Complications of sevoflurane-fentanyl versus midazolam-fentanyl anesthesia in pediatric cleft lip and palate surgery: a randomized comparison study

Careful choice of anesthetic agents in pediatric patients reduces the frequency of anesthesia-related complications. The frequency and type of intraoperative and postoperative complications of sevofluranc-fentanyl versus midazolam-fentanyl anesthesia were compared in, 140 Consecutive Children (aged 3 months to 10 years) undergoing cleft lip and palate repair. Midazolam-fentanyl anesthesia was induced with midazolam (0.05 mg/kg), fentanyl (0.005 mg/kg) and vecuronium (0.1 mg/kg), and maintained with the same agents according to the defined parametars. Sevoflurane-fentanyl anesthesia was induced and maintained with sevoflurane (5-8 vol% and 0.8-1 vol%, respectively) in ail oxygen/air mixture and supplemented with fentallyl (0.005 mg/kg). Both groups were comparable in basic demographic data, hemodynamic and respiratory parameters. Difficult intubation occurred ill 6 of 76 children (midazolam-fentanyl group) and 4 of 64 children (sevoflurane-fentanyl group) (P=0.754). Ventricular extrasystole and bronchospasm occurred ill one patient each in the sevoflurane-fentanyl,group. Postoperatively, emergence agitation was observed in the sevoflurane-fentanyl group (17 cases; P < 0.001); postoperative nausea and vomiting Occurred in 2 children (midazolan-fentanyl group) and 3 children (sevofluranc-fentanyl group) (P = 0.660). Midazolam-based anesthesia ill children is safer than sevoflurane-based anesthesia regarding occurrence of emergence agitation.