Comparison between total intravenous anesthesia using propofol or dexmedetomidine versus sevoflurane during anesthesia of children undergoing bone marrow aspiration

Abstract

Background Although bone marrow aspiration (BMA) in children is a familiar short duration procedure, nearly 65% of patients develop sever anxiety that may extend more beyond, up to chronic postoperative behavioral changes. Consequently, the objectives of any related anesthetic technique is to afford smooth nontraumatic induction with safe maintenance and rapid recovery. The rational of the current study is to assess the outcomes of total intravenous anesthesia (TIVA) using propofol or dexmedetomidine versus sevoflurane for maintenance of anesthesia in children scheduled for BMA. Patients and methods A total of 60 children aged 3–12 years of American Society of Anesthesiologists physical status I and II, who planned to undergo elective BMA and biopsy were enrolled randomly to one of three groups (20 child each) receiving either sevoflurane inhalational anesthesia for induction, then sevoflurane and fentanyl infusion for maintenance (group S), propofol infusion for induction afterward propofol and fentanyl infusions for maintenance of anesthesia (group P) or dexmedetomidine infusion for induction after that dexmedetomidine and fentanyl infusions for maintenance (group D). The primary endpoint was postoperative sedation score on arriving the postanesthetic care unit after the procedure. Secondary outcomes included procedure duration, hemodynamic variables, parents and surgeons satisfaction and incidences of any adverse events. Results Hemodynamics revealed statistically comparable significant decrease in the three studied groups relative to the preoperative baseline levels. Values of oxygen saturation in group D showed significant increase relative to those of group P. Time for spontaneous eye open were significantly shorter in group P comparable to the other two groups (P<0.001). Members of group D were more sedated relative to the other two groups. Satisfaction of both parents and surgeons were significantly higher in the group D relative to the other two studied groups (P<0.05). Conclusion TIVA with dexmedetomidine can be a superior alternative to TIVA with propofol or sevoflurane for maintenance of anesthesia in children scheduled for BMA in consequence of favorable hemodynamic stability and smooth recovery profile.