Ketamine versus sevoflurane for pediatric intracranial tumor surgery: impact on perioperative stability and postoperative recovery.
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This study compared the clinical efficacy of ketamine and sevoflurane in anesthetic management for pediatric intracranial tumor surgery, focusing on perioperative hemodynamics, inflammatory and stress responses, endotoxin (ET), nitric oxide (NO), oxidative stress, and postoperative recovery. A retrospective analysis was conducted on 229 pediatric patients who underwent intracranial tumor resection between June 2022 and August 2024, of whom 122 received ketamine anesthesia and 107 received sevoflurane. Propensity score matching was applied, yielding 62 patients in each group with balanced baseline characteristics. Perioperative indicators, including mean arterial pressure (MAP), heart rate (HR), C-reactive protein (CRP), interleukin-6 (IL-6), tumor necrosis factor-α (TNF-α), epinephrine, cortisol, ET, NO, superoxide dismutase (SOD), and malondialdehyde (MAD), were assessed at five timepoints (T1-T5). Postoperative outcomes included visual analogue scale (VAS) scores, Ramsay sedation scores, Pediatric Anesthesia Emergence Delirium (PAED) scores, emergence time, surgical duration, and adverse events. Results showed that the ketamine was associated with significantly lower MAP at T3-T4 but higher MAP at T5, and with consistently lower HR at T3-T5 compared with the sevoflurane (all P<0.01). Levels of CRP, IL-6, TNF-α, epinephrine, and cortisol were significantly lower in the ketamine group at T3-T5, suggesting reduced inflammatory and stress responses, while ET and NO levels were higher at T2-T4. Oxidative stress markers (SOD and MAD) were also lower in the ketamine group at T3-T5, indicating stronger antioxidant properties. In contrast, the sevoflurane group demonstrated lower VAS scores at 1-24 h, higher Ramsay scores at 6-24 h, and lower PAED scores at 30 min-3 h (all P<0.05), reflecting better postoperative analgesia, sedation, and reduced agitation. Emergence time was significantly longer in the ketamine group (P<0.001), though surgical duration and incidence of adverse events showed no significant difference between groups. In conclusion, ketamine provides superior intraoperative hemodynamic stability and reduces inflammatory, stress, and oxidative responses, whereas sevoflurane offers better postoperative analgesia, sedation, and recovery. Individualized anesthetic selection is recommended based on patient and surgical characteristics.