Sevoflurane, desflurane, and propofol are widely used in pediatric anesthesia because of their rapid recovery. However, emergence agitation is more reported with sevoflurane or desflurane than with propofol. Our clinical experience indicates emergence agitation with propofol is also frequent. We tested the hypothesis that depth of anesthesia could lead to frequent emergence agitation with propofol.

Sixty children, ASA 1, aged 3-12 years, undergoing general anesthesia for adenotonsillectomy were randomized to receive maintenance anesthesia with sevoflurane, desflurane, or propofol. The bispectral index was monitored and maintained within 40-65. Time to extubation, duration of postanesthetic care units stay, bispectral index just before stopping the anesthetic agent, anesthetic time, early and late postoperative Pediatric Anesthesia Emergence Delirium Scale (PAEDS), and Children's Hospital of Eastern Ontario Pain Scale (CHEOPS) were compared among the 3 groups. Data were analyzed using ANOVA (demographic data, measured time interval, BIS) and Kruskal-Wallis test (PAEDS and CHEOPS). The Spearman correlation coefficient was used to confirm the correlation between the two scales.

Although desflurane resulted in the fastest extubation, other scales were not statistically different. PAEDS and CHEOPS for sevoflurane showed a positive correlation in the early recovery period, but desflurane and propofol did not.

With the same depth of anesthesia, emergence agitation among desflurane, sevoflurane, and propofol was not different in children.