Document Type : original article


1 Associate Professor of Anesthesiology, Department of Anesthesiology, Labbafinejad Hospital, Shahid Beheshti University of Medical Sciences, Tehran, Iran.

2 Anesthesiologist, Labbafinejad Medical Center, Shahid Beheshti University of Medical Sciences, Tehran, Iran.

3 Associate Professor of Anesthesiology, Department of Anesthesiology, Labbafinejad Hospital, Shahid Beheshti University of Medical Sciences, Tehran, Iran


Background: Controlling the respiratory complications of anesthesia in children is one of the most challenging situations. The present study aimed to compare intravenous and inhalation anesthesia in respiratory adverse events in children under 7 with upper respiratory tract infection (URTI).
Method: All children with URTI referring to Labbafinejad hospital in Tehran for emergency surgery were randomly divided into two groups. The first group received Total Intra-Venous Anesthesia (TIVA) inducer and maintenance, and the second group received inhalation (Sevoflurane). The two groups were compared in terms of respiratory events at different times Laryngeal Mask Airway (LMA) implantation time, interoperation, LMA removal, and recovery).
Results: There were significant differences between the groups (p-value < 0.05) (1) before induction in terms of using respiratory sub-muscles, (2) during LMA implantation in terms of oxygen saturation percentage, stridor, cyanosis, laryngospasm, bronchospasm, and the presence of breath hold, (3) during LMA removal in terms of oxygen saturation percentage, cyanosis, laryngospasm, and bronchospasm, (4) after LMA removal in terms of stridor, cyanosis, the use of respiratory sub-muscles, persistent cough, and breath hold, and (5) in the Post-Anesthesia Care Unit (PACU) in terms of stridor and persistent cough.
Conclusion: in children with URTI, who have undergone emergency surgery, due to less PRAE in the intravenous method with Propofol, the use of TIVA method can reduce the risk of related adverse events.


  1. Kukwa W, Guilleminault C, Tomaszewska M, Kukwa A, Krzeski A, Migacz E. Prevalence of upper respiratory tract infections in habitually snoring and mouth breathing children. International journal of pediatric otorhinolaryngology. 2018; 107:37-41.
  2. Hakemi MS, Nassiri AA, Nobakht A, Mardani M, Darazam IA, Parsa M, Miri MM, Shahrami R, Ahmadi Koomleh A, Entezarmahdi K, Karimi A. Benefit of hemoadsorption therapy in patients suffering sepsis-associated acute kidney injury: a case series. Blood Purification. 2022; 51(10):823-30.
  3. Vorilhon P, Arpajou B, Roussel HV, Merlin É, Pereira B, Cabaillot A. Efficacy of vitamin C for the prevention and treatment of upper respiratory tract infection. A meta-analysis in children. European journal of clinical pharmacology. 2019; 75(3):303-11.
  4. Lear S, Condliffe A. Respiratory infection and primary immune deficiency-what does the general physician need to know? The journal of the Royal College of Physicians of Edinburgh. 2014; 44(2):149-55.
  5. Moghimi M, Behroozi MK, Maghbooli M, Jafari S, Mazloomzadeh S, Pezeshgi A. Association between abnormal serum free light chains ratio and known prognostic factors in lymphoma; a nephrology viewpoint. Journal of renal injury prevention. 2017; 6(2):148.
  6. Harless J, Ramaiah R, Bhananker SM. Pediatric airway management. International journal of critical illness and injury science. 2014; 4(1):65.
  7. Hasani A, EBRAHIM SAR. Comparison of Inhalation Induction (Single Breath Inhalation and Tidal Volume Technique) and Intravenous Induction (Thiopental And Succinylcholine). 2003.
  8. Gyorfi MJ, Kim PY. Halothane Toxicity. 2019.
  9. Drover DR, Litalien C, Wellis V, Shafer SL, Hammer GB. Determination of the pharmacodynamic interaction of propofol and remifentanil during esophagogastroduodenoscopy in children. The Journal of the American Society of Anesthesiologists. 2004; 100(6):1382-6.
  10. Lauder GR, Thomas M, von Ungern‐Sternberg BS, Engelhardt T. Volatiles or TIVA: Which is the standard of care for pediatric airway procedures? A pro‐con discussion. Pediatric Anesthesia. 2020; 30 (3):209-20.
  11. Ružman T, Šimurina T, Gulam D, Ružman N, Miškulin M. Sevoflurane preserves regional cerebral oxygen saturation better than propofol: Randomized controlled trial. Journal of clinical anesthesia. 2017; 36:110-7.
  12. De Vito A, Agnoletti V, Zani G, Corso RM, D’Agostino G, Firinu E, Marchi C, Hsu YS, Maitan S, Vicini C. The importance of drug-induced sedation endoscopy (DISE) techniques in surgical decision making: conventional versus target controlled infusion techniques—a prospective randomized controlled study and a retrospective surgical outcomes analysis. European Archives of Oto-Rhino-Laryngology. 2017; 274(5):2307-17.
  13. Gaynor J, Ansermino J. Paediatric total intravenous anaesthesia. Bja Education. 2016; 16(11):369-73.
  14. Safaeian R, Ale Nabi MAA. A Comparison between the Effects of Total Intravenous Anesthesia and Inhalational Anesthesia on Postoperative Pulmonary Function Test. Razi Journal of Medical Sciences. 2007; 14(54):101-7.
  15. Perera C, Strandvik G, Malik M, Sen S. Propofol anesthesia is an effective and safe strategy for pediatric endoscopy. Pediatric anaesthesia. 2006; 16(2):220-1.
  16. Saeed R, Ahmad N, Qamar I, Ali I, Banghash T, Javed MA. Comparison of Efficacy of Propofol 1% and Propofol 0.5% Admixture with Thiopentone 1% in Terms of Hemodynamic Stability and Ease of Insertion of LMA Among Paediatric Patients Undergoing Elective General Surgical Procedures. 2020.
  17. Omara AF, Abdelrahman AF, Elshiekh ML. Recovery with propofol anesthesia in children undergoing cleft palate repair compared with sevoflurane anesthesia. Anesthesiology and pain medicine. 2019; 9(3).
  18. Hajijafari M, Mehrzad L, Asgarian FS, Akbari H, Ziloochi MH. Effect of Intravenous Propofol and Inhaled Sevoflurane Anesthesia on Postoperative Spirometric Indices: A Randomized Controlled Trial. Anesthesiology and pain medicine. 2019; 9(6).
  19. Chai J, Wu XY, Han N, Wang LY, Chen WM. A retrospective study of anesthesia during rigid bronchoscopy for airway foreign body removal in children: propofol and sevoflurane with spontaneous ventilation. Pediatric Anesthesia. 2014; 24(10):1031-6.
  20. VON UNGERN‐STERNBERG BS, Habre W. Pediatric anesthesia–potential risks and their assessment: part I. Pediatric Anesthesia. 2007; 17(3):206-15.
  21. Chen L, Yu L, Fan Y, Manyande A. A comparison between total intravenous anaesthesia using propofol plus remifentanil and volatile induction/maintenance of anaesthesia using sevoflurane in children undergoing flexible fibreoptic bronchoscopy. Anaesthesia and intensive care. 2013; 41(6):742-9.
  22. Ortiz AC, Atallah ÁN, Matos D, da Silva EM. Intravenous versus inhalational anaesthesia for paediatric outpatient surgery. Cochrane database of systematic reviews. 2014(2).
  23. Liao R, Li JY, Liu GY. Comparison of sevoflurane volatile induction/maintenance anaesthesia and propofol–remifentanil total intravenous anaesthesia for rigid bronchoscopy under spontaneous breathing for tracheal/bronchial foreign body removal in children. European Journal of Anaesthesiology| EJA. 2010; 27(11):930-4.