[Total intravenous anesthesia (TIVA) and balanced anesthesia with short-acting anesthetics for ENT surgery in children]

U Lodes
Anaesthesiologie und Reanimation 1999, 24 (1): 13-8
It was the aim of this study to compare total intravenous anaesthesia (TIVA) with balanced anaesthesia using modern short-acting anaesthetics for ENT-surgery in children regarding the influence on haemodynamics, recovery, side-effects and costs. After approval of the Ethics Committee of the Medical Faculty of the University of Rostock, 80 children in the age of 3 to 12 years, rectally premedicated with midazolam (0.3 mg/kg) and atropine (0.01 mg/kg), were randomly assigned to TIVA (group 1, n = 41) and balanced anaesthesia (group 2, n = 39), respectively. TIVA was induced with propofol (2 mg/kg) and remifentanil (1 microgram/kg) and maintained with propofol (6 mg/kg/h) and remifentanil (0.2 microgram/kg/min). Controlled ventilation was performed with an air/oxygen mixture (1:1). Balanced anaesthesia was induced with the method of "single breath induction" using sevoflurane (8 Vol.%) in a mixture of nitrous oxide/oxygen (2:1). For maintaining balanced anaesthesia under low flow conditions, sevoflurane concentration was reduced to 1 Vol.% while the nitrous oxide/oxygen mixture was kept constant. Additionally 0.1 microgram/kg/min of remifentanil was given. For controlled ventilation, the patients of both groups were primarily relaxed for intubation with mivacurium (0.2 mg/kg) under continuous monitoring using TOF-stimulation (TOF-Guard). Further relaxation was performed with doses of 0.05 mg/kg of mivacurium after relaxometric control reached T1-level > 20% and T2-level > 0. Haemodynamic parameters (heart rate, mean arterial blood pressure), awakening time (time until the first spontaneous movements occurred), recovery time (according to Aldrete-Score > 8), side-effects (sevoflurane-induced excitation and propofol-induced pain due to the injection during induction of anaesthesia, postoperative vomiting) and costs for anaesthetic agents and relaxants were registered. The investigation showed significantly higher heart rate (p < 0.05) and significantly lower mean arterial pressure (p < 0.05) during balanced anaesthesia than during TIVA. Between the two groups there were no statistically significant differences regarding awakening time, recovery time and incidence of postoperative vomiting. In the TIVA-group, pain due to injection of propofol occurred in 10 patients (24.4%) and in group 2 sevoflurane-induced excitation during induction was registered in 22 patients (56.4%). Based on our presently existing purchase prices for the drugs used, there were no significant differences between the costs for TIVA and balanced anaesthesia. We conclude that both TIVA and balanced anaesthesia performed with short-acting anaesthetics, are suitable anaesthetic methods for ENT operations in children. Because balanced anaesthesia with sevoflurane led to higher heart rates, this kind of anaesthesia should be used with caution in children with heart diseases. The main advantage of both methods is their short recovery time.

Full Text Links

Find Full Text Links for this Article


You are not logged in. Sign Up or Log In to join the discussion.

Related Papers

Remove bar
Read by QxMD icon Read

Save your favorite articles in one place with a free QxMD account.


Search Tips

Use Boolean operators: AND/OR

diabetic AND foot
diabetes OR diabetic

Exclude a word using the 'minus' sign

Virchow -triad

Use Parentheses

water AND (cup OR glass)

Add an asterisk (*) at end of a word to include word stems

Neuro* will search for Neurology, Neuroscientist, Neurological, and so on

Use quotes to search for an exact phrase

"primary prevention of cancer"
(heart or cardiac or cardio*) AND arrest -"American Heart Association"