Sevoflurane vs. isoflurane: these are two commonly used volatile anesthetic agents, each with distinct pharmacologic properties and clinical roles. Both have been used in pediatric anesthesia for decades and are considered safe and effective when administered by trained anesthesia professionals. The choice between sevoflurane and isoflurane for pediatric general anesthesia depends on factors such as patient age, procedural requirements, physiological effects, and recovery characteristics.
Sevoflurane is the most frequently used inhalational anesthetic in pediatric practice, particularly for the induction of anesthesia. Its low blood–gas partition coefficient allows for rapid uptake and elimination, enabling quick onset of anesthesia and precise control of anesthetic depth. Notable advantages of sevoflurane are its non-pungent odor and minimal airway irritation, which make it well suited for mask induction. This method of delivery is especially relevant in children, for whom intravenous access may be difficult or distressing prior to induction.
Compared with sevoflurane, isoflurane has a higher blood–gas solubility, resulting in slower induction and emergence. It also has a pungent odor and is more likely to provoke airway irritation, coughing, or breath-holding if used for inhalational induction. For these reasons, isoflurane is rarely chosen for induction in pediatric patients. It may be used for maintenance of anesthesia following intravenous induction, where its properties can be used effectively without compromising airway comfort, as long as its effect duration, side effects, and molecular mechanism are suitable for the clinical scenario.
Both anesthetic agents have predictable cardiovascular effects. Sevoflurane generally provides stable hemodynamics, although dose-dependent reductions in systemic blood pressure can occur. Isoflurane is associated with peripheral vasodilation and may produce more pronounced hypotension, but it tends to preserve cardiac output. In healthy pediatric patients, these effects are typically mild and easily managed, and they rarely represent the primary determinant in anesthetic selection.
Recovery profiles differ between the two agents and may influence their use depending on the clinical setting. Sevoflurane’s rapid elimination often results in faster awakening, which is advantageous for short procedures and ambulatory surgery. However, this rapid emergence has been associated with emergence agitation in some children, characterized by transient confusion, restlessness, or inconsolability during early recovery. Isoflurane’s slower offset may lead to a more gradual and sometimes calmer emergence but can prolong recovery time, which may be less desirable in outpatient settings.
From a safety perspective, both sevoflurane and isoflurane are well studied in pediatric anesthesia. Like all known volatile anesthetics, they can trigger malignant hyperthermia in genetically susceptible individuals, underscoring the importance of preoperative assessment and appropriate monitoring. Additionally, current evidence regarding the potential neurodevelopmental effects of anesthetic exposure in early childhood suggests that short exposures to general anesthesia are unlikely to cause long-term cognitive or behavioral impairment, which have been seen experimentally with prolonged or frequent exposure.
In clinical practice, sevoflurane is often preferred over isoflurane for pediatric general anesthesia due to its ease of administration, rapid onset, and favorable tolerability, particularly during induction. Isoflurane remains a dependable alternative for maintenance of anesthesia in selected cases. Ultimately, anesthetic choice reflects a careful balance of pharmacologic properties, procedural needs, and individual patient considerations, with the overarching goal of ensuring safe, effective, and well-tolerated anesthesia for children.
