Lower Incidence Of Emergence Agitation Research Articles

Effect of ice popsicle treatment on emergence agitation in children undergoing oral surgery with sevoflurane anaesthesia: A prospective randomized controlled study

Emergence agitation is a common postoperative complication during recovery in children. The purpose of this study is to explore whether the use of ice popsicle could prevent emergence agitation in children undergoing oral surgery with sevoflurane anaesthesia. In this prospective randomized controlled study, 100 children undergoing oral surgery were randomly assigned to Group 1 which received ice popsicle after emergence (intervention, n=50) or Group 2 which received verbal encouragement from their parents (control, n=50). The primary outcome was the 2-hour postoperative incidence of EA. Group 1 had a significant lower incidence of emergence agitation (22% vs 58%, P<0.001) compared with Group 2. The mean agitation score was significantly lower in Group 1 vs Group 2 at 10 minutes (1.64 vs 2.12, P=0.024) and 20min (1.60 vs 2.14, P=0.004) after emergence. The peak agitation and pain scores were significantly lower in Group 1 than in Group 2 (P<0.001). Findings from this study suggest that ice popsicle is an effective, cheap, pleasurable, and easily administered method for alleviating emergence agitation in paediatric patients after oral surgery under general anaesthesia. These results are worthy of confirmation in other surgeries. This approach is highly accepted by both children and their parents, and our findings support the effectiveness of ice popsicle in relieving emergence agitation and pain after oral surgery in children. Chinese Clinical Trial Registry, ChiCTR1800015634.

Effect of Preoperative Preconditioning of Patients with External Nasal Compression for Different Time Intervals on Emergence Agitation After Nasal Surgeries: A Randomised Controlled Trial

Introduction: Emergence agitation is a commonly experienced phenomenon in the waking period of general anaesthesia, which can adversely affect the recovery of patients in the postoperative period. Patients undergoing nasal surgeries under general anaesthesia, involving postoperative nasal packing, tend to have a higher rate of emergence agitation after extubation. Non pharmacological methods like nasal clips, can be safe and costeffective alternatives to pharmacological agents for controlling emergence agitation. Aim: To evaluate the efficacy of preoperatively applying nasal clips for various durations in patients scheduled for nasal surgeries under general anaesthesia, which require nasal packing in the postoperative period, in reducing emergence agitation after extubation. Materials and Methods: The present randomised controlled trial was conducted at department of Anesthesia, Shrimati Bhikhiben Kanjibhai Shah Medical Institute and Research Centre (SBKS MIRC) in Piparia, Vadodara, Gujarat, India. A total of 75 patients with ASA I and II, aged 18-65 years, posted for elective nasal surgeries under general anaesthesia with postoperative bilateral nasal packing, were randomly divided into three groups. Group A (25 patients) wore nasal clips for 30 minutes preoperatively, Group B (25 patients) wore the clip for 40 minutes preoperatively, and Group C (25 patients) served as the control group without nasal clips. At the time of extubation, the emergence agitation score, ability to cough, time to verbal response, respiratory rate, incidences of desaturation, laryngospasm, or any other complications were observed and noted by an anaesthetist who was unaware of the application of nasal clips preoperatively. All data statistically analysis were performed using Statistical Package for Social Sciences (SPSS) for Windows (version 21.0; IBM Corporation). Results: All three groups were comparable (p&gt;0.05) in terms of demographic profile, type and duration of surgery, and baseline haemodynamic parameters like Heart Rate (HR), Mean Arterial Pressure (MAP), Oxygen Saturation (SpO2 ), and baseline Electrocardiography (ECG). Emergence agitation was significantly lower in Group A and B as compared to Group C (p-value=0.02). On comparing Groups A and B, Group B had a significantly lower incidence of emergence agitation (p-value=0.02). There were two cases of dangerous emergence agitation in the control group and one case in Group A while no cases were reported in Group B. Other parameters at extubation were comparable among all groups. Patient satisfaction was significantly higher in Groups A and B in comparison to Group C. Conclusion: The present study suggests that preoperative preconditioning with nasal clips for 40 minutes in patients undergoing elective nasal surgeries can be a useful and safe method to reduce postoperative emergence agitation.

Evaluation of the Efficacy of Propofol-Magnesium Sulfate Combination for Sedation in Paediatric Magnetic Resonance Imaging of Brain.- a Randomized Controlled Trial

Background and Aims: The key to successful sedation for pediatric magnetic resonance imaging (MRI) is to keep the child completely immobile while ensuring rapid recovery. We compared the efficacy of propofol-midazolam and propofol-magnesium sulfate sedation for MRI of the brain in the paediatric population. Methods: Total 60 paediatric patients, aged 1 to 8 years awaiting for MRI brain were randomly allocated into two groups. Group I patients received midazolam 0.05mg/kg and Group II patients received magnesium sulfate 30 mg/kg infusion in the preinduction room. In the MRI room all patients were sedated with 1-2 mg/kg bolus and 100 ug/kg/min infusion of propofol. The two groups were compared for sedation characteristics like discharge time, total number of additional propofol boluses, agitation scores, haemodynamic parameters and adverse events. Fisher exact test was used for all quantitative data. Results: Induction time, scan quality, requirement of additional propofol boluses and awakening time were comparable for the groups (P&gt;0.05). There was no statistically significant incidence of airway instrumentation between both groups (p=0.14)). Heart rate remained on lower normal side, 20 minutes after induction in Group II (P&lt;0.00). Incidence of emergence agitation was significantly lower in Group II (P&lt;0.01). The discharge time was shorter in Group II (41.03 ± 8.39 min versus 32.83 ± 5.97 min; P&lt;0.001). Conclusion: Propofol-magnesium sulfate sedation is a better alternative to propofol-midazolam combination for paediatric brain MRI, as it provides a shorter discharge time and a lower incidence of emergence agitation.

Effects of different doses of dexmedetomidine on postsurgical emergence agitation and oxidative stress in children

Purpose: To study the effects of various dexmedetomidine (DEX) doses on post-surgical emergence agitation (EA) and oxidative stress in children.Methods: At various times, mean arterial pressure (MAP) and heart rate (HR) were measured: prior to anesthesia (T0), during intubation (T1), at onset of operation (T2), and at the end of surgery (T3). The incidence of post-surgical EA was estimated, and the extent of agitation were determined based on pediatric anesthesia emergence delirium (PAED). Post-surgical pain was determined using facial pain scale (FPS). Serum levels of cortisol (Cor), epinephrine (E), and norepinephrine (NE) were quantified at T0 and T3. Extubation time and awakening time, as well as postoperative complications were recorded.Results: At T1, T2 and T3, levels of HR and MAP were significantly increased in all three groups, when compared to the corresponding values at T0, with group C having peak values, followed by A and B. Group B had a lower incidence of EA than groups A and C, but EA incidence was lower in group A than in group C. The lowest scores for PAED and FPS were in group B (p &lt; 0.05). Blood levels of Cor, E and NE at T0 were comparable amongst the three groups. However, at T3, serum levels of these parameters were lower in group B than in each of the other 2 groups.Conclusion: At a dose of 0.5 μg/kg, DEX effectively reduces the incidence of post-surgical EA, improves hemodynamics, and alleviates oxidative stress responses in pediatric anesthesia.

Hemodynamic Response of High- and Low-Dose Dexmedetomidine of Pediatric in General Anesthesia: A Systematic Review and Meta-Analysis of Randomized Controlled Trials.

Dexmedetomidine is a highly selective α2-adrenoceptor agonist, which is off-labelled use for pediatric sedation. However, the hemodynamic responses of dexmedetomidine remain unclear in the pediatric population. The primary objectives of this systematic review and meta-analysis were to examine the hemodynamic effects of high-dose and low-dose dexmedetomidine in pediatric patients undergoing surgery. EMBASE, MEDLINE, and CENTRAL were systematically searched from its inception until April 2019. All randomized clinical trials comparing high-dose (＞ 0.5 mcg/kg) and low-dose (≤ 0.5 mcg/ kg) dexmedetomidine in pediatric surgical patients were included, regardless of the types of surgeries. Observational studies, case series, and case reports were excluded. Four trials (n = 473) were included in this review. Our review demonstrated that high-dose dexmedetomidine was associated with lower heart rate than low-dose dexmedetomidine after intravenous bolus of dexmedetomidine (studies, 3; n = 274; mean difference [MD], -5 [-6 to -4]; P ＜ 0.0001) and during surgical stimulant (studies, 2; n = 153; MD, -11 [-13 to -9]; P ＜ 0.0001). In comparison to the low-dose dexmedetomidine, high-dose dexmedetomidine was also associated with a significant longer recovery time (studies, 3; n = 257; MD, 5.90 [1.56 to 10.23]; P = 0.008) but a lower incidence of emergence agitation (studies, 2; n = 153; odds ratio, 0.17 [0.03 to 0.95]; P = 0.040). In this meta-analysis, low-dose dexmedetomidine demonstrated better hemodynamic stability with shorter recovery time than high-dose dexmedetomidine. However, these findings need to be interpreted with caution due to limited published studies, a small sample size, and a high degree of heterogeneity.

Hemodynamic Response of High- and Low-Dose Dexmedetomidine of Pediatric in General Anesthesia: A Systematic Review and Meta-Analysis of Randomized Controlled Trials.

Dexmedetomidine is a highly selective α2-adrenoceptor agonist, which is off-labelled use for pediatric sedation. However, the hemodynamic responses of dexmedetomidine remain unclear in the pediatric population. The primary objectives of this systematic review and meta-analysis were to examine the hemodynamic effects of high-dose and low-dose dexmedetomidine in pediatric patients undergoing surgery. EMBASE, MEDLINE, and CENTRAL were systematically searched from its inception until April 2019. All randomized clinical trials comparing high-dose (＞ 0.5 mcg/kg) and low-dose (≤ 0.5 mcg/ kg) dexmedetomidine in pediatric surgical patients were included, regardless of the types of surgeries. Observational studies, case series, and case reports were excluded. Four trials (n = 473) were included in this review. Our review demonstrated that high-dose dexmedetomidine was associated with lower heart rate than low-dose dexmedetomidine after intravenous bolus of dexmedetomidine (studies, 3; n = 274; mean difference [MD], -5 [-6 to -4]; P ＜ 0.0001) and during surgical stimulant (studies, 2; n = 153; MD, -11 [-13 to -9]; P ＜ 0.0001). In comparison to the low-dose dexmedetomidine, high-dose dexmedetomidine was also associated with a significant longer recovery time (studies, 3; n = 257; MD, 5.90 [1.56 to 10.23]; P = 0.008) but a lower incidence of emergence agitation (studies, 2; n = 153; odds ratio, 0.17 [0.03 to 0.95]; P = 0.040). In this meta-analysis, low-dose dexmedetomidine demonstrated better hemodynamic stability with shorter recovery time than high-dose dexmedetomidine. However, these findings need to be interpreted with caution due to limited published studies, a small sample size, and a high degree of heterogeneity.

The Addition of Intravenous Propofol and Ketorolac to a Sevoflurane Anesthetic Lessens Emergence Agitation in Children Having Bilateral Myringotomy with Tympanostomy Tube Insertion: A Prospective Observational Study.

The aim of this prospective observational study was to determine if children undergoing bilateral myringotomy and tympanostomy tube insertion with a sevoflurane anesthetic plus intravenous propofol and ketorolac experienced a lower incidence of emergence agitation than those receiving a sevoflurane anesthetic alone. Duration of procedure, length of stay in post-anaesthesia care and level of nursing effort required to care for patients were also assessed. In this study, 49 children younger than 13 years of age received a sevoflurane anesthetic. Fifty-one percent of these patients also received a single injection of propofol 1 mg/kg and ketorolac 0.5 mg/kg at the end of the procedure. Patients were assessed for emergence agitation using the Pediatric Anesthesia Emergence Delirium scale in the post-anaesthesia care unit. Four children receiving a sevoflurane anesthetic alone experienced emergence agitation, while no children receiving propofol and ketorolac experienced emergence agitation (p = 0.05). The length of stay until discharge from the hospital was 6.98 min longer for patients receiving propofol and ketorolac but did not reach statistical significance (p = 0.23). Nurses reported greater ease in caring for patients receiving the propofol and ketorolac injection (recovery questionnaire score 4.50 vs. 3.75, p = 0.002). In this study, adding a single injection of intravenous propofol and ketorolac to the end of a brief sevoflurane anesthetic for bilateral myringotomy with tube insertion was associated with a lower incidence of emergence agitation without significantly increasing the time to discharge from the hospital.

The effect of ketamine on emergence agitation in children: A systematic review and meta-analysis.

Ketamine is believed to reduce the incidence of emergence agitation in children undergoing surgery or procedure. However, recent randomized controlled trials reported conflicting findings. To investigate the effect of ketamine on emergence agitation in children. Databases of MEDLINE, EMBASE, and CENTRAL were systematically searched from their start date until February 2019. Randomized controlled trials comparing intravenous ketamine and placebo in children were sought. The primary outcome was the incidence of emergence agitation. Secondary outcomes included postoperative pain score, duration of discharge time, and the adverse effects associated with the use of ketamine, namely postoperative nausea and vomiting, desaturation, and laryngospasm. Thirteen studies (1125 patients) were included in the quantitative meta-analysis. The incidence of emergence agitation was 14.7% in the ketamine group and 33.3% in the placebo group. Children receiving ketamine had a lower incidence of emergence agitation, with an odds ratio being 0.23 (95% confidence interval: 0.11 to 0.46), certainty of evidence: low. In comparison with the placebo, ketamine group achieved a lower postoperative pain score (odds ratio: -2.42, 95% confidence interval: -4.23 to -0.62, certainty of evidence: very low) and lower pediatric anesthesia emergence delirium scale at 5minutes after operation (odds ratio: -3.99, 95% confidence interval: -5.03 to -2.95; certainty of evidence: moderate). However, no evidence was observed in terms of incidence of postoperative nausea and vomiting, desaturation, and laryngospasm. In this meta-analysis of 13 randomized controlled trials, high degree of heterogeneity and low certainty of evidence limit the recommendations of ketamine for the prevention of emergence agitation in children undergoing surgery or imaging procedures. However, the use of ketamine is well-tolerated without any notable adverse effects across all the included trials. CRD42019131865.

Premedication with dexmedetomidine to reduce emergence agitation: a randomized controlled trial

BackgroundNasal bone fracture is the most common type of facial fracture, and the high incidence of severe emergence agitation occurring after closed reduction of the nasal bone fracture can be challenging to manage. The purpose of this trial was to evaluate whether pre-operative administration of dexmedetomidine is effective in reducing the incidence and severity of emergence agitation in adults undergoing closed reduction of nasal bone fractures.MethodsIn this randomized controlled trial, 90 patients who were scheduled to undergo closed reduction of a nasal bone fracture were prospectively included and were randomly assigned to either the control group (n = 45; 0.9% saline infusion) or the dexmedetomidine group (n = 45; 1 μ/kg over 10 min, pre-operatively). The primary endpoint was Aono’s four-point scale scores after anesthesia. The recovery time and numeric rating scale score were assessed as secondary endpoints.ResultsAono’s four-point scale scores were lower in the dexmedetomidine group than in the control group (median: 1 [1] vs. 1 [1, 2], 95% confidence interval of difference: 0.01 to 0.02, P = 0.02). The number, severity, and duration of agitation episodes were significantly lower in the dexmedetomidine group than in the control group. Furthermore, the number of patients exhibiting intraoperative movement was lower in the dexmedetomidine group.ConclusionsPre-operative administration of dexmedetomidine demonstrated several significant benefits, such as a lower incidence of emergence agitation, reduced agitation severity, and a shorter duration of agitation. Additionally, we observed more stable maintenance of intraoperative anesthesia with less movement during the surgery.Trial registrationIdentifier: KCT0000585 (registration date: 12–19- 2012).

Intraoperative dexmedetomidine infusion is associated with reduced emergence agitation and improved recovery profiles after lung surgery: a retrospective cohort study.

PurposeThis retrospective cohort study aimed to investigate the association between intraoperative dexmedetomidine infusion and emergence agitation (EA), and recovery profiles after lung surgery in adult patients. It was hypothesized that dexmedetomidine was associated with reduced EA and improved recovery profiles.Patients and methodsA single-center chart review was conducted on elective lung surgeries in adults between January and December 2016. The primary outcome was the incidence of EA in postanesthesia care units (PACUs). The secondary outcomes included rescue analgesia, shivering, time to extubation, residual sedation, postoperative pulmonary events, duration of PACU stay, length of hospital stay, and intraoperative hemodynamic changes. Univariate and multivariate regression analyses were used to analyze data.ResultsAmong 2,468 patients, 814 received an intraoperative dexmedetomidine infusion. Intraoperative dexmedetomidine infusion was associated with a lower incidence of EA (10.9% vs 15.0%; adjusted OR, 0.67; 95% CI, 0.51–0.87; P=0.003), rescue analgesia (7.6% vs 12.2%; adjusted OR, 0.63; 95% CI, 0.47–0.86; P=0.003), shivering (4.2% vs 6.6%; adjusted OR, 0.58; 95% CI, 0.38–0.88; P=0.010), and intraoperative bradycardia (18.6% vs 12.6%; adjusted OR, 1.51; 95% CI, 1.19–1.92; P=0.001). No differences were observed in residual sedation, duration of PACU stay, postoperative pulmonary events, and length of hospital stay between the groups.ConclusionThis retrospective study suggested that intraoperative dexmedetomidine infusion was associated with a lower incidence of EA, rescue analgesia, and shivering in adults after lung surgery. Intraoperative bradycardia was the main side effect.

Evaluation of Propofol in Comparison with Other General Anesthetics for Surgery in Children Younger than 3 Years: a Systematic Review and Meta-Analysis.

BackgroundDespite well-known advantages, propofol remains off-label in many countries for general anesthesia in children under 3 years of age due to insufficient evidence regarding its use in this population. This study aimed to evaluate the efficacy and safety of propofol compared with other general anesthetics in children under 3 years of age undergoing surgery through a systematic review and meta-analysis of existing randomized clinical trials.MethodsA comprehensive literature search was conducted of MEDLINE, Embase, and the Cochrane Central Register of Controlled Trials to find all randomized clinical trials comparing propofol with another general anesthetic that included children under 3 years of age. The relative risk or arcsine-transformed risk difference for dichotomous outcomes and the weighted or standardized mean difference for continuous outcomes were estimated using a random-effects model.ResultsA total of 249 young children from 6 publications were included. The children who received propofol had statistically significantly lower systolic and diastolic blood pressures, but hypotension was not observed in the propofol groups. The heart rate, stroke volume index, and cardiac index were not significantly different between the propofol and control groups. The propofol groups showed slightly shorter recovery times and a lower incidence of emergence agitation than the control groups, while no difference was observed for the incidence of hypotension, desaturation, and apnea.ConclusionThis systematic review and meta-analysis indicates that propofol use for general anesthesia in young healthy children undergoing surgery does not increase complications and that propofol could be at least comparable to other anesthetic agents.

Preoperative external nasal compression: does it decrease emergence agitation after nasal surgery?

Background Emergence agitation after nasal surgeries in adults is common. Acute postoperative nasal obstruction with nasal packing is an important factor in developing agitation after nasal surgeries. Aim The aim of this study was to evaluate the effectiveness of preoperative nasal obstruction by means of external nasal compression on the incidence of emergence agitation after nasal surgeries. Methods Sixty patients of American Society of Anesthesiologists I or II between 20 and 45 years of age who were scheduled for nasal surgery were randomly assigned into three equal groups: the control (C) group, the T10 group, in which nasal compression was carried out for 10 min, and the T30 group, in which nasal compression was carried out for 30 min preoperatively. All patients received the same anesthetic technique. The incidence of agitation, and recovery characteristics were evaluated during emergence. Patient satisfaction was evaluated 24 h after surgery. Results There was a significantly lower incidence of emergence agitation and fentanyl consumption during the emergence period in the T30 group. Moreover, patient satisfaction with recovery was significantly higher in the T30 group. Conclusion Elective preoperative external nasal obstruction may decrease the incidence of emergence agitation and improve patient satisfaction with recovery after nasal surgery.

Effects of Dexmedetomidine Infusion on the Recovery Profiles of Patients Undergoing Transurethral Resection.

Transurethral resection has been the gold standard in the operative management of benign prostatic hyperplasia and bladder tumor; however, it is associated with several complications that may cause patient discomfort. We evaluated the usefulness of continuous infusion of dexmedetomidine on emergence agitation, hemodynamic status, and recovery profiles in patients undergoing elective surgery by a randomized clinical trial. Sixty patients aged 30 to 80 yr who were scheduled for elective transurethral resection under general anesthesia were included in this study. Participants were randomly assigned to two groups (control group, group C; dexmedetomidine group, group D). A total of 60 male patients were enrolled in this study and randomly assigned to group C (n=30) or group D (n=30). The quality of emergence in group D was marked by a significantly lower incidence of emergence agitation than in group C (P=0.015). Patients in group D therefore felt less discomfort induced by the indwelling Foley catheter than those in group C (P=0.022). No statistically significant differences were found between the two groups with respect to side effects including bradycardia (P=0.085), hypotension (P=0.640), and postoperative nausea and vomiting (P=0.389). Our study showed that intraoperative dexmedetomidine infusion effectively reduced the incidence and intensity of emergence agitation and catheter-induced bladder discomfort without delaying recovery time and discharge time, thus providing smooth emergence during the recovery period in patients undergoing transurethral resection (Clinical Trial Registry No. KT0001683).

Lower incidence of emergence agitation in children after propofol anesthesia compared with sevoflurane: a meta-analysis of randomized controlled trials

Emergence agitation (EA) from general anesthesia has been reported as an adverse effect of sevoflurane in children. We describe a meta-analysis of randomized controlled trials that compared the incidence of EA between children who underwent sevoflurane anesthesia and those who underwent propofol anesthesia. A literature search was conducted to identify clinical trials that met our inclusion criteria. Prospective randomized trials comparing sevoflurane and propofol anesthesia in children less than 15 years of age were included in the meta-analysis. Data from each trial were combined using the random effects model to calculate pooled odds ratios (ORs) and their corresponding 95 % confidence intervals (CIs). The heterogeneity of data was assessed by Cochran's Q and I (2) tests. Sensitivity analysis was conducted for study quality, patient age, and type of surgical procedure. The meta-analysis included 14 studies, in which 560 patients received sevoflurane and 548 received propofol. The pooled OR for EA was 0.25 with a 95 % CI of 0.16-0.39 (P = 0.000), which indicates that propofol anesthesia resulted in a lower incidence of EA. The heterogeneity of data was not statistically supported (P = 0.191). All sensitivity analyses strengthened the evidence for the lower incidence of EA with propofol. Our meta-analysis demonstrated that EA in children is less likely to occur after propofol anesthesia compared with sevoflurane anesthesia.

The application of dexmedetomidine in children undergoing vitreoretinal surgery

Dexmedetomidine is a highly selective alpha-2 adrenergic agonist that has a sedative effect and has been shown to reduce anesthetic requirements. It also has a sympatholytic effect, which may prove useful when used to blunt the sympathetic surge during intubation and extubation. However, its effects on intraocular pressure, hemodynamic stability, attenuation of extubation response, and emergence agitation remain unclear for pediatric patients undergoing vitreoretinal surgery. We focused on these effects in this study. Sixty ASA I-II patients undergoing vitreoretinal surgery, were anesthetized with sevoflurane 1-2% end-tidal concentration in oxygen supplemented by remifentanil 0.2μg/kg/min. Intraocular pressure was measured after inhalation of sevoflurane (IOP(Baseline)) and 10min after intravenous administration of dexmedetomidine 0.5μg/kg or normal saline (IOP(10min)), after induction of anesthesia. Blood pressure and heart rate were recorded every 5min during surgery. The incidence and severity of coughing and emergence agitation and untoward airway events after extubation, for example breath holding, laryngospasm, bronchospasm, and oxygen desaturation, were assessed. Extubation time and emergence time were also documented. There was no significant difference in intraocular pressure at the two time points between the groups (p>0.05). In both groups mean arterial pressure and heart rate decreased from baseline after anesthetic induction (p<0.05). The increase from intraoperative values in mean arterial pressure and heart rate associated with extubation was diminished in the dexmedetomidine group compared with the control group (p<0.05). Coughing after extubation was less common (10 vs. 21) and less severe (3 moderate and 7 minimal; vs. 2 severe, 7 moderate and 12 minimal) in the dexmedetomidine group than in the control group (p<0.05). There were no significant differences between the groups in time to emergence or extubation (p>0.05). The dexmedetomidine group had a lower incidence of emergence agitation than the control group (10 vs. 43.3%, p<0.05). The incidence of breath holding, laryngospasm, bronchospasm and oxygen desaturation was not significantly different between the groups (p>0.05). Dexmedetomidine 0.5µg/kg had no effect on intraoperative hemodynamics or intraocular pressure, but attenuated the hemodynamic response to extubation and diminished emergence agitation in pediatric patients undergoing vitreoretinal surgery.

The influence of GABAAγ2 genetic polymorphism on the emergence agitation induced by sevoflurane

Background: Sevoflurane is one of the most popular anesthetics, used in pediatric anesthesia, but emergence agitation is more common with using sevoflurane as compared to that with using the other inhalation anesthetics. Sevoflurane exerts its effect on γ-aminobutyric acid (GABA) ergic transmission. This study aimed to investigate if genetic variations at the GABRγ2 (single nucleotide polymorphism [SNP] 211037 C/T, nucleotide position 3145 in intron A/G) on the 5q33 chromosome were associated with the development of emergence agitation when sevoflurane is used. Methods: One hundred fourteen, pre-school aged patients who were to undergo tonsillectomy and adenoidectomy were included in this study. Anesthesia was induced with 5 mg/kg of thiopental sodium, 0.02 mg/kg of atropine and 0.1 mg/kg of vecuronium, and this was maintained with 3% sevoflurane and 50% N2O in oxygen. The incidence of emergence agitation and the emergence agitation scores were assessed at 0 min, 10 min, 20 min and 30 min after arriving at the post anesthetic care unit (PACU). Genomic DNA from peripheral leukocytes was isolated using the QIAamp Blood Minikits and the GABRγ2 genetic polymorphisms were analyzed by performing polymerase chain reaction-restriction fragment length polymorphism (PCR-RFLP) method. Results: There were no significant differences of the emergence agitation scores among the genotypes in the GABRγ2SNP211037 C/T and GABRγ2-nucleotide position 3145 in intron A/G. There was a trend in which the AA group in the GABRγ2nucleotide position 3145 in intron A/G has a lower incidence of emergence agitation compared with the non-AA group, but this was without statistical significance (P = 0.07). Conclusions: There is a possibility that the GABR2 genetic polymorphism may affect the development of emergence agitation when sevoflurane is used in pediatric anesthesia. (Korean J Anesthesiol 2008; 55: 139∼44)

Propofol reduces the incidence of emergence agitation in preschool-aged children as well as in school-aged children: a comparison with sevoflurane

Young age is considered as one of the factors associated with emergence agitation (EA) following sevoflurane anesthesia. The relationship between EA following propofol anesthesia and young age has not yet been examined. This study was designed to compare the incidence of EA in younger children and older children following either propofol or sevoflurane anesthesia. Ninety-six preschool-aged (2-5 years) children and 90 school-aged (6-11 years) children (American Society of Anesthesiologists [ASA] I or II) scheduled to undergo otorhinolaryngological surgery were randomly assigned to receive either propofol or sevoflurane. These children were divided into the following four groups: propofol-preschool (P-pre), sevoflurane-preschool (S-pre), propofol-school (P-school), and sevoflurane-school (S-school) groups. Recovery times and incidence of EA were compared among the four groups. We observed that the recovery times were similar in the four groups. After extubation, the incidence of EA in the S-pre group was significantly higher than that in the other groups. After eye opening, the incidence of EA in the S-pre and S-school groups was significantly higher than that in the P-pre or P-school groups. At all recovery times, no difference was observed in the incidence of EA between the P-pre and P-school groups. Propofol, in comparison with sevoflurane, resulted in a lower incidence of EA, with no relation to age.

Delayed emergence process does not result in a lower incidence of emergence agitation after sevoflurane anesthesia in children

Emergence agitation (EA) is more frequent after sevoflurane anesthesia than other inhalational agents but the etiology remains unclear. We investigated whether the EA after sevoflurane anesthesia is related to rapid emergence. Eighty-five patients, aged 1-7 years, undergoing elective urology surgery were studied. After induction, anesthesia was maintained with 2.0-2.5% sevoflurane and 50% N(2)O. BIS was monitored continuously throughout surgery and emergence. At the end of surgery, the children were randomly assigned to one of two groups: group I, immediate cessation of sevoflurane; or group G, gradual decrease of sevoflurane with the rate of 0.1%.min(-1). Emergence agitation score was recorded during recovery. Times from immediate cessation or start of decrease of sevoflurane to BIS 70, 80, 90 and extubation were significantly longer in group G. The incidence of severe agitation (score > or =3) was not significantly different between group I and group G: which were 35.7% and 32.6%, respectively. Prolonged recovery did not reduce the incidence of EA following sevoflurane anesthesia in children.