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Pediatric Anesthesia Emergence Delirium Scale and Children's Hospital of Eastern Ontario Pain Scale at Postanesthetic Care Unit
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Sevoflurane, desflurane, and propofol are widely used in pediatric anesthesia because of their rapid recovery. However, emergence agitation is more reported with sevoflurane or desflurane than with propofol. Our clinical experience indicates emergence agitation with propofol is also frequent. We tested the hypothesis that depth of anesthesia could...
Citations
... However, there are concerns about the EA after sevoflurane anesthesia, and the Incidence of EA has varied between 10-80% depending on the definition of EA used and the study design [28]. Several previous studies found no significant difference between sevoflurane and desflurane for the incidence of EA [1,29], but some prospective studies have shown that sevoflurane resulted in EA more frequently [26] or vice versa [28,30]. There are also conflicting results in the literature for the incidence of EA between sevoflurane and isoflurane anesthesia. ...
Emergence agitation (EA) in children after sevoflurane anesthesia is common. The purpose of this study was to compare the incidences of EA between ketamine and thiopental sodium induction in children underwent sevoflurane anesthesia. We also evaluated if a small dose of fentanyl could reduce the incidence of EA.
The patients who were scheduled for strabismus or entropion surgery were divided into 4 groups. The patients in Groups 1 and 2 were induced anesthesia with ketamine 1.5 mg/kg; those in Groups 3 and 4 were induced with thiopental sodium 5 mg/kg. The patients in Groups 1 and 3 received an injection of fentanyl 1.5 microg/kg, whereas the patients in Groups 2 and 4 received IV saline of the same volume. Anesthesia was maintained with sevoflurane. The recovery characteristics and EA in recovery room were assessed.
The incidence of EA was significantly higher in Groups 2 and 4 and there was no difference between Groups 2 and 4. Group 2 had almost an eleven-fold higher risk of developing EA than did Group 1, and the incidence of EA in Group 4 was sixty-nine-fold higher than that of Group 1. The risk factor for EA was only the kind of medication. Preoperative anxiety had no significant correlation with EA.
The incidence of EA after sevoflurane anesthesia is similar between ketamine and thiopental sodium anesthetic induction in children undergoing pediatric ophthalmic surgery. Also, the addition of a small dose of fentanyl after anesthetic induction decreases the incidence of EA.
Background:
Emergence delirium is a common complication in paediatric anaesthesia associated with significant morbidity. Total intravenous anaesthesia (TIVA) and intra-operative dexmedetomidine as an adjuvant to sevoflurane anaesthesia can both reduce the incidence of emergence delirium compared with sevoflurane alone, but no studies have directly compared their relative efficacy.
Objective:
The study objective was to compare the effects of TIVA and dexmedetomidine on the incidence of paediatric emergence delirium.
Study design:
The current study is a systematic review and network meta-analysis (NMA) of randomised controlled trials.
Data sources:
We conducted a systematic search of 12 databases including Medline (Ovid) and Web of Science (Clarivate Analytics) from their respective inception to December 2020.
Eligibility:
Inclusion criteria were randomised controlled trials of paediatric patients undergoing general anaesthesia using sevoflurane, sevoflurane with dexmedetomidine or TIVA. Data were extracted by two reviewers according to Preferred Reporting Items for Systematic Reviews and Meta-analyses guidelines and analysed using NMA methodology. Risk ratios and 95% credible intervals (CrI) were calculated for all outcomes [emergence delirium, postoperative nausea and vomiting (PONV), and time to emergence and extubation]. The protocol was registered with PROSPERO (CRD42018091237).
Results:
The systematic review returned 66 eligible studies comprising 5257 patients with crude median emergence delirium incidences of 12.8, 9.1 and 40% in the dexmedetomidine with sevoflurane, TIVA and sevoflurane alone groups, respectively. NMA indicated that compared with TIVA, sevoflurane with adjuvant dexmedetomidine decreased the incidence of emergence delirium without statistical difference (risk ratio 0.88, 95% CrI 0.61 to 1.20, low quality of evidence), but resulted in a higher incidence of PONV (risk ratio: 2.3, 95% CrI 1.1 to 5.6, low quality of evidence).
Conclusion:
Clinical judgement, considering the patient's risk factors for the development of clinically significant outcomes such as emergence delirium and PONV, should be used when choosing between TIVA and sevoflurane with adjuvant dexmedetomidine. These findings are limited by the low quality of evidence (conditional recommendation).
The purpose of this study was to test whether pre-operative visual information and parental presence had positive effects on anxiety, delirium, and pain in pediatric patients who awoke from general anesthesia in a post-surgical stage.
This study used a non equivalent control-group post test design (n=76). Independent variables were provision of pre-operative visual information and parental presence for post-surgical pediatric patients in PACU (post anesthesia care unit). Dependent variables were anxiety, delirium, and pain in the pediatric patients measured three times at 10 minute intervals after extubation in the PACU. Measurements included Numerical Rating Scale for assessing state anxiety, Pediatric Anesthesia Emergence Delirium Scale by Sikich & Lerman (2004) for delirium, and Objective Pain Scale by Broadman, Rice & Hannallah (1988) for pain.
Experimental group showed significantly decreased state anxiety at time points-10, 20, and 30 minutes after extubation. Delirium was significantly lower at 10 minutes and 30 minutes after extubation in the experimental group. Pain was significantly lower at 10 minutes after extubation in the experimental group.
The results of this study suggest that this intervention can be a safe pre-operative nursing intervention for post-surgical pediatric patients at PACU.
