RESUMEN
UNLABELLED: We studied the emergence characteristics of unpremedicated children tracheally extubated while deeply anesthetized ("deep extubation") with isoflurane or sevoflurane. Forty children were assigned to one of two groups, Group I or Group S. At the end of the operation, Group I patients were extubated while breathing 1.5 times the minimum alveolar anesthetic concentration (MAC) of isoflurane. Group S patients were tracheally extubated while breathing 1.5 times the MAC of sevoflurane. Recovery characteristics and complications were noted. Group S patients were arousable sooner than Group I patients (10.1 + 6.5 vs 16.3 + 9.9 min). Later arousal scores and times to discharge were the same. There were no serious complications in either group. Breath-holding was more common in Group I. We conclude that the overall incidence of airway problems and desaturation episodes was similar between groups. Emergency delirium was common in both groups (32% overall: 40% for Group I, 25% for Group S). IMPLICATIONS: Deep extubation of children can be safely performed with either isoflurane or sevoflurane. After deep tracheal extubation, airway problems occur but are easily managed. Return to an arousable state occurred more quickly with sevoflurane, although time to meeting discharge criteria was not different between the two groups. Emergence delirium occurs frequently with either technique.
Asunto(s)
Anestésicos por Inhalación , Intubación Intratraqueal/métodos , Isoflurano , Éteres Metílicos , Adolescente , Nivel de Alerta , Niño , Preescolar , Delirio/etiología , Humanos , Lactante , Intubación Intratraqueal/efectos adversos , Sevoflurano , Factores de Tiempo , Vómitos/etiologíaRESUMEN
With careful attention to patient selection and anesthesia, as well as easy-to-manage dressings and urinary diversions, outpatient surgery for all degrees of hypospadias can be performed safely and economically. By using these techniques over an eighteen-month period all hypospadias operations were performed in the outpatient department. This included thirty-four minor operations as well as twenty-five major hypospadias repairs. Seven complications were encountered in the fifty-nine operations.