Sevoflurane and Laryngeal Mask Airway Versus Propofol Infusion and Facemask for EUA in Children
- Conditions
- AnesthesiaChildren, Only
- Interventions
- Registration Number
- NCT06656455
- Lead Sponsor
- American University of Beirut Medical Center
- Brief Summary
The goal of this clinical trial is to find out the optimal technique of anesthesia for eye examination in children. The main question it aims to answer is:
Is propofol infusion and simple oxygen facemask associated with earlier discharge from the operating room, and hence rapid turnover and greater efficiency compared to sevoflurane via LMA? Researchers will compare time to discharge from the operating room to see if eye examination for children less than 7 years using a propofol infusion pump based anesthesia and simple oxygen facemask results in a shorter discharge time from the operating room in comparison with sevoflurane via LMA.
Participants will will be assigned to receive general anesthesia by one of two treatment groups.
- Detailed Description
Children younger than 5 years can be uncooperative during an examination and may render it impossible. The main objective of anesthesia for ophthalmic examination is to provide ideal conditions for optimal exam with a quick onset and offset of anesthesia as well as rapid recovery and early discharge. Two commonly used sedation techniques for young children are: sevoflurane via laryngeal mask airway (LMA) or propofol infused intravenously. Both have been shown to be safe and effective and allow rapid changes in anesthesia depth and minimal postoperative morbidity. However, their induction, emergence characteristics, and side effect profiles may differ. From previous studies, it is still not evident whether propofol infusion using oxygen facemask or sevoflurane administration via LMA is superior with respect to earlier discharge from operating room in children undergoing eye examination under anesthesia (EUA).
In the literature, there are no studies directly comparing those two different techniques for ophthalmic examination.
The aim of this study is to find out the optimal technique of anesthesia for eye examination in children resulting in earlier discharge from the operating room thus decreasing the turnover time between cases and providing optimal surgical conditions, without interfering with the well-being of the child or compromising the airway security.
In a prospective randomized study, a total sample of 60 children scheduled for eye examination under anesthesia (30 in each arm of the study) aged between 1-7 years with American Society of Anesthesiologists physical status 1 to 3 will be assigned to receive general anesthesia by one of two treatment groups. After induction with sevoflurane 8% in oxygen, patients randomized to group S will be given propofol 2 mg/kg and fentanyl 1µg/kg intravenously and anesthesia will be maintained with sevoflurane via LMA. Patients randomized to group P will be given propofol 1 mg/kg and fentanyl 1µg/kg intravenously and anesthesia will be maintained with a continuous infusion of propofol 200 µg/kg/min with oxygen 3 L/min via simple mask and oral airway if needed. In both groups sevoflurane concentration or propofol infusion will be titrated to keep optimal conditions. The primary outcome is time to discharge from the operating room. Secondary outcomes are surgical conditions, respiratory events, agitation and other side effects as well as recovery times. Normally distributed data will be summarized as mean ± SD and nonnormally distributed data will be summarized as median \[interquartile range\].
It is believed that propofol infusion and simple oxygen facemask will be associated with earlier discharge from the operating room, and hence rapid turnover and greater efficiency compared to sevoflurane via LMA. This study would have an impact on the current practice for pediatric ophthalmic EUA and may help find out the best technique that decreases the turnover time between cases resulting in higher operating time efficiency while providing optimal surgical conditions and patients' safety.
Recruitment & Eligibility
- Status
- COMPLETED
- Sex
- All
- Target Recruitment
- 60
- Children presented to the Operating Room of the American University of Beirut Medical Center
- 1 to 6 years old
- With American Society of Anesthesiologists physical status 1-3
- Scheduled for ophthalmic EUA with or without laser/cryotherapy procedure
- Children with full stomach or significant aspiration risk (including hiatal hernia)
- Children who are morbidly obese or have a current upper respiratory tract infection
- Children who have oropharyngeal pathology (e.g., radiotherapy for hypopharynx/larynx), tracheostomies, or a family history of malignant hyperthermia
- Children of parents who refuse to give consent
- Children having allergy to the anesthetics used
- Any surgical procedure expected to last for more than 60 minutes
Study & Design
- Study Type
- INTERVENTIONAL
- Study Design
- PARALLEL
- Arm && Interventions
Group Intervention Description Group P Propofol with oxygen via simple mask Patients randomized to group P will be given propofol 1 mg/kg and fentanyl 1µg/kg intravenously and anesthesia will be maintained with a continuous infusion of propofol 200 µg/kg/min with oxygen 3 L/min via simple mask and oral airway if needed. Group S sevoflurane via LMA Group S will be given propofol 2 mg/kg and fentanyl 1µg/kg intravenously and anesthesia will be maintained with sevoflurane via LMA
- Primary Outcome Measures
Name Time Method Time to discharge from the operating room Time from the end of surgery to discharge from OR, assessed up to 40 minutes Time to discharge from the operating room in minutes
- Secondary Outcome Measures
Name Time Method Duration of anesthesia From the start till the end of anesthesia, assessed up to 120 minutes Duration of anesthesia in minutes
Duration of surgical procedure From the start of eye examination till the completion of the procedure, assessed up to 60 minutes Duration of surgical procedure in minutes
Change in the airway management Number of participants with change in airway management assessed by the data collector during the procedure Change in the airway management
Ophthalmologist satisfaction score During the procedure Ophthalmologist satisfaction score measured on likert scale (ranging from 1 till 5 with 1 representing the least degree of satisfaction and 5 the highest).
Apnea During the procedure Apnea \>10 seconds
Desaturation During the procedure SPO2\<94%
Laryngospasm During the procedure Laryngospasm requiring treatment
Emergence agitation Immediately after the procedure Emergence agitation on a four-point scale
Interruption During the procedure Number of interruptions of EUA
Wake up time Time from the end of anesthesia drug administration to spontaneous eye opening, assessed up to 180 minutes Wake up time in minutes
PACU stay duration Time from arrival to PACU till achievement of an Aldrete score of 9, assessed up to 180 minutes PACU stay duration in minutes
Emesis Number of participants who developed emesis, assessed by the data collector immediately after the procedure Emesis
Administration of pain medication Number of participants who were administered pain medication, assessed by the data collector immediately after the procedure Administration of pain medication
Airway Obstruction Number of participants who had an airway obstruction, assessed by the data collector during the procedure Airway Obstruction
Hypoventilation Number of participants who developed hypoventilation, assessed by the data collector during the procedure Hypoventilation
Excess secretions Number of participants who developed excess secretions, assessed by the data collector during the procedure Excess secretions
Induction time Time from anesthesia start to surgery start, assessed up to 60 minutes Induction time in minutes
Nonoperative time Time from anesthesia start to surgery start combined with the time to discharge from OR, assessed up to 60 minutes Nonoperative time in minutes
Trial Locations
- Locations (1)
American University of Beirut Medical Center
🇱🇧Beirut, Lebanon