Sevoflurane, with its low pungency, rapid emergence and recovery, is an attractive anesthetic in paediatric anesthesia, but the high incidence of postoperative agitation represents a problem. Propofol-anesthesia is recognised for its rapid and clear-headed emergence. We tested the hypothesis that the maintenance of anesthesia with sevoflurane after propofol induction reduces the incidence of excitatory behavior compared with thiopental sodium induction.

Children aged 4-10 years, undergoing elective tonsillectomy, were randomly assigned to receive propofol 2.5 mg/kg (Group P) or thiopental sodium 5 mg/kg (Group T) for induction. After loss of consciousness, tracheal intubation was performed with rocuronium 0.6 mg/kg and all patients received sevoflurane (2-3 vol.%)-N₂O (2 L/min)-O₂ (2 L/min) for anesthesia maintenance. Ventilation was controlled to maintain normocarpnia. At the end of surgery, sevoflurane and N₂O were discontinued and muscle relaxant was reversed. Extubation time, agitation grade in recovery room, postoperative side effects and time in the recovery room were checked and compared between the two groups.

Time to extubation (6.84 ± 1.57 vs 8.48 ± 1.05 min), discharge from the recovery room(33.7 ± 3.9 vs 55.0 ± 7.9 min) and emergence agitation incidence (8% vs 92%) were significantly different in Group P and Group T, respectively (P < 0.05). The incidence of nausea and vomiting was not significantly different (4% vs 16%).

Emergence agitation after sevoflurane anesthesia was significantly reduced by propofol induction compared with thiopental sodium.