Forty-two children (aged 2-16 years) were randomly assigned to receive either sevoflurane (n = 21) or halothane (n = 21) in nitrous oxide/oxygen. After pre-medication with midazolam, anaesthesia was induced by facemask and the anaesthetic concentration was increased until loss of eyelash reflex (sevoflurane, 6%; halothane, 2.5%). Thereafter, 1-1.5 MAC of the inhalational agents were maintained until skin closure. Intra-operative analgesia was provided either by intermittent intravenous (i.v.) bolus doses of fentanyl (2-3 micrograms kg-1) or by a regional blockade. Induction was smooth and the time to loss of eyelash reflex was slightly shorter with sevoflurane than with halothane, the difference not quite reaching statistical significance (P = 0.06). In both groups, heart rate remained stable and blood pressure decreased significantly during induction. Haemodynamic parameters remained stable during anaesthetic maintenance; no cardiac dysrhythmias were observed. Emergence time with sevoflurane was 12.9 min vs. 16.3 min with halothane, but this difference was not statistically significant. It is concluded that sevoflurane is as suitable for paediatric patients as halothane. The slightly faster emergence time offered by sevoflurane over halothane was of no clinical significance in the present study.
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Article Synopsis
- Halothane was the primary inhalational anesthetic for children from the late 1950s until the late 1990s, but it posed significant risks, particularly for neonates and infants, due to its negative effects on heart function.
- In neonates, halothane caused increased rates of hypotension and cardiac arrest because their hearts are still developing and are more sensitive to the drug compared to older children.
- By the late 1990s, newer anesthetics like sevoflurane, which had a safer profile for pediatric patients, led to halothane's decline and eventual removal from pediatric anesthesia in North America.
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