Comparison of two rapid recovery anaesthetic techniques using propofol versus sevoflurane in adjustable strabismus surgery

Background: Suture adjustment in strabismus surgery in children requires fast recovery. This study was performed to compare two different anaesthetic techniques as regards recovery profile and the occurrence of complications. Methods: Thirty children, aged 4-10 years and scheduled for adjustable strabismus surgery were randomly divided into two equal groups to receive either propofol or sevoflurane, combined with nitrous oxide (50%), remifentanil infusion and mivacurium infusion. Times to extubation (ET), to spontaneous eye opening (SEOT), and to obeying commands (OCT) were recorded. Complications, namely postoperative nausea and vomiting (PONV), chest rigidity or emergence agitation, were recorded. 'Near' measurements of horizontal alignment using prism and alternate cover test were taken in the primary gaze immediately, 24 hours and 6 months postoperatively. Results: Sevoflurane group had significantly shorter recovery times [ET, SEOT and OCT of 9 (1.1) min, 12 (2) min and 13 (2.1) min, respectively] as compared to propofol [13 (1) min, 15 (2.3) min, 16 (1.2) min, respectively; P < 0.05]. PONV and agitation occurred more often with sevoflurane [6 patients] than propofol [1 patient; P < 0.05], while chest wall rigidity was comparable in the two groups. Drift from immediately after recovery to 24 hours was 13.28 (7.78) prism dioptres (PDs), from 24 hours postoperatively to 6 months postoperatively was -7.85 (13.1) PDs, and from immediately after recovery to 6 months postoperatively was -5.42 (9.29) PDs. Conclusion: Both techniques used in the study provided sufficiently faster recovery to allow for surgical adjustment. Sevoflurane had statistically, but not clinically, faster recovery profile, albeit with more incidence of PONV and emergence agitation.