caution in children with Duchenne's muscular dystrophy as hyperkalemia may occur in young males and myocardial depression in adolescents. Rapid recovery after desflurane and single-breath inductions with sevoflurane continue to fascinate clinicians.