Comparative safety assessment of maintenance of anesthesia with propofol or sevoflurane in reconstructive surgery on the hip joint in children with severe forms of cerebral palsy

Introduction. To date, we have an unsolved question about choosing the optimal drug for maintaining anesthesia during surgical interventions in children, suffering from severe forms of cerebral palsy, with the aim of preventively reducing the risks of developing perioperative adverse events.

The objective was to compare the incidence of perioperative adverse events in children with severe cerebral palsy using propofol or sevoflurane as a means of maintaining general anesthesia during orthopedic interventions on the hip joint.

Materials and methods. A prospective randomized comparative study included 170 patients with cerebral palsy, spastic hip dislocations, for which orthopedic interventions were performed. Depending on the drug used to maintain general anesthesia, the children were divided into two groups. In the first group, patients received propofol (CP-P), in the second – sevoflurane (CP-S). Hemodynamic parameters, time to tracheal extubation after the end of the operation, and the frequency of adverse events were assessed in the perioperative period.

Results. At the time of surgery, intergroup differences in hemodynamic parameters were recorded, while the time to tracheal extubation did not differ. Intraoperatively unstable hemodynamics was recorded in patients with CP-P in 8% (95% CI from 3.4% to 16.2%) of cases, in CP-C in 17% (95% CI from 12.1% to 30.1%) of cases (p = 0.07). Acute neurological and respiratory disorders were not detected (0%, 95% CI from 0% to 3.4%). Biochemical blood tests of patients in the groups differed in the level of aspartate aminotransferase, gamma-glutamyl transferase, and total bilirubin.

Conclusions. Propofol and sevoflurane as agents for maintenance of general anesthesia in children with severe cerebral palsy cause adverse perioperative events with equal frequency during orthopedic hip interventions and have the same safety profile.

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