Abstract
Objectives: This study was designed to see the risk factors that contribute to emergence agitation (EA) and also to know the effectiveness of low-flow (LF) anesthesia technique in EA in pediatric patients.
 Methods: A total of 200 pediatric patients aged 6 months–6 years underwent surgery with general anesthesia were divided into two groups. The high-flow (HF) group was maintained with 5 l fresh gas flow (FGF), and the LF group was maintained with 500 ml FGF. The outcome was measured after the surgery was completed on Face, Legs, Activity, Cry, and Consolability and pediatric anesthesia emergence delirium (PAED) scores. Agitation defined in PAED score ≥10, and no agitation defined in PAED score <10.
 Results: EA incidence in the HF group was higher compared to the LF group (59.5 vs. 4.7%, p<0.001). HF anesthesia technique was a single risk factor for agitation event, whereas LF anesthesia may prevent EA incidence until up to 92.7%.
 Conclusion: LF anesthesia reduced agitation incidences. The effectiveness of LF was 92.7% in reducing the incidence of agitation. HF anesthesia was the main risk factor for agitation incidences.
Highlights
Emergence agitation (EA) is a common problem in pediatric anesthesia [1]. It is defined as a consciousness dissociation that characterized when the patient is not consolable, uncooperative, irritable, destructive, crying, and unable to recognize people that are familiar in their daily life, on the emergence of anesthesia
Sevoflurane consumption per min was higher in HF groups compared to the LF group (18 [13] vs. 40 [25.5], p
The findings show that HF technique was the main risk factor to agitation incidences in the pediatric population (p
Summary
Emergence agitation (EA) is a common problem in pediatric anesthesia [1]. It is defined as a consciousness dissociation that characterized when the patient is not consolable, uncooperative, irritable, destructive, crying, and unable to recognize people that are familiar in their daily life, on the emergence of anesthesia. Some risk factors known for this condition are rapid emergence, use of volatile agents, post-operative pain, choking sensation, and patient’s psychological condition. It is a self-limiting condition that occurs for 5–15 min. Some agents used for eliminating this condition are hypnotics-sedative drugs (e.g., midazolam, flumazenil, and propofol) and analgesics such as opioids and NSAID [3]
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