Abstract
BackgroundSevoflurane is commonly usedin pediatric anesthesia due to its non-irritating airway properties, and rapid induction and emergence. However, it is associated with emergence agitation (EA) in children. EA may cause injury to the child or damage to the surgical site and is a cause of stress to both caregivers and families. The efficacy of remifentanil and additional alfentanil on EA in the pediatric patients underwent ophthalmic surgery with sevofluraneanesthesiawas not well evaluated to date. This study was designed to compare the effects of remifentanil and remifentanil plus alfentanil on EA in children undergoing ophthalmic surgery with sevofluraneanesthesia.MethodsChildren (aged 3–9 years) undergoing ophthalmic surgery undersevoflurane anesthesia were randomly assigned to group S (sevoflurane alone), group R (sevofluraneandremifentanil infusion, 0.1 μg/kg/min), or group RA (sevoflurane withremifentanil infusion and intravenous injection of alfentanil 5 μg/kg 10 min before the end of surgery). Mean arterial pressure (MAP), heart rate (HR), and sevoflurane concentration were checked every 15 min after induction of anesthesia. The incidence of EA, time to extubation from discontinuation of sevoflurane inhalation, and time to discharge from the postanesthesia care unit was assessed.ResultsThe incidence of EA was significantly lower in groups R (32 %, 11/34; P = 0.01) and RA (31 %, 11/35; P = 0.008) than group S (64 %, 21/33). The time to extubation was prolonged in group RA (11.2 ± 2.3 min; P = 0.004 and P = 0.016) compared with groups S (9.2 ± 2.3 min) andR (9.5 ± 2.4 min). MAP and HR were similar in all three groups, apart from a reduction in HR at 45 min in groups R and RA. However, the sevoflurane concentration was lower in groups R and RA than group S (P < 0.001).ConclusionsThe administration of remifentanil to children undergoing ophthalmic surgery undersevoflurane anesthesia reduced the incidence of EA without clinically significant hemodynamic changes. However, the addition of alfentanil(5 μg/kg)10 min before the end of surgery provided no additional benefit compared withremifentanil alone.Trial registrationClinical trial number: NCT02486926, June.29.2015.
Highlights
Sevoflurane is commonly usedin pediatric anesthesia due to its non-irritating airway properties, and rapid induction and emergence
Reduction of the heart rate was significant in groups R (101.3 ± 15.2 beats/min; P < 0.001) and RA (104.2 ± 12.1 beats/min; P = 0.003) versus group S (115.5 ± 10.7 beats/ min) at 45 min after induction of anesthesia (Table 2)
End-tidal sevoflurane concentration was lower in groups R (P < 0.001) and RA (P < 0.001) versus group S at 15, 30, and 45 min after induction of anesthesia (Table 3)
Summary
Sevoflurane is commonly usedin pediatric anesthesia due to its non-irritating airway properties, and rapid induction and emergence. Emergence agitation (EA) or emergence delirium defined as “a combative, excited, and disoriented behavior that requires transient restraint during emergence from anesthesia” It may cause delayed recovery and discharge from the post anesthesia care unit (PACU), injury to the patient and surgical site damage, makes monitoring difficult, and causes stress inboth caregivers and families [1,2,3]. Ophthalmology procedures and surgery involving the tonsils, thyroid, and middle ear have been reported to have high incidences of EA [6] Variouspharmacological agents, such as clonidine [5, 7], dexmedetomidine [8, 9], fentanyl [8, 10,11,12], propofol [12], and ketamine [13, 14], have been used to prevent and treat EA in children. Their reported efficacies are various and there were no gold-standard regimen for decreasing the EA in pediatric patients
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