Comparison of the effects of desflurane and sevoflurane on emergence characteristics in pediatric patients premedicated with ketamine

Abstract

Objectives: Desflurane may be useful for ambulatory anesthesia. However, desflurane-induced airway irritability makes its use challenging, especially in children. Ketamine can be used to reduce separation anxiety and emergence agitation (EA). However, ketamine may increase bronchial secretions. This study compared desflurane with sevoflurane anesthesia, in terms of emergence time and EA, in preschool children with intravenous (IV) ketamine premedication. Methods: Fifty-six children were scheduled for elective epiblepharon surgery. In the waiting room, ketamine (1 mg/kg) was intravenously administered to patients to reduce separation anxiety. After transport to the operating room, general anesthesia was induced with sevoflurane. The anesthetic agent was changed to desflurane in the desflurane group (group D), while sevoflurane was continued in the sevoflurane group (group S) during surgery. Emergence time (time to gag reflex and time to extubation) and EA (measured using the Pediatric Anesthesia Emergence Delirium [PAED] scale) were compared between the two groups. Respiratory complications were also recorded. Results: Time to gag reflex (611.1 ± 288.9 s vs. 275.0 ± 126.7 s, P < 0.001) and time to extubation (756.3 ± 267.2 s vs. 425.9 ± 122.9 s, P < 0.001) were significantly shorter in group D than group S. EA did not differ between the two groups. There were no severe respiratory complications. Conclusions: Emergence time was shorter for desflurane anesthesia than sevoflurane anesthesia in preschool children who received IV ketamine premedication. Desflurane anesthesia with IV 0.1 mg/kg of ketamine premedication could be used safely in pediatric ophthalmic surgery; there were no significant respiratory events.