Comparison of sevoflurane volatile induction/maintenance anaesthesia and propofol-remifentanil total intravenous anaesthesia for rigid bronchoscopy under spontaneous breathing for tracheal/bronchial foreign body removal in children.

BACKGROUND AND OBJECTIVE

Foreign body aspiration is a life-threatening condition, with children under 3 years of age most at risk. This study was designed to compare the clinical characteristics of sevoflurane volatile induction/maintenance anaesthesia (VIMA) and propofol-remifentanil total intravenous anaesthesia (TIVA) for children undergoing rigid bronchoscopy under spontaneous breathing for tracheal/bronchial foreign body removal.

METHODS

Sixty-four children undergoing rigid bronchoscopy were allocated randomly to receive sevoflurane (Group VIMA; n = 32) or propofol-remifentanil (Group TIVA, n = 32) between 2007 and 2009. Respiratory rate, heart rate and mean blood pressure were compared at the time points including baseline level (T 0); laryngoscopy (T lary); insertion of rigid bronchoscope (T bron); 5, 10 and 20 min during procedure (T 5 min, T 10 min, T 20 min); the end of procedure (Tend) and discharge (T dis). Induction time, emergence time, intubating condition scores and the incidence of adverse events were compared.

RESULTS

Time for loss of consciousness (Group VIMA 95.6 ± 15.2 s vs. Group TIVA 146.2 ± 26.9 s, P < 0.05), time of Bispectral Index value decreased to 40 (Group VIMA 115.3 ± 16.5 s vs. Group TIVA 160.4 ± 25.8 s, P < 0.05) and emergence time (Group VIMA 10.5 ± 2.6 min vs. Group TIVA 16.9 ± 3.1 min, P < 0.05) in Group VIMA were significantly shorter than those in Group TIVA. Intubating condition scores between the two groups were comparable (8.1 ± 0.9 in Group VIMA vs. 8.1 ± 1.0 in Group TIVA). The incidence rates of breath holding (Group VIMA 6.25% vs. Group TIVA 31.25%, P < 0.05) and desaturation (Group VIMA 15.63% vs. Group TIVA 37.50%, P < 0.05) in Group VIMA were significantly lower than those in Group TIVA. Heart rate, mean blood pressure and respiratory rate were significantly higher in Group VIMA than in Group TIVA.

CONCLUSION

Compared with propofol-remifentanil TIVA, sevoflurane VIMA provides more stable haemodynamics and respiration, faster induction and recovery and higher incidence of excitement in paediatric patients undergoing tracheal/bronchial foreign body removal under spontaneous breathing.