Total Intravenous Anesthesia (TIVA)/Sevoflurane Initiated Intravenous Anesthesia (SIIVA) in Pediatric Patients

Study Overview
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Brief Summary
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Because Propofol is the primary anesthetic agent, and inhalational agents remain in trace quantities at the end of the procedure Sevoflurane initiated intravenous anesthesia (SIIVA) or not present at all Total intravenous anesthesia (TIVA) it is likely that different criteria may be predictive of extubation success in these patients compared to inhalational anesthesia.

Detailed Description
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This is because these anesthetic regimens have different pharmacologic mechanisms of actions, and therefore interact with central nervous system in different ways leading to potentially the need for different extubation criteria in patients receiving TIVA or SIIVA. Additionally, intravenous agents likely have less of an effect on airway reflexes and ventilation at light levels of anesthesia. This study is proposing an observational study to examine the predictive value of various extubation criteria in the setting of SIIVA and TIVA.

Official Title
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A Prospective Observational Study Evaluating Extubation Criteria in Children Less 10 Years of Age and Younger Undergoing Intravenous Anesthesia

Conditions
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Extubation

Intervention / Treatment
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* Other: Total intravenous anesthesia (TIVA)
* Other: Sevoflurane initiated intravenous anesthesia (SIIVA)


Participation Criteria
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Eligibility Criteria
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Inclusion Criteria: Pediatric patients <10 years of age Undergoing elective or emergency surgery with planned airway instrumentation with an endotracheal tube (ETT) Patients having general anesthesia with a planned SIIVA or TIVA technique Patients with an end tidal agent concentration of Sevoflurane<0.1% at the time of emergence and extubation following sevoflurane induction to place IV Exclusion Criteria: History of home oxygen use or ventilator dependence Patients with cyanotic congenital heart disease Patients undergoing anesthesia for imaging procedures alone Patients intended to be managed with supraglottic airway Patients having an anesthesia time < 30 minutes Monitored Anesthesia Care (not general anesthesia) Patients with contraindication to receiving Propofol (i.e. mitochondrial myopathy)

Ages Eligible for Study
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Maximum Age: 9 Years

Sexes Eligible for Study
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All

Accepts Healthy Volunteers
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No

Study Plan
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How is the study designed?
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Arms and Interventions

| Participant Group/Arm | Intervention/Treatment |
| --- | --- |
| Total intravenous anesthesia (TIVA)<br>TIVA is achieved without inhalational agents and may be performed in cases where patients have an intravenous line in place prior to induction of anesthesia | Other: Total intravenous anesthesia (TIVA)<br>* TIVA anesthetic -no inhalational gases for surgery<br>|
| Sevoflurane initiated intravenous anesthesia (SIIVA)<br>SIIVA is a modification of TIVA in the setting where a patient does not tolerate the insertion of an intravenous line prior to induction of anesthesia. The patient undergoes induction of anesthesia with sevoflurane and transition to Propofol IV anesthesia for maintenance once the intravenous line is in place and discontinues the inhalational agent, sevoflurane. | Other: Sevoflurane initiated intravenous anesthesia (SIIVA)<br>* SIIVA - sevoflurane anesthetic gases for surgery<br>|

What is the study measuring?
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Primary Outcome Measures

| Outcome Measure | Measure Description | Time Frame |
| --- | --- | --- |
| Extubation success rate | quality of extubation will be assess using a standard rubric for all extubation | Day 1 | 

Secondary Outcome Measures

| Outcome Measure | Measure Description | Time Frame |
| --- | --- | --- |
| Rate of extubation that requiring intervention | desaturation, laryngospasm, airway obstruction or other issues | Day 1 | 

 Terms related to the study
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Keywords Provided by Centre Hospitalier Valida
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anesthesia, Propofol, inhalational agents