[Paediatric anaesthesia: inhaled or intravenous technique?]

Abstract

Total intravenous anaesthesia has recently gained more interest in paediatric anaesthesia. However, the global experience with children is limited, therefore, the knowledge acquired in adult practice is often applied uncritically to the paediatric patient. Induction of anaesthesia by mask is a widely used and generally accepted technique; it has gained even more popularity since the introduction of sevoflurane into clinical practice. This drug has markedly improved the safety because of the reduced cardiovascular side-effects. The availability of venous access is a prerequisite for intravenous induction. Pain on injection, bradycardia, and difficulties in dosing the individual patient are the main drawbacks. Inhaled anaesthetics allow to monitor breath by breath the individual pharmacokinetics. On the other hand, maintenance of anaesthesia by an intravenous infusion of propofol is mainly based on assumptions, even when the drug is administered by computer-controlled pumps. Large aberrations from the predicted values can occur in the individual patient. Intraoperative awareness is possible, however, its incidence is generally underestimated. Paravenous infusion and pump dysfunction are typical complications of an intravenous technique. A reduced incidence of postoperative vomiting and agitation are recognised advantages of an intravenous technique. Propofol-infusion-syndrome results from prolonged administration in children and in adults. It can even occur after the use of the substance for a few hours. The duration of a safe period for administration is completely unknown, especially for neonates and infants. In summary, both techniques can be used in children; both have advantages and drawbacks. Because the experience with small children is very limited, we have to re-evaluate our practice with a critical eye day by day.