Emergence Agitation Scale Research Articles

Mother-Infant Interaction and Maternal Postnatal Psychological Distress Associate with Child's Social-Emotional Development During Early Childhood: A FinnBrain Birth Cohort Study.

We studied the effects of mother-infant interaction and maternal pre- and postnatal psychological distress on children's social-emotional problems and competences, as well as whether interaction quality moderates the association between distress and children's outcomes. Maternal pre- and postnatal psychological distress were measured using the SCL and EPDS questionnaires, whereas mother-infant interaction was measured when the child was 8months old using the EA Scales. Children's social-emotional development was measured using the BITSEA questionnaire at 2years old and using the SDQ questionnaire at 4years old, where higher maternal structuring was associated with fewer social-emotional problems in children and higher maternal sensitivity was associated with greater social-emotional competence in children at 2years old. Further, higher postnatal distress was found associated with greater social-emotional problems at 2years old, though neither these effects nor moderating effects at 4years old were observed after multiple-comparison corrections. Our findings support direct associations of both mother-infant interaction and maternal postnatal psychological distress with children's social-emotional development during toddlerhood.

The Effect of Low Dose Nalbuphine or Ketamine in the Prevention of Emergence Agitation after Sevoflurane Anesthesia in Children Undergoing Tonsillectomy with or without Adenoidectomy

Abstract Background Emergence agitation (EA) in children is increased after sevoflurane anesthesia. Nalbuphine and midazolam have been used for prophylactic treatment with controversial results. Patients and Methods Totally, 90 children between 4 and 10 years of age and of American Society of Anesthesiologists I-II undergoing adenotonsillectomy under sevoflurane-based anesthesia were enrolled in the study. Children were randomly allocated to one of the three groups: group N received nalbuphine 0.1 mg/kg, group K received ketamine 0.25 mg /kg and group S received the equivalent volume saline. The study medications will be given after discontinuation of sevoflurane by the end of surgery. In the post anesthesia care unit EA was assessed with emergence agitation scale upon admission (T0), after 5 min (T5), 10 min (T10), 15 min (T15), 20 min (T20), 25 min (T25) and 30 min (T30). Results In the PACU, the incidence of EA (emergence agitation scale) were significantly lower in the N Group (6.6%) and K Group (16.6%) compared to S group (33%) with (p = 0.044), the duration in PACU was significantly prolonged in S group compared to K group and N group (p- value 0.011), more patients experienced postoperative pain (mCHEOPS) in S group compared to N group and K group ( p-value 0.001). Conclusion Nalbuphine 0.1 mg/kg or ketamine 0.25 mg/kg are effective in preventing emergence agitation following sevoflurane-anesthetized adenotonsillectomy paediatric patients.

Comparison between the effect of ketamine-dexmedetomidine versus ketamine-propofol on emergence agitation in pediatrics undergoing adenotonsillectomy by sevoflurane anesthesia

Background Pediatric Emergence Agitation (PEA) Emergence agitation (EA) is a state of anxiety, irritability, non-purposeful movement, thrashing, and disorientation during early recovery from general anesthesia. it can be harmful for the children and their family, causing bleeding at the surgical site, parental unhappiness, and anxiety. Aim To decrease the incidence of emergence agitation (EA) in pediatrics undergoing adenotonsillectomy under sevoflurane anesthesia, by using ketamine-dexmedetomidine (KD) or ketamine-propofol (KP). Patients and methods In this prospective randomised controlled clinical trial, 63 children were randomly assigned to one of three groups of similar size: group C (Control group) (n=21), who received a single intravenous bolus of 10 ml 0.9% normal saline; group KD (n=21), who received 0.15 mg/kg ketamine and 0.3 μg/kg dexmedetomidine; 10 min before the end of surgery, and group KP (n=21), who received 0.15 mg/kg ketamine and 0.5 mg/kg propofol, 10 min before the end of surgery. The primary outcome was the post anesthesia EA which was evaluated using the pediatric anesthesia emergence agitation scale (PAED) score out come was assessment of OPS and complications. Results There were significant difference between the groups regarding the heart rate which was faster in the control group immediately, 5, 10, and 15 min post extubation. In the KD group the extubation time was the longest compared with the KP group and the control group. The PAED scores were significantly different among the three studied groups at 10, 20, 25, 30, 35, 40, 45, 50, 55, and 60 min. Conclusion The combination of ketamine (0.15 mg/kg) and dexmedetomidine (0.3 μg/kg) given 10 min before the completion of surgery was more effective in preventing emerging agitation than ketofol.

Comparison of Emergence Agitation Scale Scores and Creatine Kinase Levels After General Anesthesia in Children: A Prospective Cohort Study.

IntroductionA simple indicator of muscle damage is creatine kinase (CK). Although CK elevation is informative for malignant hyperthermia, no study has examined the relationship between the anesthetically awake state and CK in children. We aimed to prospectively examine the relationship between the awakening state and CK on the day after surgery in children who have undergone anesthesia with volatile inhalation anesthetics.MethodsThe study included 119 patients aged 0-15 years and scheduled to undergo general anesthesia for cleft lip and palate-related surgery. Emergence agitation (EA) was assessed after completion of general anesthesia using the five-point EA scale, and patients were divided into the following five groups according to the EA score: EA1, EA2, EA3, EA4, and EA5. The primary outcome was ΔCK (comparison of CK values one week prior to surgery to CK values on the day after surgery) in each EA group. The secondary outcome was ΔCK when the EA score was divided into the following two groups: EA ≤2 (EA score of 1 or 2) and EA ≥3 (EA score of 3, 4, or 5).ResultsThe median ΔCK values in the EA1 to EA5 groups were 3 (quartile −19~9), 5 (−32~88), 99.5 (−18~190.5), 121 (29~219.5), and 144 (41~340.5), respectively, indicating a statistically significant difference overall. Statistically significant differences were also observed between the EA1 and EA4 groups and between the EA2 and EA4 groups. The median ΔCK values in the EA ≤2 and EA ≥3 groups were 3 (quartile −27~85) and 108 (23.5~206.7), respectively, indicating a statistically significant difference.ConclusionThe results of this study revealed that a higher EA score at the time of anesthesia awakening is associated with a larger ΔCK, indicating that a high CK level on the day after surgery is highly related to the state of the patient upon awakening.

Role of nebulised dexmedetomidine, midazolam or ketamine as premedication in preschool children undergoing general anaesthesia-A prospective, double-blind, randomised study.

ABSTRACTBackground and Aims:Preschool age children are psycho-biologically vulnerable to all surgical procedures. In this study, we investigated the effect of nebulised dexmedetomidine, midazolam and ketamine as sedative premedication for alleviating parental separation anxiety, facilitating face mask acceptance and reducing emergence agitation in paediatric patients undergoing general anaesthesia.Methods:A prospective, randomised, double-blind study was done involving 96 children of age 3–7 years, randomly allocated into three equal groups and pre-medicated with either nebulised dexmedetomidine 2 mg/kg (GroupD), midazolam 0.2 mg/kg (GroupM) or ketamine 2 mg/kg (Group K). The scores of sedation scale, parental separation anxiety scale, mask acceptance scale and emergence agitation scale were recorded along with haemodynamic parameters. Two-way repeated measures analysis of variance (ANOVA), post hoc test and Kruskal–Wallis test were used for statistical analysis.Results:A statistically significant difference in sedation score was seen between the different study groups, χ2(2) = 8.561, P = 0.014 with mean rank sedation score of 56.50 for Group D, 38.92 for Group M and 43.84 for Group K. Parental separation anxiety scale score and Mask acceptance scale score also showed statistically significant difference between the different study groups, χ2(2) = 9.369, P = 0.009 and χ2(2) = 11.97, P = 0.003, respectively.Conclusion:Nebulisation with dexmedetomidine produced easy parental separation, more satisfactory sedation and face mask acceptance with less postoperative agitation than nebulisation with midazolam or ketamine.

A Comparison of Intranasal Dexmedetomidine, Esketamine or a Dexmedetomidine-Esketamine Combination for Induction of Anaesthesia in Children: A Randomized Controlled Double-Blind Trial.

Objective: To compare the efficacy of dexmedetomidine, esketamine or combined intranasal administration on the induction of inhalation anaesthesia in children. Methods: Ninety children aged 1–6 years were randomly allocated into three equal groups to be premedicated with either intranasal dexmedetomidine 2 μg/kg (Group D), esketamine 1 mg/kg (Group S), or dexmedetomidine 1 μg/kg combined with esketamine 0.5 mg/kg (Group DS). The primary endpoint was the Induction Compliance Checklist (ICC) Scale. Secondary outcomes included the sedation success rate; the modified Yale Preoperative Anxiety Scale score; the time of reaching up to two points on the University of Michigan Sedation Scale (UMSS); Parental Separation Anxiety Scale; anaesthesiologist satisfaction with induction based on the visual analogue scale; emergence agitation scale score; and adverse effects. Results: The children in the DS group showed a high degree of cooperation with inhalation anaesthesia induction, and their ICC score was significantly lower than that of the D and S groups (p = 0.001), but there was no difference between the D and S groups. The success rate of sedation was higher in Group DS (90%) than in Group D (70%) and Group S (53.3%) (p = 0.007). Anaesthesiologist satisfaction with induction was significantly higher in Group DS than in Groups D and S (p = 0.001). The incidence of emergence agitation and the Paediatric Anaesthesia Emergence Delirium (PAED) score in the DS group were lower than those in the D and S groups. Conclusions: Preoperative intranasal administration of dexmedetomidine combined with esketamine can significantly improve the cooperation of children with inhalation anaesthesia masks. It is a sedation method that has a high success rate and reduces the incidence and degree of emergence agitation.

The role of mother's prenatal substance use disorder and early parenting on child social cognition at school age

AbstractThis prospective longitudinal study examined how maternal prenatal substance use disorder (SUD) and early mother–infant interaction quality are associated with child social cognition (emotion recognition and mentalization) at school age. A sample of 52 poly‐substance‐using mothers receiving early interventions and 50 non‐users, along with their children, was followed from pregnancy to school age. First‐year mother–infant interaction quality was measured with EA scales. At school age, child facial emotion recognition was measured with DANVA and mentalization with LEAS‐C. SUD group children did not differ from comparison children in social cognition, but higher severity of maternal prenatal addiction predicted emotion recognition problems. High early mother–infant interaction quality predicted better emotion recognition and mentalization, and mother–infant interaction quality mediated the effect of prenatal SUD on emotion recognition. The results highlight the need for early treatments targeting both parenting and addiction, as well as long‐term developmental support for these children.Highlights We examined how mother's prenatal substance use disorder (SUD) and early mother–infant interaction predict child social cognition at school age. Questionnaires, observational and computer tasks were used. Maternal prenatal addiction severity and early parenting problems predicted problematic child social cognition. Early interventions should simultaneously target addiction and parenting. Attention should also be paid to the long‐term developmental support of children.

A molecular interaction-diffusion framework for predicting organic solar cell stability.

Rapid increase in the power conversion efficiency of organic solar cells (OSCs) has been achieved with the development of non-fullerene small-molecule acceptors (NF-SMAs). Although the morphological stability of these NF-SMA devices critically affects their intrinsic lifetime, their fundamental intermolecular interactions and how they govern property-function relations and morphological stability of OSCs remain elusive. Here, we discover that the diffusion of an NF-SMA into the donor polymer exhibits Arrhenius behaviour and that the activation energy Ea scales linearly with the enthalpic interaction parameters χH between the polymer and the NF-SMA. Consequently, the thermodynamically most unstable, hypo-miscible systems (high χ) are the most kinetically stabilized. We relate the differences in Ea to measured and selectively simulated molecular self-interaction properties of the constituent materials and develop quantitative property-function relations that link thermal and mechanical characteristics of the NF-SMA and polymer to predict relative diffusion properties and thus morphological stability.

The Cycle of Abuse: Emotional Availability in Resilient and Non-Resilient Mothers with Early Life Maltreatment

Background: Early life maltreatment (ELM) has a high risk of transmission across generations, known as “the cycle of abuse.” ELM is also an important risk factor for developing mental disorders, and having a mental disorder increases the risk of child abuse. Both the abuse potential in mothers with ELM and in mothers with a history of mental disorders might be associated with a disturbed mother-child interaction. Objective: The current study examined differences in emotional availability between mothers with a history of ELM and previous or current mental disorders (non-resilient), mothers with ELM without mental disorders (resilient), and control mothers without ELM and without mental disorders. Methods: Thirty-three non-resilient mothers, 18 resilient mothers, and 37 control mothers and their 5- to 12-year-old children participated in a standardized mother-child interaction task. Videotaped interactions were rated by three independent, trained raters based on the Emotional Availability Scales (EA Scales) and compared between the groups. Results: The non-resilient mothers and their children showed reduced maternal sensitivity, structuring, non-intrusiveness, non-hostility, responsiveness, and involvement compared to the resilient mothers and their children and the control mothers and their children (p = 0.006, η_p² = 0.12). No differences on any of the EA Scales were found between resilient mothers and control mothers. Conclusions: These deficits in mother-child interaction in non-resilient mothers might contribute to mechanisms that could explain the cycle of abuse. Interestingly, resilient mothers, who did not develop a mental disorder despite having experienced ELM, did not show these deficits. Thus, prevention programs promoting resilience might be a key to break the cycle of abuse.

The emotional availability in mother-child and father-child interactions in families with children with Autism Spectrum Disorder

BackgroundEmotional availability (EA) is a dyadic relationship construct that can be considered an index of emotional quality of parent-child interaction. Using this construct, some research showed that both parent and child components of EA reflect key aspects of the parent-child relationship, but there are few studies that investigated these aspects in families with children with Autism Spectrum Disorder (ASD). The present study addresses several specific issues about the emotional availability of parents of children diagnosed with Autism Spectrum Disorder (ASD). MethodWe observed free-play interactions of 40 children with ASD (chronological age = 41.6 months, SD = 12; M mental age = 30.9 months, SD = 13.3) playing separately with their mothers and fathers one by one. We coded each parent-child dyad using the Emotional Availability Scales (EAS, Biringen, 2008). ResultsFindings showed that mothers and fathers were equally emotionally available to their children. There were no differences between the two in parents’ EA scales nor in their associations with child level of functioning and severity of the symptoms. In addition, children showed similar mean levels of Responsiveness and Involvement in mother-child and father-child interactions. However, children’s emotional availability was associated to their cognitive functioning and the severity of their symptoms. ConclusionsThe emotional quality of dyadic interaction is equal in mother-child and father-child dyads in families of children with ASD. We discuss the clinical utility of the EA Scales for assessing relationship between parents and their children with ASD and we speculate the possible relevance of our findings on father-child relationship for future intervention studies involving fathers on par with mothers.

Maternal and Infant Iron Status Are Related to Mother-Infant Interactions (P10-094-19)

ObjectivesTo examine the association between iron status and mother-infant interactions in dyads from rural Bangladesh. MethodsMaternal-infant interactions were assessed in dyads from a substudy nested within a randomized controlled trial in rural Bangladesh. Recorded interactions (10 minutes free-play; 2 minutes diapering) at baseline (BL) (infant age 6–18 mo; n = 116), midline (ML) (+ 3 mo; n = 324), and endline (EL) (+ 6 mo; n = 336) were coded per the Emotional Availability Scales (EAS; 4 maternal scales: sensitivity, structuring, non-intrusiveness, non-hostility; 2 child scales: responsiveness, involvement). Ferritin (Ft), transferrin receptor (TfR), and hemoglobin (Hb; in infants only) concentrations were measured at BL and EL. Group differences (categorized by iron status irrespective of intervention group) were assessed via ANCOVA (covariates: socioeconomic status, mean upper arm circumference, weight-for-age Z-score, child sex and age and maternal depressive symptoms (Center for Epidemiologic Studies Depression Scale) and reasoning abilities (Raven’s Progressive Matrices)). Stepwise regressions were run to determine predictors of the EAS scores. ResultsPrevalence of iron deficiency (ID; Ft < 23.7 mg/L) in infants dropped from 55% to 38% and of ID anemia (IDA; Hb < 110 g/L) from 53% to 32%, respectively. Only 12% of mothers were ID (Ft < 15.0 μg/L). Dyads of iron sufficient (IS) infants had higher involvement scores at BL and ML (both P ≤ 0.04), and higher sensitivity and structuring but lower non-intrusiveness scores (all P < 0.01) at ML vs dyads of ID infants. In the regressions, iron status of the mother and/or child was significantly predictive of maternal behaviors for most of the EA scales at all time points with better iron status predicting better behavioral scores except for non-intrusiveness. At BL (but not EL), child BL TfR was negatively related to involvement and responsiveness. No other iron status variables were associated with child behavior at any time point. ConclusionsAn association exists between maternal and infant iron status and dyadic interaction. Adequate iron status appears to benefit the dyadic relationship. Funding SourcesUSAID through the Johns Hopkins Global Research Activity Cooperative Agreement.

Ni‐Metalloid (B, Si, P, As, and Te) Alloys as Water Oxidation Electrocatalysts

AbstractBreakthroughs toward effective water‐splitting electrocatalysts for mass hydrogen production will necessitate material design strategies based on unexplored material chemistries. Herein, Ni‐metalloid (B, Si, P, As, Te) alloys are reported as an emergent class of highly promising electrocatalysts for the oxygen evolution reaction (OER) and insight is offered into the origin of activity enhancement on the premise of the surface electronic structure, the OER activation energy, influence of the guest metalloid elements on the lattice structure of the host metal (Ni), and surface‐oxidized metalloid oxoanions. The metalloids modify the lattice structure of Ni, causing changes in the nearest Ni–Ni interatomic distance (dNi–Ni). The activation energy Ea scales with dNi–Ni indicating an apparent dependence of the OER activity on lattice properties. During the OER, surface Ni atoms are oxidized to nickel oxyhydroxide, which is the active state of the catalyst, meanwhile, the surface metalloids are oxidized to the corresponding oxoanions that affect the interfacial electrode/electrolyte properties and hence the adsorption/desorption interaction energies of the reacting species.

Compassion in a Doctor-Patient Relationship: Objectively Measuring Compassionate Behavior Using the Emotional Availability (EA) Scales

Most research on compassion utilizes self-report measures (Seppala, Simon-Thomas, Brown, Worline, Cameron, & Doty, in press). Indeed, when it comes to the measurement of self-compassion, the subjective report of the individual can provide an authentic window about compassion toward the self. How else can we understand another’s subjective feelings and experience about the suffering or concerns of another? Compassionate behavior toward another person, on the other hand, can and should be measured more objectively than self-report allows. Compassionate behavior toward another can best be measured by how that individual actually interacts with others. Here, we will describe an objective manifestation of compassionate behavior, and one that has a wide evidence base in developmental research on caregiver-child relationships—the concept of “emotional availability” or EA. We believe that this construct is applicable to patient-healer relationships, such as the doctor-patient relationship. The measurement of EA is through the EA Scales (Biringen, Robinson, & Emde, 1998; Biringen, 2008), which consist of 4 qualities for the doctor—sensitivity, appropriate structuring, nonintrusiveness, and nonhostility. The client’s feelings about the doctor’s behavioral and affective style is measured through two qualities: patient’s responsiveness to the doctor and the patient’s engagement and involvement of the doctor. We believe these qualities can be important to measure in a doctor-patient relationship, to assess in the medical school admissions process, as well as to nurture during medical training.

Comparison of nebulised dexmedetomidine, ketamine, or midazolam for premedication in preschool children undergoing bone marrow biopsy

BackgroundThe aim of our study was to compare the efficacy of dexmedetomidine, ketamine, and midazolam for sedative premedication administered by nebuliser 30 min before general anaesthesia in preschool children undergoing bone marrow biopsy and aspiration. MethodsNinety children aged 3–7 yr were randomly allocated into three equal groups to be premedicated with either nebulised ketamine 2 mg kg−1 (Group K), dexmedetomidine 2 μg kg−1 (Group D), or midazolam 0.2 mg kg−1 (Group M). The primary endpoint was a five-point sedation score on arrival in the operating room 30 min after end of study drug administration. Secondary outcomes included: parental separation anxiety scale; medication and mask acceptance scales; haemodynamic variables; recovery time; postoperative face, legs, activity, cry, and consolability scale; emergence agitation scale; and adverse effects. ResultsThe median (range) sedation score on arrival in the operating room was 3.5 (1–4), 2.0 (2–3) and 2.0 (1–3) in Groups M, D, and K, respectively (P=0.000). Subjects in Group D showed higher medication (P<0.03) and mask acceptance scores (P<0.015) and more satisfactory parental separation anxiety scale (P<0.044). The median (range) recovery time was significantly shorter in Group D [5.5 (4–8) min] compared with Group K [10.0 (5–15) min, P=0.000] and M [8.0 (6–15) min, P=0.000]. The incidence of emergence agitation was lower in Group D (P<0.008). ConclusionsPreschool children premedicated with nebulised dexmedetomidine had more satisfactory sedation, shorter recovery time, and less postoperative agitation than those who received nebulised ketamine or midazolam. Clinical trial registrationNCT02935959.

Effect of Pregabalin Premedication on Emergence Agitation in Children after Sevoflurane Anesthesia: A Randomized Controlled Study.

Background:Emergence agitation (EA) is common in pediatrics after sevoflurane anesthesia.Aims:We intended to study the effect of preoperative pregabalin on EA in pediatrics after sevoflurane anesthesia.Settings and Design:This study design was a prospective randomized controlled double-blinded study.Patients and Methods:Sixty children with American Society of Anesthesiologists physical status Classes I–II, aged 4–10 years, prepared for adenotonsillectomy under sevoflurane anesthesia were randomized to two equal groups (control Group C and pregabalin Group P). Children received either placebo syrup (Group C) or pregabalin syrup 1.5 mg/kg (Group P) ½ h preoperatively. We recorded postoperative EA scale (EAS) (10, 20, and 30 min postoperatively), time to open the eye, time to extubate, postanesthesia care unit (PACU) duration of stay, number of paracetamol doses (15 mg/kg) given (to control postoperative pain), and complications as vomiting and dizziness on discharge.Statistical Analysis Used:Independent sample t-test and Chi-square test were used as appropriate.Results:Pregabalin Group P showed less EAS, less analgesic (paracetamol) requirement, and less vomiting with insignificant effects on time to open the eye or extubation and PACU duration of stay compared to control group.Conclusion:Preoperative pregabalin decreased postoperative EAS, analgesic (paracetamol) requirement, and vomiting in pediatrics after adenotonsillectomy using sevoflurane anesthesia without affecting time to open the eye or extubation and PACU duration of stay.

Effects of sevoflurane versus other general anaesthesia on emergence agitation in children.

Effects of sevoflurane versus other general anaesthesia on emergence agitation in children.

The effect of different drugs on sevoflurane emergence agitation in pediatric patients undergoing hypospadias repair surgery

BackgroundVarious methods are used to decrease the incidence of emergence agitation (EA) in children following general anaesthesia with sevoflurane.ObjectiveThe present study aims to compare the effect of intravenous injection of small dose of propofol, fentanyl or ketamine at the end of surgery, just before the discontinuation of sevoflurane on the incidence and severity of sevoflurane emergence agitation in children undergoing hypospadias repair operations.Patients and methodsEighty patients undergoing elective hypospadias repair under sevoflurane general anaesthesia with caudal block were randomly divided into four groups (20 patients each); group P received intravenous 1 mg/kg propofol, group K received intravenous 0.25 mg/kg ketamine, group F received intravenous 1 μg/kg fentanyl, and group S received intravenous saline as control group. All those injections were given just before the discontinuation of sevoflurane. The emergence agitation was evaluated by emergence agitation scale from awakening every 5 min for 30 min. Complications like laryngospasm, desaturation, cough, and vomiting were recorded. Awakening time and PACU duration were also recorded.ResultsThe incidence of emergence agitation was significantly lower in groups P and F (p < 0.05). The time for awakening was significantly prolonged in groups P, K and F (p < 0.05), while PACU duration was significantly prolonged in group F (p < 0.05). No significant complications occurred except a significantly higher incidence of vomiting in group F.ConclusionThe use of propofol or fentanyl just before the discontinuation of sevoflurane reduces the incidence of emergence agitation in children, on the other hand fentanyl was accompanied with a significantly longer PACU duration and higher incidence of vomiting.

A Dose-Finding Study of Preoperative Intravenous Dexmedetomidine in Children's Emergence Delirium after Epiblepharon Surgery

Emergence delirium (ED) is a leading problem in children after general anesthesia. Dexmedetomidine (DEX) can be administered prior to general anesthesia to decrease ED, although wide ranges of dose are used. This study was conducted to investigate the proper dosages of DEX to attenuate children's ED after sevoflurane anesthesia. Twenty-five children, aged 3 to 9, undergoing repair of epiblepharon were studied. A chosen dosage of DEX was infused for 10 minutes in the preoperative holding area. The dose of DEX started from 0.25 µg/kg, and then was increased or decreased by 0.25 µg/kg depending on the response of the previous patient, using the Dixon up-and-down method. After the surgery under general anesthesia with sevoflurane, ED was assessed by the Cravero 5-point emergence agitation scale (5-point scale) at the postanesthesia care unit. The 50% and 95% effective concentrations (EC50 and EC95 ) of DEX to attenuate ED were calculated by isotonic regression estimators. The EC50 to attenuate ED was 1.0 (95% confidence interval [CI] 0.29 to 1.71) and EC95 was 1.43 µg/kg (95% CI -1.73 to 4.60). No patient failed parental separation while the Modified Observer's Assessment of Alertness/Sedation Scale at the end of the infusion was scattered from 1 to 5. One child who received 1.50 µg/kg had brief desaturation but recovered soon after being given a verbal command. Dexmedetomidine can be safely used between 1.0 and 1.43 µg/kg to attenuate children's ED after sevoflurane anesthesia.

Emergence agitation in children undergoing adenotonsillectomy: a comparison of sevoflurane vs. sevoflurane‐remifentanil administration

Sevoflurane is widely used in paediatric anaesthesia but frequently causes emergence agitation (EA). This study evaluated whether limiting the sevoflurane concentration by combining remifentanil with sevoflurane reduced the incidence of EA. Eighty-four preschool children scheduled for adenotonsillectomy were randomly assigned to either the remifentanil or sevoflurane group. In the remifentanil group, anaesthesia was induced with thiopental, rocuronium, and 1% sevoflurane. It was maintained with 1% sevoflurane, 60% nitrous oxide in oxygen, and a continuous infusion of remifentanil. For the sevoflurane group, anaesthesia was induced with thiopental, rocuronium, and 8% sevoflurane, and was maintained with 2-3% sevoflurane. Both groups received ketorolac 1 mg/kg and dexamethasone 0.15 mg/kg. EA was measured using the paediatric anaesthesia emergence delirium (PAED) scale and a four-point EA scale in the post-anaesthesia care unit. The scores on the PAED scales were significantly lower in the remifentanil group than in the sevoflurane group [median (interquartile range); 6 (4.25-10.25) vs. 11 (7.75-14.0), P = 0.007], and the proportion of patients with PAED scores ≥ 10 was significantly lower in the remifentanil group than in the sevoflurane group [15 (35.7%) vs. 27 (64.2%), P = 0.009]. The incidence of EA evaluated using the four-point scale was also lower in the remifentanil group [11 (26.1%) vs. 21 (50%), respectively, P = 0.025]. The incidence of EA was lower in children undergoing adenotonsillectomy who received a lower concentration of sevoflurane combined with remifentanil than in those given a higher concentration of sevoflurane without remifentanil.

Effect of oral dextromethorphan versus oral ketamine on sevoflurane related emergence agitation in children undergoing adenotonsillectomy

BackgroundEmergence agitation is a popular phenomenon after sevoflurane anesthesia. Our aim was to study the efficacy of oral dextromethorphan compared to oral ketamine on sevoflurane related agitation.MethodsIn a prospective, randomized, double- blinded study 120, ASA I, aged 4–10 years old children undergoing adenotonsillectomy were randomly divided into three groups to receive oral dextromethorphan 1 mg/kg (Group D, n = 39), oral ketamine 5 mg/kg (Group K, n = 39) or placebo(Group C, n = 38) as premedication 1 h before surgery. Standard general anesthesia was induced and maintained with sevoflurane in N2O/O2. The following were recorded by a blinded anesthetist; Child separation and cooperation at induction, duration of operation, duration of anesthesia, duration of extubation, duration of emergence, state of emergence on admission to PACU using emergence agitation scale, number of patients required postoperative fentanyl to control agitation, duration of discharge from PACU, vital signs (heart rate, blood pressure, and Spo2) in PACU, and side effects (Nausea, vomiting, respiratory depression, and hallucination).ResultsThe agitated patients that required fentanyl treatment were statistically significant low in groups D and K compared to group C (p < 0.05). Child separation and child cooperation at induction from parents was successful in all children in group K with statistical significant difference compared to other groups (p < 0.05). There were increases in duration of anesthesia, extubation, and emergence in group K compared to other groups without increase in the duration of stay in PACU.ConclusionOral premedication with either dextromethorphan 1 mg/kg or ketamine 5 mg/kg were comparable in reducing significantly the incidence of postoperative sevoflurane related emergence agitation in comparison to placebo treated group without reported side effects in children undergoing adenotonsillectomy.