Awakening properties of sevoflurane and isoflurane in paediatric patients undergoing surgery for spinal dysraphism

Background: Isoflurane had always been known to have neuroprotective properties. Sevoflurane by virtue of its low solubility provides rapid onset and offset of an aesthesia, thus facilitating early postoperative evaluation of the patients especially in the neurosurgical procedures. However superior role of sevoflurane to isoflurane in pediatric patients requiring intermediate lasting anaesthesia remains controversial. Therefore the aim of this prospective comparative randomized study was to compare inhaled anesthetics sevoflurane and isoflurane in paediatric patients undergoing surgery for spinal dysraphism on the basis of early post recovery outcomes, pain, intraoperative and postoperative hemodynamics, and postoperative side effects of both the agents. Materials and Methods: 60 patients scheduled for spinal dysraphism surgery of ASA physical status I & II, of either sexes, aged between 6 months - 6 years, were divided into two groups. After I.V. induction maintenance anesthesia was given on low-flow with inhalational agent as isoflurane for Group I (n=30), and sevoflurane for Group II (n=30). The primary end points being post-anaestheisa recovery, extubation time, discharge readiness in PACU and emergence agitation, While the secondary end points included intraoperative and postoperative Heat Rate, noninvasive blood pressure and SpO2 and postoperative complications such as nausea, vomiting, shivering, and desaturation episodes (SpO2<95%). Results: While faster times to awakening and extubation were observed with sevoflurane compared with isoflurane (p< 0.001), no difference in discharge readiness in recovery room was seen. Moreover, emergence agitation was almost absent in both the groups and no complications were observed in PACU during our observation period. Conclusion: Both isoflurane and sevoflurane can be used safely in maintenance of anaesthesia in pediatric patients undergoing spinal dysraphism surgery. Since isoflurane is a cheaper alternative, so in developing countries it could be preferred over sevoflurane on the basis of risk benefit ratio.