Abstract
Inhalation anesthetics have long been an essential part of supplemented and combined anesthesia administered to pediatric patients. Sevoflurane is currently used in most cases, with desflurane and nitrous oxide being used to a lesser extent.
Due to its properties, sevoflurane is intended both for smooth inhalation introduction and for anesthesia in all age groups of children, including newborns and premature infants. Supplemented with sufentanil and cisatracurium, or combined with levobupivacaine, it is the basis for safe general anesthesia characterized by circulatory stability and ease of control.
Desflurane is not suitable for inhalation as it irritates the respiratory tract. Both sevoflurane and desflurane have low neurotoxicity for a maturing child's brain.
Isoflurane has eliminated the risk of neurotoxicity from pediatric anesthesia. Emergence from sevoflurane anesthesia is rapid, and is only accompanied by postoperative nausea or vomiting in exceptional cases.
Sevoflurane and desflurane do not have an analgesic effect; therefore, postoperative analgesia must be provided after painful procedures. In 25-50% of cases, restlessness and confusion, known as emergence delirium (ED), are observed after inhalation anesthesia.
This is probably caused by a rapid emergence from the anesthesia and the inability of a small child to compensate for discomfort. It is more common where no sedative medicine has been used during the anesthesia.
This condition may be counteracted by the i.v. application of 1 mg/kg of propofol. It appears that inhalation of sevoflurane will long be a safe basis for pediatric anesthesia.
Neurotoxicity or other complications (e.g. malignant hyperthermia) should never be completely excluded. Therefore, anesthesia should be indicated prudently, its duration minimized, and artificial hypoxia, hypoglycemia, hypotension, hypothermia, and other factors that may compromise the success of the anesthesia of the child should be carefully eliminated.