Skip to main navigation menu Skip to main content Skip to site footer

Clinical Research

Vol 8 No 2 (2023): December

Impact of Sevoflurane and Propofol on Pediatric Laryngeal Reflexes During Anesthesia Induction

(*) Corresponding Author
September 11, 2023


This study aimed to investigate the influence of sevoflurane and propofol anesthesia, administered at two distinct levels of hypnosis, on laryngeal reflexes in children aged 2 to 6 undergoing surgery. Seventy participants were randomly assigned to receive either sevoflurane or propofol anesthesia, and their responses to laryngeal irritation were evaluated. Results revealed that regardless of the level of hypnosis, sevoflurane anesthesia led to a higher incidence of laryngospasm apnea compared to propofol anesthesia, with some episodes lasting over five seconds. Conversely, children receiving propofol anesthesia exhibited more frequent exhalation and coughing responses. These findings highlight the importance of appropriate anesthetic dosages in pediatric cases, as the choice of anesthetic agent can significantly impact airway defense reflexes, with potential clinical implications for airway management during anesthesia induction in children.

Highlights :

  • Sevoflurane anesthesia in children aged 2 to 6 is associated with a higher incidence of laryngospasm apnea compared to propofol anesthesia, emphasizing the need for careful anesthetic selection in pediatric cases.
  • Propofol anesthesia induces more frequent exhalation and coughing responses, suggesting potential advantages in airway management during anesthesia induction in children.
  • This study underscores the critical role of appropriate anesthetic dosages in mitigating the risk of exaggerated airway defense reflexes and ensuring patient safety during pediatric surgery.

Keywords : Pediatric anesthesia, Sevoflurane, Propofol, Laryngeal reflexes, Airway management



  1. B. R. Fink, "The etiology and treatment of laryngeal spasm," Anesthesiology, vol. 17, pp. 569–577, 1956.
  2. D. O. Warner, "Laryngeal reflexes," Anesthesiology, vol. 88, pp. 1433–1434, 1998.
  3. G. L. Olsson and B. Halen, "Laryngospasm during anaesthesia: A computer-aided incidence study in 136,929 patients," Acta Anaesthesiol Scand, vol. 28, pp. 567–575, 1984.
  4. J. P. Morray et al., "A comparison of pediatric and adult anesthesia closed malpractice claims," Anesthesiology, vol. 78, pp. 461–467, 1993.
  5. M. L. Lopez Gil, J. Brimacombe, and B. Clar, "Sevoflurane versus propofol for induction and maintenance of anaesthesia with the laryngeal mask airway in children," Paediatr Anaesth, vol. 9, pp. 485–490, 1999.
  6. H. Viitanen et al., "Sevoflurane maintained anesthesia induced with propofol or sevoflurane in small children: Induction and recovery characteristics," Can J Anaesth, vol. 46, pp. 21–28, 1999.
  7. L. Simon et al., "LARYNGEAL REFLEX RESPONSES IN ANESTHETIZED CHILDREN," Anesthesiology, vol. 103, no. 6, Dec. 2005.
  8. Y. Tagaito, S. Isono, and T. Nishino, "Upper airway reflexes during a combination of propofol and fentanyl anesthesia," Anesthesiology, vol. 88, pp. 1459–1466, 1998.
  9. A. Tanaka, S. Isono, T. Ishikawa, and T. Nishino, "Laryngeal reflex before and after placement of airway interventions: Endotracheal tube and laryngeal mask airway," Anesthesiology, vol. 102, pp. 20–25, 2005.
  10. W. L. Roy and J. Lerman, "Laryngospasm in paediatric anaesthesia," Can J Anaesth, vol. 35, pp. 93–98, 1988.
  11. M. Wheeler, C. J. Cote´, and D. I. Todres, "Pediatric airway," in A Practice of Anesthesia for Infants and Children, 3rd edition, C. J. Cote´, D. I. Todre, J. F. Ryan, and N. G. Goudsouzian, Eds. Philadelphia: WB Saunders, 2001, pp. 79–113.
  12. C. L. Rosen, L. D’Andrea, and G. G. Haddad, "Adult criteria for obstructive sleep apnea do not identify children with serious obstruction," Am Rev Respir Dis, vol. 146, pp. 1231–1234, 1992.
  13. A. Sanchez-Armengol et al., "Polysomnographic studies in children with Aden tonsillar hypertrophy and suspected obstructive sleep apnea," Pediatr Pulmonol, vol. 22, pp. 101–105, 1996.
  14. T. Nishino, K. Kochi, and M. Ishii, "Differences in respiratory reflex responses from the larynx, trachea, and bronchi in anesthetized female subjects," Anesthesiology, vol. 84, pp. 70–74, 1996.
  15. T. Nishino, K. Hiraga, and Y. Honda, "Inhibitory effects of CO2 on airway defensive reflexes in enflurane-anesthetized humans," J Appl Physiol, vol. 66, pp. 2642–2646, 1989.
  16. M. King, S. Kelly, and M. Cosio, "Alteration of airway reactivity by mucus," Respir Physiol, vol. 62, pp. 47–59, 1985.
  17. G. Afshan, U. Chohan, M. Qamar-Ul-Hoda, and R. S. Kamal, "Is there a role of a small dose of propofol in the treatment of laryngeal spasm?," Paediatr Anaesth, vol. 12, pp. 625–628, 2002.
  18. A. Davidson, "The correlation between bispectral index and airway reflexes with sevoflurane and halothane anaesthesia," Paediatr Anaesth, vol. 14, pp. 241–246, 2004.
  19. P. S. Glass et al., "Bispectral analysis measures sedation and memory effects of propofol, midazolam, isoflurane, and alfentanil in healthy volunteers," Anesthesiology, vol. 86, pp. 836–847, 1997.
  20. I. Constant et al., "Changes in electroencephalogram and autonomic cardiovascular activity during induction of anesthesia with sevoflurane compared with halothane in children," Anesthesiology, vol. 91, pp. 1604–1615, 1999.
  21. I. Keidan, A. Perel, E. L. Shabtai, and R. M. Pfeffer, "Children undergoing repeated exposures for radiation therapy do not develop tolerance to propofol: Clinical and Bispectral Index data," Anesthesiology, vol. 100, pp. 251–254, 2004.
  22. C. S. Degoute et al., "EEG bispectral index and hypnotic component of anaesthesia induced by sevoflurane: Comparison between children and adults," Br J Anaesth, vol. 86, pp. 209–212, 2001.
  23. B. Vivien et al., "Overestimation of Bispectral Index in sedated intensive care unit patients revealed by administration of muscle relaxant," Anesthesiology, vol. 99, pp. 9–17, 2003.
  24. E. Figueredo, M. Vivar-Diago, and F. Munoz-Blanco, "Laryngo-pharyngeal complaints after use of the laryngeal mask airway," Can J Anaesth, vol. 46, pp. 220–225, 1999.
  25. J. Brimacombe et al., "Pharyngolaryngeal, neck, and jaw discomfort after anesthesia with the face mask and laryngeal mask airway at high and low cuff volumes in males and females," Anesthesiology, vol. 93, pp. 26–31, 2000.
  26. N. M. Bauman, A. D. Sandler, C. Schmidt, J. W. Maher, and R. J. Smith, "Reflex laryngospasm induced by stimulation of distal esophageal afferents," Laryngoscope, vol. 104, pp. 209–214, 1994.
  27. M. Doi and K. Ikeda, "Airway irritation produced by volatile anaesthetics during brief inhalation: comparison of halothane, enflurane, isoflurane and sevoflurane," Can J Anaesth, vol. 40, pp. 122–126, 1993.
  28. K. McKeating, I. M. Bali, and J. W. Dundee, "The effects of thiopentone and propofol on upper airway integrity," Anaesthesia, vol. 43, pp. 638–640, 1988.


Download data is not yet available.