Recovery with Propofol Anesthesia in Children Undergoing Cleft Palate Repair Compared with Sevoflurane Anesthesia

Abstract

Background: Nowadays, propofol total intravenous anesthesia (propofol TIVA) is a very attractive choice for routine pediatric anesthesia practice. Objectives: To compare propofol- vs. sevoflurane-based anesthesia for pediatrics undergoing cleft palate repair in emergence characteristics and respiratory adverse effects. Methods: Eighty infants, aged from six months to one year, scheduled for cleft palate repair surgery, were randomly divided into two groups (40 patients each). The group I received general anesthesia induced with intravenous propofol 2.5 mg/kg, 0.1 mg/kg of lidocaine, fentanyl one µg/kg and cisatracurium 0.15 mg/kg, and maintained by a continuous infusion of propofol 9 mg/kg/hr and cisatracurium 3 µg/kg/hr. While in the group II, general anesthesia induced by O2/sevoflurane, intravenous fentanyl one µg/kg and cisatracurium 0.15 mg/kg then the maintenance was carried out by O2/air, sevoflurane 2 MAC, and cisatracurium three µg/kg/hr. Postoperative FLACC behavioral pain assessment Scale, modified Hannallah score, postoperative laryngeal spasm incidence, the recovery time, time to extubation, and postoperative complication were recorded. Results: The quality of emergence was assessed by modified Hannallah score, there was a significant decrease in the number of patients developed agitation after propofol TIVA in comparison to sevoflurane anesthesia (P < 0.001) with a significant decrease in the number of patients developed postoperative laryngeal spasm (P < 0.047). On the other hand, a significantly prolonged time of extubation was observed in the propofol TIVA group (P < 0.001). Conclusions: Propofol TIVA regimen was the more peaceful recovery approach with less perioperative respiratory complications than sevoflurane-based anesthesia in infants undergoing cleft palate repair surgery.