Induction, emergence and recovery characteristics were compared during
sevoflurane or
halothane anaesthetic in a large (428) multicentre, international study of children undergoing elective inpatient
surgical procedures. Two hundred and fourteen children in each group underwent inhalation induction with
nitrous oxide/
oxygen and
sevoflurane or
halothane. Incremental doses of either study
drug were added until loss of eyelash reflex was achieved. Steady state concentrations of anaesthesia were maintained until the end of surgery when anaesthetic agents were terminated simultaneously. Time variables were recorded for induction, emergence and the first need for
analgesia in the recovery room. In addition, in 86 of the children in both groups, venous blood samples were drawn for plasma
fluoride levels during and after surgery. There was a trend toward smoother induction (induction of anaesthesia without coughing, breath holding, excitement
laryngospasm,
bronchospasm, increased secretion, and
vomiting) in the
sevoflurane group with faster induction (2.1 min vs 2.9 min, P = 0.037) and rapid emergence times (10.3 min vs 13.9 min, P = 0.003). Among the children given
sevoflurane, 2% developed
bradycardia compared with 11% in the
halothane group. Postoperatively, 46% of the children in the
halothane group developed
nausea and or
vomiting versus 31% in the
sevoflurane group (P = 0.002). Two children in the
halothane group developed
cardiac dysrhythmia and were dropped from the study. In addition, a child in the
halothane group developed
malignant hyperthermia, received
dantrolene, and had an uneventful recovery. Mean maximum inorganic
fluoride concentration was 18.3 microM.l-1. The
fluoride concentrations peaked within one h of termination of
sevoflurane anaesthetic and returned rapidly to baseline within 48 h. This study suggests that
sevoflurane may be the
drug of choice for the anaesthetic management of children.