Recovery and Vomiting after Pediatric Tonsillectomy with or without Adenoidectomy: Comparison between TIVA using Propofol and Thiopentone Induced Halothane Maintained Anesthesia
Iraqi Postgraduate Medical Journal,
2017, Volume 16, Issue 2, Pages 122-128
Vomiting in the first few hours after recovery is considered as the main factor that delayed hospital discharge in pediatric outpatient surgery . Children having tonsillectomy with or without adenoidectomy operations have a high incidence of vomiting. Propofol has a short duration of action with rapid recovery and a proved antiemetic effect. Using propofol in total intravenous anesthesia, the incidence of vomiting is lower than the traditional thiopentone induced halothane maintained technique.
The aim of the study is to compare recovery characteristics and vomiting between total intravenous anesthesia using propofol as the sole anesthetic agent with the anesthetic technique using thiopentone for induction and halothane for maintenance to assess which is more suitable for outpatient pediatric surgery.
PATIENTS AND METHOD:
Forty healthy unpremedicated children, ASA Ӏ, aged 7-12 years undergoing tonsillectomy with or without adenoidectomy were randomly allocated into 2 groups. Group (1) children were induced with 2-3 mg.kg-1 propofol while group (2) children were induce with thiopentone 5-6 mg.kg-1 . Maintenance was 0.2 mg.kg-1 propofol in group (1) and 0.8% halothane in group (2). Both groups received 0.5mg.kg -1 atracurium to facilitate intubation and maintain muscle relaxation. Oxygen 100% was administered to both groups. Other treatment and procedures were standardized intra and postoperatively . Extubation time, time for spontaneous eye opening and the state of recovery after thirty minutes were compared. Results of postoperative vomiting were analyzed in the first 6 hours and beyond that.
Extubation time in group (1) was 4.75 ± 0.89 minutes and in group (2) it was 8.87 ± 1.86 minutes. The time for spontaneous eye opening in group (1) was 5.5 ± 1.22 minutes and in group (2) it was 13.125 ± 1.69 minutes. Both were significantly different . Nevertheless, both groups had a comparable modified Aldrete score which consists of 10 points and a score of 8-10 is considered ready to discharge to the general care unit. All patients in group (1) had a score of 10, while 1 patient had a score of 10, 14 patients with 9 and 5 patients with 8 in group (2). The incidence of vomiting in the first 6 hours after recovery was significantly lower in group (1) as well as the incidence after 6 hours. The same is applied to the incidence of recurrent vomiting (˃ 1 attack) in the first 6 hours, while recurrent vomiting after 6 hours were comparable in both groups. The overall incidence of recurrent vomiting was 35% in group (2) and 0% in group (1).
Despite a comparable recovery, propofol has a lower incidence of vomiting after tonsillectomy with or without adenoidectomy in healthy children than thiopentone induced halothane maintained anesthesia and is more suitable for outpatient pediatric surgery.
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