Christopher Heard1, Michael Harutunians, James Houck, Prashant Joshi, Kristin Johnson, Jerrold Lerman. 1. From the *Department of Anesthesiology, †Division of Pediatric Critical Care, ‡Department of Community and Pediatric Dentistry, ¶Department of Clinical Pharmacy, Women and Children's Hospital of Buffalo, Buffalo, New York; §Division Pediatric Critical Care, Children's Hospital and Medical Center, Omaha, Nebraska; and ‖Department of Anesthesiology, University of Rochester, Rochester, New York.
Abstract
BACKGROUND: Both propofol infusions with oxygen delivered through nasal cannula and isoflurane/N2O (nitrous oxide) delivered via a laryngeal mask airway (LMA) are used to provide anesthesia for children undergoing magnetic resonance imaging scans. We compared the incidence of adverse events and perioperative physiologic responses in children anesthetized with these 2 regimens. METHODS:One hundred-fifty healthy children, ages 1 to 10 years, were randomized to receive either a propofol infusion (starting at 300 µg kg·min) with oxygen via nasal cannula (n = 75) or isoflurane with 70% N2O in oxygen delivered via an LMA (n = 75), both after a sevoflurane/N2O/oxygen induction. Adverse airway events, as well as hemodynamic, respiratory, and other physiologic responses were recorded during the magnetic resonance imaging scans and in the postanesthesia care unit by a single research nurse who was blind to the treatments. All parents were contacted postoperatively to complete a postanesthetic follow-up. RESULTS:All 150 children completed their scans. The frequency of all adverse airway events during emergence and recovery after propofol (12%) was significantly less than that after isoflurane/N2O/LMA (49%) (95% confidence interval for the risk difference was 23%-50%) (P = 0.0001). Hemodynamic responses and recovery times for the 2 treatments were similar. Early recovery, defined as the time interval from admission to the postanesthesia care unit until eye opening and wakefulness (modified Aldrete score >5), after propofol was more rapid than that after isoflurane/N2O/LMA (P = 0.0001 and P = 0.0012, respectively). No scans had to be repeated. CONCLUSIONS: The frequency of adverse airway events during emergence and recovery after propofol infusion with oxygen by nasal cannula is less than with isoflurane/N2O/LMA in children.
RCT Entities:
BACKGROUND: Both propofol infusions with oxygen delivered through nasal cannula and isoflurane/N2O (nitrous oxide) delivered via a laryngeal mask airway (LMA) are used to provide anesthesia for children undergoing magnetic resonance imaging scans. We compared the incidence of adverse events and perioperative physiologic responses in children anesthetized with these 2 regimens. METHODS: One hundred-fifty healthy children, ages 1 to 10 years, were randomized to receive either a propofol infusion (starting at 300 µg kg·min) with oxygen via nasal cannula (n = 75) or isoflurane with 70% N2O in oxygen delivered via an LMA (n = 75), both after a sevoflurane/N2O/oxygen induction. Adverse airway events, as well as hemodynamic, respiratory, and other physiologic responses were recorded during the magnetic resonance imaging scans and in the postanesthesia care unit by a single research nurse who was blind to the treatments. All parents were contacted postoperatively to complete a postanesthetic follow-up. RESULTS: All 150 children completed their scans. The frequency of all adverse airway events during emergence and recovery after propofol (12%) was significantly less than that after isoflurane/N2O/LMA (49%) (95% confidence interval for the risk difference was 23%-50%) (P = 0.0001). Hemodynamic responses and recovery times for the 2 treatments were similar. Early recovery, defined as the time interval from admission to the postanesthesia care unit until eye opening and wakefulness (modified Aldrete score >5), after propofol was more rapid than that after isoflurane/N2O/LMA (P = 0.0001 and P = 0.0012, respectively). No scans had to be repeated. CONCLUSIONS: The frequency of adverse airway events during emergence and recovery after propofol infusion with oxygen by nasal cannula is less than with isoflurane/N2O/LMA in children.