Total Intravenous Anesthesia (TIVA)/Sevoflurane Initiated Intravenous Anesthesia (SIIVA) in Pediatric Patients

This study compares two intravenous anesthesia techniques — Total Intravenous Anesthesia (TIVA) and Sevoflurane-Initiated Intravenous Anesthesia (SIIVA) — in children under 10 years old undergoing surgery requiring a breathing tube. Both techniques use intravenous drugs (primarily propofol) to maintain anesthesia after the initial induction, but SIIVA begins with brief sevoflurane inhalation to establish IV access before switching to intravenous drugs. The study examines outcomes such as how smoothly children wake up from anesthesia, how quickly they recover, and whether there are any complications. Children under 10 years old undergoing elective or emergency surgery with planned endotracheal intubation who are receiving a TIVA or SIIVA anesthesia technique are eligible. Children using home oxygen, those with cyanotic congenital heart disease, those undergoing imaging-only procedures, or those planned for a supraglottic airway are excluded. Surgeries shorter than 30 minutes are also excluded. Children who cannot receive propofol due to mitochondrial disease are excluded. Pediatric anesthesia is technically challenging and carries unique risks compared to adults. Emergence agitation — distressing, thrashing wakefulness immediately after surgery — is common in young children and can cause injury and significant family distress. Understanding which intravenous maintenance technique leads to smoother, calmer emergence could directly improve the experience and safety of surgery for millions of children each year.