Respiratory Adverse Events After LMA® Mask Removal in Children
A Randomized Trial Comparing Propofol to Sevoflurane
March 2023 by Dr Justin Skowno
This RCT in 134 low risk children having general anaesthesia with an LMA were randomized between propofol and sevoflurane anaesthesia, with fentanyl analgesia, awake LMA removal and other clinical processes standardized between groups. They measure the rates of post operative respiratory adverse events, and showed clearly that sevoflurane led to a higher rate across multiple metrics (cough, laryngospasm, desaturation) than propofol. Most of their propofol anaesthetics were “pure” TIVA, with only 3 needing sevoflurane inductions. Secondary outcomes measured included emergence agitation and PONV, and for both of these sevoflurane had higher rates than propofol. This study specifically follows up work done at Perth Children’s Hospital on PRAE and propofol-sevoflurane differences. It is methodologically rigorous and easy to read, with a good discussion section.
My main conflict of interest to declare is that I do virtually all my anaesthetics as TIVA, and so a paper like this is one I really like. It is very useful to guide your practice if you are not set in your ways yet. It looks at a very common anaesthetic recipe, applicable to a large number of procedures, and shows clearly that propofol has lower rates of respiratory complications, as well as PONV and emergence agitation (secondary outcomes). These are all things we specifically want to reduce in our patients, and the authors provide a useful head on head comparison to guide one’s choice. Over to you.