Total intravenous propofol and remifentanil versus balanced anesthesia with sevoflurane and remifentanil for pediatric lower abdominal surgery

Background This study aimed to evaluate and compare the induction, the maintenance, hemodynamic responses and the recovery profile of propofol-remifentanil combination (total intravenous anesthesia) and sevoflurane-remifentanil under the Bispectral index for pediatric patients undergoing short lower abdominal surgery. Materials and methods Sixty ASA physical status I and II patients aged 3–10 years scheduled for elective lower abdominal procedure were assigned to receive either the propofol and remifentanil combination (group P/R = 30 patients) or sevoflurane and remifentanil (group S/R = 30 patients) under Bispectral index monitoring. In both groups, anesthesia was started with remifentanil infusion (0.5 μg/kg/min) for 2 min. In the P/R group, a bolus dose of propofol 2 mg/kg was given, and then the infusion was started (7.5 mg/kg/h) and reduced gradually to 3 mg/kg/h. In the S/R group, sevoflurane 2 vol% in 100% O2 was added and increased gradually to 8 vol%, and then reduced to 4, 3, 2 vol%. Results Induction of anesthesia was rapid in the P/R group (2.3 ± 0.7 min) compared with the S/R group (2.6 ± 1.3 min). Hypotension occurred after induction 10% in the P/R group versus 30% in the S/R group. Bradycardia was a defining feature in the P/R group only. Group P/R achieved rapid extubation in 12 min and was transferred to the postanesthesia care unit, in 17 min compared with 15 and 20 min, respectively, in the S/R group. Conclusion This study indicates that the propofol-remifentanil combination is superior to the sevoflurane-remifentanil combination, with faster induction and recovery, although both techniques are considered to be safe and effective for providing anesthesia to pediatric patients.