Quality of Recovery in Pediatrics After Tonsillectomy Under Total Intravenous Anesthesia Versus Sevoflurane Anesthesia

Abstract

Mafalda Lisboa, Sonia Duarte, Catarina S Nunes and Humberto Machado

Introduction: Inhalational anesthetics are often the first choice in pediatric anesthesia. However, the most recent literature demonstrates possible advantages of total intravenous anesthesia (TIVA). The goal of this study was to compare the postoperative quality in children submitted to tonsillectomy under TIVA versus sevoflurane anesthesia.

Materials and Methods: Prospective observational case-control study (Sevoflurane vs TIVA) including children submitted to (adeno) tonsillectomy to compare the quality of anesthesia considering intra and postoperative parameters. Data was collected from clinical records, anesthetic monitoring and interviews.

Results: From the 52 children included, 25% received TIVA. TIVA group had a shorter time for liquid diet reintroduction (42 minutes vs. 95 minutes) (p<0.05) and the Sevoflurane group had a lower mean blood pressure variation (p=0.027). Mean wake up time was similar for both groups (11.3±6.2 minutes for TIVA and 11.6±5.3 minutes for Sevoflurane). In PACU, TIVA group demonstrated, although not statistically significant, a shorter time of stay (40 minutes vs. 41 minutes), less emergence delirium (7.7% vs. 12.5%) and less nausea and vomiting (0% vs. 5.1%). At 24 hours, TIVA group presented, although not statistically significant, less nausea and vomiting (7.7% vs 13.5%), lower pain (69.2% with <5 on the numerical pain scale vs 56.8%) and higher parental satisfaction (10 vs 8).

Conclusion: This study suggests that TIVA for tonsillectomy may be associated with better recovery quality. However, given the limited sample size of this study, it should be repeated in a larger sample, or in a multicentric study, for more robust conclusions.

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