Comparative Study between Isoflurane, Sevoflurane and Desflurane in Neurosurgical Paediatric Patients Undergoing Craniotomy for Supratentorial Tumour Resection

Background: The aim of this prospective, comparative and randomized study was to compare the inhalational anaesthetics isoflurane, sevoflurane and desflurane in pediatric patients undergoing craniotomy for excision of supratentorial tumours. We assessed early postoperative recovery outcome, intra-operative haemodynamics and degree of brain swelling, as well as postoperative vomiting and shivering. Methods: Sixty patients scheduled for supratentorial brain tumour excision were randomly allocated into one of three groups (20 patients each); isoflurane, sevoflurane, and desflurane group. After IV induction of anaesthesia, maintenance was achieved using the inhalational anaesthetic according to its group. Emergence and tracheal extubation times and the interval time needed to reach Aldrete score ^9 were the primary endpoints. The secondary endpoints included intraoperative degree of brain swelling, intraoperative HR and MAP as well as postoperative vomiting and shivering. Results: The mean emergence time, extubation time and the interval required to reach Aldrete score 9 were significantly shorter in desflurane and sevoflurane groups than isoflurane group. No statistically significant changes in the three groups regarding intraoperative brain swelling, haemodynamics, and postoperative shivering or vomiting. Conclusion: Desflurane and sevoflurane can be used safely in maintenance of anesthesia in neurosurgical paediatric patients. Emergence times are shorter with desflurane or sevoflurane than with isoflurane. They have similar intraoperative and postoperative incidence of adverse effects compared with those who received isoflurane. Thus, desflurane can be considered to be a suitable alternative to isoflurane for paediatric neurosurgical anaesthesia.