Aanesthetic Agents for Day Surgery - NIHR Health Technology ...

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Literature review
TABLE 4 Comparisons under study in the paediatric review
Comparison No. of studies Studies
Propofol vs thiopentone induction 3 Cheng et al., 1998; 139 Hannallah et al., 1994; 146
into savings in resource use. Hannallah and
co-workers 146 found no reduction in length
of stay with propofol.
Inhalational versus intravenous induction
Four studies examined inhalational versus
intravenous induction. 144,146,148,161 Kotiniemi
and Ryhanen 148 reported a reduction in PONV
before and after discharge for halothane over
thiopentone. Viitanen and co-workers 161 did not
find any differences in PONV before or after discharge
or length of stay for propofol and sevoflurane.
Hannallah and co-workers 146 reported a
reduction in PONV before discharge for propofol
versus halothane, but also reported a reduction
in PONV after discharge in children induced
and maintained with halothane versus propofol.
Gurkan and co-workers 144 measured only emesis
and the number of occurrences of the oculocardiac
reflex during strabismus surgery. They
found less vomiting with propofol.
Sevoflurane versus halothane induction
Nine studies examined the use of sevoflurane
versus the use of halothane for induction and
maintenance. 13,143,147,149,151,153,155,164,166
Runcie et al., 1993 157
Propofol vs sevoflurane induction 2 Gurkan et al., 1999; 144 Viitanen et al., 1999 161
Halothane vs thiopentone induction 1 Kotiniemi and Ryhanen, 1996 148
Propofol vs halothane induction 4 Crawford et al., 1998; 140 Hannallah et al., 1994; 146
Ved et al., 1996; 160 Watcha et al., 1991 163
Sevoflurane vs halothane induction + maintenance 11 Sury et al., 1996; 13 Ariffin et al., 1997; 138 Greenspun
et al., 1995; 143 Johannesson et al., 1995; 147 Lermasn
et al., 1996; 149 Meretoja et al., 1996; 151 Naito et al.,
1991; 153 Piat et al., 1994; 155 Vitanen et al., 2000; 162
Walker et al., 1997; 164 Welborn et al., 1996 166
Propofol vs isoflurane maintenance 3 Davis et al., 1997; 141 Hamunen et al., 1997; 145
Martin et al., 1993 150
Halothane vs desflurane maintenance 2 Davis et al., 1994; 142 Welborn et al., 1996 166
Propofol vs halothane maintenance 4 Moore and Underwood, 1994; 152 Reimer et al.,
1993; 156 Ved et al., 1996; 160 Weir et al., 1993 165
Halothane ± nitrous oxide 4 Pandit et al., 1995; 154 Splinter et al., 1995; 158
Crawford et al., 1998; 140 Watcha et al., 1999 163
Propofol vs sevoflurane maintenance 2 Gurkan et al., 1999; 144 Uezono et al., 2000 159
Sevoflurane vs halothane maintenance 2 Ariffin et al., 1997; 138 Viitanen et al., 2000 162
Intravenous versus inhalational maintenance
Three studies compared isoflurane with propofol.
141,145,150 Davis and co-workers 141 and Hamunen
and co-workers 145 reported no reduction in PONV
before discharge. Martin and co-workers 150
measured PONV before and after discharge and
reported a reduction in both parameters. Martin
and co-workers 150 and Davis and co-workers 141
reported no change in length of stay with the
two regimens.
Four studies compared propofol with
halothane. 152,156,160,165 Reimer and co-workers 156
reported that, in a study of strabismus patients,
the use of propofol with or without the use of
N 2O decreased only early emesis when compared
with thiopentone or halothane; the overall rate of
PONV was not reduced. All studies reported no
reduction in PONV before discharge. Moore and
Underwood 152 measured the rate of PONV after
discharge, and reported no reduction. No studies
reported a difference in length of stay. Ved and
co-workers 160 found less vomiting with propofol,
but no difference in discharge times or admission
rates. Weir and co-workers 165 measured only
emesis, and found less with propofol.