Child receiving IV anesthesia

IV vs. Inhalation: Which Anesthesia Method is Safer for Children?

Elliot Brynn in Health & Wellness December 2025 • 3 min read.

"A new study suggests intravenous induction with propofol may reduce respiratory complications in high-risk pediatric patients undergoing anesthesia."

For children undergoing general anesthesia, the method of induction—whether inhalational or intravenous—can significantly impact their safety, especially for those at higher risk of complications. Traditionally, inhalational induction using sevoflurane has been common due to its ease of administration.

However, intravenous induction with propofol is gaining traction due to its potential to mitigate certain risks associated with anesthesia. A recent study by Ramgolam and colleagues delves into comparing these two methods specifically in children with pre-existing respiratory risk factors, revealing some insightful findings.

The challenge with children is often the aversion to needles, making inhalational induction seem like the easier option. Yet, the study's results prompt a closer look at the benefits of intravenous methods, particularly concerning respiratory complications that pose a significant risk during anesthesia.

Propofol vs. Sevoflurane: Comparing the Risks

The study, featured in Anesthesiology, directly compared inhalational (using sevoflurane) and intravenous (using propofol) anesthesia induction in a randomized clinical trial. The researchers aimed to determine if children with respiratory risk factors experienced fewer complications with intravenous induction versus inhalational. The study involved 300 children up to 8 years old undergoing elective surgical procedures.

To participate, children had to exhibit at least two of the following risk factors:

Recent cold (within 2 weeks)
History of wheezing (at least 3 episodes in the past year)
Breathlessness upon exertion
Nighttime dry cough
Eczema history
Exposure to passive smoking
Family history of fever, asthma, or eczema

Children who had been pre-medicated with midazolam before anesthesia were excluded. The remaining children were divided into two groups: an inhalational group (IG) induced with sevoflurane via mask and an intravenous group (IVG) induced with propofol. Anesthesia was maintained with sevoflurane in both groups, and airway management was achieved using a laryngeal mask.

Intravenous Anesthesia: A Safer Start?

This research suggests that for children with respiratory risk factors, intravenous induction with propofol may offer a safer alternative to inhalational methods, especially during the critical induction phase. Given the potential for reduced complications, clinicians may want to consider intravenous induction for high-risk pediatric patients.

About this Article -

This article was crafted using a human-AI hybrid and collaborative approach. AI assisted our team with initial drafting, research insights, identifying key questions, and image generation. Our human editors guided topic selection, defined the angle, structured the content, ensured factual accuracy and relevance, refined the tone, and conducted thorough editing to deliver helpful, high-quality information.See our About page for more information.

Everything You Need To Know

What does inhalational induction involve, and what are its potential drawbacks?

Inhalational induction involves using a gas, typically sevoflurane, which is administered through a mask for the patient to breathe in. This method is favored for its ease of use, especially with children who may be afraid of needles. However, it can sometimes lead to respiratory complications, particularly in children with pre-existing respiratory issues. This is because the inhaled anesthetic can irritate the airways, potentially causing bronchospasm or laryngospasm. The significance lies in its widespread use and the need to understand its potential risks versus benefits, especially when compared to intravenous methods.

What is intravenous induction, and why might propofol be used for it?

Intravenous induction uses medications like propofol, delivered directly into the bloodstream through a vein. Propofol is valued for its ability to provide a smooth and rapid onset of anesthesia. Its importance stems from its potential to reduce respiratory complications during induction compared to inhalational methods. It is especially relevant for children with respiratory risk factors, where minimizing airway irritation is crucial. The implication is that propofol could offer a safer start to anesthesia in these vulnerable patients, but requires careful consideration of the child's aversion to needles.

What is sevoflurane, and why is it commonly used in pediatric anesthesia?

Sevoflurane is an inhalational anesthetic commonly used for inducing and maintaining anesthesia. It works by depressing the central nervous system, leading to loss of consciousness. Sevoflurane is significant because it's easy to administer and has a relatively quick onset of action, making it suitable for children. However, it can cause respiratory irritation and complications, such as coughing or bronchospasm, especially in children with pre-existing respiratory conditions. The implications involve balancing its ease of use against the potential for respiratory adverse effects.

What are considered respiratory risk factors in children undergoing anesthesia, and why are they important?

Respiratory risk factors in children are conditions or characteristics that increase the likelihood of respiratory complications during anesthesia. These factors can include a recent cold, a history of wheezing, breathlessness upon exertion, nighttime dry cough, eczema history, exposure to passive smoking, or a family history of fever, asthma, or eczema. Identifying these risk factors is crucial because they can significantly impact the choice of anesthesia method. Children with these factors may be more susceptible to complications like bronchospasm or laryngospasm during inhalational induction. The implications highlight the need for careful pre-operative assessment and tailored anesthesia planning.

What is midazolam, and why were children who received it excluded from the study?

Midazolam is a benzodiazepine medication often used for premedication before anesthesia. Its primary purpose is to reduce anxiety and provide sedation, making the induction process smoother for both the child and the medical staff. Midazolam is significant because it helps alleviate fear and resistance, particularly in young children who may be apprehensive about medical procedures. However, in the context of comparing anesthesia methods, children pre-medicated with midazolam were excluded from this study. The implication of this exclusion suggests that researchers aimed to isolate the effects of the induction method (propofol vs. sevoflurane) without the confounding influence of premedication on respiratory outcomes.