Emergence and extubation remain high risk periods for pediatric patients undergoing general anaesthesia. It is likely that different criteria may be predictive of extubation success in patients who have inhalational anaesthesia compared to IV anaesthesia (either sevoflurane initiated intravenous anaesthesia (SIIVA) or total intravenous anaesthesia (TIVA)). This is because these anaesthetic regimens have different pharmacologic mechanisms of actions, and therefore interact with the central nervous system differently potentially leading to a need for different extubation criteria. Additionally, intravenous agents likely have less of an effect on airway reflexes and ventilation at light levels of anaesthesia. This phenomenon might be more pronounced in children, since the average length of time of anaesthesia is generally much shorter in children than in adults, increasing the impact of the induction type on the emergence period. This multicentre, prospective observational study will examine the predictive value of various common extubation criteria in the setting of SIIVA and TIVA. Between two US sites and one in Australia (Perth Children’s Hospital), 600 children aged under 10 years of age will be recruited. If different extubation criteria can be identified for children undergoing SIIVA or TIVA, this information can help tailor anaesthetic management and improve safety.
Professor Britta Regli-von Ungern-Sternberg, Perth Children’s Hospital, Western Australia; Associate Prof Tom Templeton, Atrium Health Wake Forest Baptist, USA; Dr Julia Galvez Delgado, Boston Children’s Hospital, USA.
The project was awarded A$70,000 funding through the ANZCA research grants program for 2025.