Comparison of Sevoflurane Versus Propofol for Maintenance of General Anesthesia and Their Effects on Emergence Delirium in Pediatric Patients

Abstract

Background: Emergence delirium is a common postoperative behavioral disturbance in children and may be influenced by the anesthetic technique used for maintenance of general anesthesia.

Objective: To compare sevoflurane and propofol for maintenance of general anesthesia with respect to the incidence and severity of emergence delirium, rescue sedation, recovery characteristics, and postoperative adverse events in pediatric patients.

Methods: This comparative study included 60 pediatric patients undergoing elective surgery under general anesthesia at The Childrens' Hospital & the University of Child Health Sciences, Lahore, over one year from January to December 2025. Patients were allocated equally to sevoflurane maintenance (Group S, n=30) or propofol maintenance (Group P, n=30). Emergence delirium was assessed using the Pediatric Anesthesia Emergence Delirium (PAED) scale at 5, 10, 15, 20, and 30 minutes after emergence; a PAED score ≥10 was considered emergence delirium. Rescue sedation, eye-opening and extubation times, postoperative FLACC pain score, PACU stay, and adverse events were recorded. A p-value <0.05 was considered statistically significant.

Results: Emergence delirium occurred in 15/30 (50.0%) children receiving sevoflurane compared with 6/30 (20.0%) receiving propofol (p=0.015). The mean peak PAED score was higher with sevoflurane (12.1 ± 4.8 vs. 8.0 ± 3.9; p<0.001), and rescue sedation was more frequently required (40.0% vs. 13.3%; p=0.020). Sevoflurane was associated with faster eye opening (6.9 ± 2.4 vs. 9.1 ± 3.0 minutes; p=0.003) and extubation (7.8 ± 2.5 vs. 10.2 ± 3.1 minutes; p=0.002), while postoperative pain scores and PACU stay were comparable.

Conclusion: Propofol maintenance was associated with a lower incidence and severity of emergence delirium and reduced rescue-sedation requirements compared with sevoflurane, although sevoflurane allowed faster initial emergence. Propofol may therefore provide smoother behavioral recovery in pediatric patients.