Occurrence Of Emergence Agitation Research Articles

Effects of intra-operative administration of intravenous dexmedetomidine on incidence of emergence phenomenon after general anaesthesia in adults; An observational study

Background: The occurrence of emergence agitation (EA) is the most common and practical problem faced in the immediate post-operative period during the process of Extubation under General Anaesthesia. Dexmedetomidine, an α2 adrenoceptor agonist is an excellent drug that has been shown effective to decrease the preoperative anxiety and smooth induction and emergence. Aims and Objectives: To assess the effect of intravenous dexmedetomidine primarily on EA and other complications that may occur during emergence from general anesthesia. Materials and Methods: 80 patients of either gender aged 18–65 years with ASA status I and II, undergoing various elective general and urological surgeries under general anesthesia were included in the study. Patients receiving adjuvant drug dexmedetomidine, were labelled as Group D (n=40) and those who didn’t receive any adjuvant were labelled as group C (n=40). Dexmedetomidine was given at 1 μg/kg and then maintained at infusion of 0.4 μg/kg/h till the end of the surgery for group D. The hemodynamic parameters and SpO2 were measured during the intraoperative period at various intervals of time till the end of surgery and also on arrival to the recovery room till patient was discharged from post-anesthesia care unit in both the groups. Results: The use of IV dexmedetomidine has proved significantly effective in prevention of incidence of EA with the overall incidence of agitation of 7.5% in Group D as compared to 42.5% in group C. Conclusion: Intraoperative administration of intravenous dexmedetomidine decreased the incidence of EA and other emergence phenomena like cough, pain and PONV with stable hemodynamics, safety profile, good analgesic properties and opioids sparing side effects.

Subanesthetic-dose propofol infusion for preventing emergence agitation in children: a retrospective observational study.

Anesthesia maintenance using propofol and a propofol bolus dose at the end of surgery have been shown to prevent emergence agitation (EA).However, the preventive effect of subanesthetic propofol infusion during sevoflurane anesthesia on EA remains unknown. We aimed toevaluate the effect of subanesthetic propofol infusion on EA in children. We retrospectively compared the incidences of severe EA requiring pharmacological intervention in children who underwent adenoidectomy, tonsillectomy with or without adenoidectomy, or strabismus surgery between maintenance with sevoflurane alone (sevoflurane group) and maintenance with subanesthetic propofol with sevoflurane (combination group). A multivariable logistic regression model adjusted for confounders was used to assess the association between anesthesia methods and the occurrence of EA. Additionally, we estimated the direct effect of anesthesia methods by a mediation analysis, excluding the indirect effects of intraoperative fentanyl and droperidol administration. Among 244 eligible patients, 132 and 112 were in the sevoflurane and combination groups, respectively. The crude incidence of EA was significantly lower in the combination group (17.0% [n = 19]) than in the sevoflurane group (33.3% [n = 44]) (P = 0.005).After adjusting for confounders, the incidence of EA was still significantly lower in the combination group (adjusted odds ratio [aOR]: 0.48, 95% confidence interval [CI] 0.25-0.91). The mediation analysis revealed a direct association of anesthesia methods with a lower EA incidence in the combination group (aOR: 0.48, 95% CI 0.24-0.93) than in the sevoflurane group. Subanesthetic propofol infusion may effectively prevent severe EA requiring the administration of opioids or sedatives.

Effect of Preoperative Thoracic Paravertebral Blocks on Emergence Agitation During Tracheal Extubation: A Randomized Controlled Trial.

ObjectiveThis study aims to compare the effects of preoperative thoracic paravertebral blocks (TPVB) with intercoastal nerve blocks (ICNB) on emergence agitation (EA) during tracheal extubation in patients who underwent thoracoscopic lobectomy.Design, Setting, and ParticipantsA randomized clinical trial was conducted in patients undergoing thoracoscopic lobectomy at Beijing Chest Hospital between June 2019 and December 2020.InterventionsPatients were randomly assigned 1:1 to receive either ultrasound-guided preoperative TPVB or ICNB.Main Outcomes and MeasuresThe primary outcome was the occurrence of emergency agitation, which was evaluated by Aono’s four-point scale (AFPS). Secondary outcomes included hemodynamics [mean arterial pressure (MAP) and heart rate (HR)]; and post-operative pain intensity [visual analog scale (VAS), Ramsay sedation score (RSS), and patient-controlled analgesia (PCA) demand times].ResultsAmong the 100 patients aged 55–75 years old, 50 were randomized to each group; 97 patients completed the trial. Compared to the ICNB group, the occurrence of EA in the TPVB group was significantly lower [31.3% (15/48) vs. 12.2% (6/49), relative risk = 1.276, 95% CI: 1.02–1.60, P = 0.028]. For patients in the TPVB group, the MAP and HR at 5, 10, and 30 min after extubation were significantly lower; the intraoperative details including emergence time, extubation time, and consumption of sufentanil were significantly shorter than that in the ICNB group. Additionally, patients in the TPVB group showed significantly lower VAS at rest or coughing and significantly lower RSS at 60 and 240 min after extubation than patients in the ICNB group (all P < 0.05).ConclusionPreoperative TPVB was associated with less EA during tracheal extubation when compared with ICNB in patients undergoing thoracoscopic lobectomy.Clinical Trial Registration[http://www.chictr.org.cn/index.aspx], identifier [ChiCTR1900023852].

Efficacy of intraoperative magnesium sulfate versus ketamine on emergence agitation in pediatric patients under sevoflurane anesthesia: a randomized clinical trial

BackgroundOver the years, sevoflurane has been proven to be the most effective inhalational anesthetic for induction and maintenance of general anesthesia in pediatrics. However, one of the downsides of utilizing sevoflurane anesthesia in pediatrics is emergence agitation (EA). A variety of drugs have been evaluated for prophylaxis against the occurrence of EA. Both magnesium and ketamine were evaluated in controlling this phenomenon; however, the usefulness of using intraoperative magnesium and ketamine infusions in preventing EA is still debatable.MethodsFifty-two children aged 4–7 years who were having elective lower abdominal or pelvic surgeries under sevoflurane anesthesia were enrolled then allocated randomly into one of two groups (n = 26 each). The magnesium group (M) included 26 patients who received intravenous (IV) loading dose of magnesium 15 mg/kg before the surgical incision followed by IV infusion 10 mg/kg/h over the duration of surgery, while the ketamine group (K) included 26 patients who received an IV loading dose of ketamine 1 mg/kg before the surgical incision, then IV infusion 1 mg/kg/h over the duration of surgery. For each patient, the agitation score (Pediatric Anesthesia Emergence Delirium [PAED] scale) and pain score, as well as the time to endotracheal tube (ETT) removal, regain of mental orientation, and transfer from the post-anesthesia care unit (PACU) to ward were all documented.ResultsIntraoperative magnesium sulfate infusion showed a lower PAED score on immediate arrival to PACU than intraoperative ketamine infusion, with less time to tracheal extubation, recovery of mental orientation, and discharge from PACU with a P value below 0.001, while there was no statistical significance between both groups as regards PAED score after 30 min in PACU, pain score, or perioperative vital data.ConclusionsMagnesium sulfate was found superior to ketamine in lowering the severity of the postoperative agitation in pediatric patients undergoing abdominal or pelvic surgeries under sevoflurane anesthesia. Also, patients restored their consciousness and mental orientation faster in the magnesium group compared to ketamine. This has increased the PACU stay in the ketamine group.

Adverse respiratory events with sevoflurane compared with desflurane in ambulatory surgery: A systematic review and meta-analysis.

BACKGROUNDAn increasing number of studies have concluded that the number of adverse events in the upper airway caused by desflurane does not differ significantly from the number of adverse events caused by sevoflurane. The advantages of desflurane in ambulatory surgery should be reassessed.OBJECTIVESThe aim of this study was to compare adverse respiratory events and recovery outcomes in patients undergoing desflurane or sevoflurane-based anaesthesia in ambulatory surgery.DESIGNA systematic review and meta-analysis of randomised controlled trials (RCTs).DATA SOURCESA systematic search for eligible RCTs in PubMed, Medline, Cochrane Central Register of Controlled Trials, ScienceDirect and Embase published up to June 2019.ELIGIBILITY CRITERIARCTs investigating the occurrence of adverse respiratory events, including airway irritation, stridor, coughing, respiratory distress and laryngospasm, emergence agitation, postoperative nausea and vomiting (PONV), time to eye opening and time to discharge from the operation room after desflurane or sevoflurane-based anaesthesia.RESULTSThirteen trials were included and analysed. A total of 634 patients were included in the desflurane group, and 633 patients in the sevoflurane group. The occurrence of respiratory complications was significantly higher with desflurane-based anaesthesia than with sevoflurane-based anaesthesia (Total n = 673, 20.0 vs. 12.8%, relative risk (RR) 1.59 (95% CI 1.15 to 2.20)) with low heterogeneity (I2 = 20%). There was no difference in the occurrence of emergence agitation (Total n = 626, 29.1 vs. 27.2%, RR 1.05 (95% CI 0.84 to 1.30)) or the incidence of PONV between the desflurane and sevoflurane groups (Total n = 989, 19.0 vs. 21.0%, RR 0.95 (95% CI 0.71 to 1.26)). Time to eye opening was significantly faster with desflurane than that with sevoflurane (Total n = 1072, mean difference = −3.32 min (95% CI −4.02 to −2.61)) with a substantial heterogeneity (I2 = 72.6%). There was no significant difference in the time to discharge from the operation room between the two groups (Total n = 1056, mean difference = −0.45 min (95% CI −5.89 to 4.99)).CONCLUSIONDespite recent reports that there is no significant difference in adverse respiratory events between desflurane and sevoflurane, a pooled analysis revealed that desflurane resulted in a higher rate than sevoflurane. Therefore, the consequences of desflurane should not be neglected and its airway irritant properties should be taken into account.TRIAL REGISTRATIONPROSPERO (CRD42019147939).

A Comparative Study of Oral Dexmedetomidine versus Oral Midazolam As preanesthesia Medication in Pediatric Patients to Reduce anxiety

Introduction: Preoperative period is a stressful period. In children the preoperative anxiety is expressed as difficult separation from parents and difficult mask induction. The level of preoperative anxiety also affects postoperative outcomes. To overcome anxiety premedication is often used by pediatric anesthesiologist.&#x0D; Objective: The objective of this study was to compare the effect of oral midazolam 0.5mg/kg and oral dexmedetomidine 4μg/kg on parental separation, mask induction and postoperative emergence agitation in children undergoing elective surgery under general anesthesia.&#x0D; Methodology: 120 children aged 2-8years undergoing elective surgery under general anesthesia were divided into two groups: Group M and Group D. Patients in group M received oral midazolam 0.5mg/kg and patients in group D received oral dexmedetomidine 4μg/kg. After 45min of premedication sedation score was assessed in both the groups. Ease of parental separation and mask acceptance was compared in both the groups. In the postoperative period occurrence of emergence agitation was compared in both the groups.&#x0D; Results: There was no statistically significant difference in preoperative sedation score in both the groups. Parent separation anxiety score and mask acceptance score were statistically similar in both the groups. But emergence agitation was significantly lesser in patients who received dexmedetomidine premedication.&#x0D; Conclusions: Premedication with oral midazolam as well as oral dexmedetomidine effectively reduces parental separation anxiety and produces satisfactory mask induction in pediatric age group. However, dexmedetomidine is more effective in reducing emergence delirium in comparison to midazolam.

Effect of Total Intravenous Anesthesia vs Volatile Induction With Maintenance Anesthesia on Emergence Agitation After Nasal Surgery

Emergence agitation is common after nasal surgery under general anesthesia and may lead to serious consequences for the patient, including an increased risk of injury, pain, hemorrhage, and self-extubation. Despite decades of research, studies on the incidence, risk factors, and prevention of emergence agitation in adult patients are ongoing, and opinions differ on the different effects of inhalation and intravenous anesthesia. To investigate the effect of anesthetic method on the occurrence of emergence agitation after nasal surgery. This prospective, randomized, single-blind, clinical trial included 80 patients undergoing open rhinoplasty, septoplasty, turbinoplasty, endoscopic sinus surgery, and functional endoscopic sinus surgery under general anesthesia who were randomized to receive total intravenous anesthesia (TIVA) with remifentanil hydrochloride and propofol (n = 40) or volatile induction and maintenance of anesthesia (VIMA) with sevoflurane and nitrous oxide (n = 40) in Asan Medical Center, a tertiary referral center in Seoul, Republic of Korea. Data were collected from August 24 through October 14, 2016, and analyzed from October 26, 2016, through September 14, 2017. The occurrence of emergence agitation defined by the following 2 individual criteria: a Richmond Agitation-Sedation Scale score of at least 1 and a Riker Sedation-Agitation Scale score of at least 5 immediately after extubation. Among the 80 patients included in the analysis (68.8% men [n = 55]; mean [SD] age, 41.6 [17.9] years), emergence agitation measured by the Richmond Agitation Sedation Scale occurred in 8 of 40 patients (20.0%) in the VIMA group and 1 of 40 (2.5%) in the TIVA group. The risk difference was 17.5 (95% CI, 3.6-31.4). Emergence agitation measured by the Riker Sedation-Agitation Scale score occurred in 10 of 40 patients (25.0%) in the VIMA group and 1 of 40 (2.5%) in the TIVA group. The risk difference was 22.5 (95% CI, 7.3-37.7). The occurrence of emergence agitation after nasal surgery under general anesthesia can be significantly reduced by using TIVA rather than VIMA. CRIS identifier: KCT0002145.

The Efficacy of Intraoperative EEG to Predict the Occurrence of Emergence Agitation in the Postanesthetic Room After Sevoflurane Anesthesia in Children

Emergence agitation (EA) is common after sevoflurane anesthesia, but there are no definite predictors. This study investigated whether intraoperative electroencephalography (EEG) can indicate the occurrence of EA in children. A prospective predictive study design was used. EEG-derived parameters (spectral edge frequency 95, beta, alpha, theta, and delta power) were measured at 1.0 minimum alveolar concentration (MAC) and 0.3 MAC of end-tidal sevoflurane (EtSEVO) in 29 patients. EA was evaluated using an EA score (EAS) in the postanesthetic care unit on arrival (EAS 0) and at 15 and 30minutes after arrival (EAS 15 and EAS 30). The correlation between EEG-derived parameters and EAS was analyzed using Spearman correlation, and receiver-operating characteristic curve analysis was used to measure the predictability. EA occurred in 11 patients. The alpha power at 1.0 MAC of EtSEVO was correlated with EAS 15 and EAS 30. The theta/alpha ratio at 0.3 MAC of EtSEVO was correlated with EAS 30. The area under the receiver-operating characteristic curve of percentage of alpha bands at 0.3 MAC of EtSEVO and the occurrence of EA was 0.672. Children showing high-alpha powers and low theta powers (= low theta/alpha ratio) during emergence from sevoflurane anesthesia are at high risk of EA in the postanesthetic care unit.

The plasma levels of brain-derived neurotrophic factor are positively associated with emergence agitation in the elderly after gastrointestinal surgery.

To explore the association between plasma concentrations of brain-derived neurotrophic factor (BDNF) and the occurrence of emergence agitation (EA) in the elderly after gastrointestinal surgery. Seventy-two patients were recruited, who received gastrointestinal surgery and general anesthesia. BDNF level of blood was detected by ELISA before anesthesia (baseline), 10min after tracheal intubation before the start of surgery, at skin closure, 10min after tracheal extubation, and 24h postoperatively. Patients with a Ricker Sedation-Agitation Scale (RSAS) score ≥5 at any time in the post anesthesia care unit were considered to have emergence agitation. The incidence of EA in this population was 40% (29/72). The EA group had higher plasma BDNF levels at skin closure (497.86±69.65 vs. 307.86±51.91, p<0.05) and especially at 10min after tracheal extubation (900±224.6 vs. 476.28±107.15, p<0.001). Moreover, the levels of plasma BDNF at skin closure, 10min after tracheal extubation and postoperative pain, were positively related with RSAS scores. Our results suggest that plasma BDNF is associated with the occurrence of emergence agitation after gastrointestinal surgery.

Comparative study between the effect of propofol and fentanyl on the incidence and severity of emergence agitation after sevoflurane anesthesia in pediatrics

Introduction The occurrence of emergence agitation (EA) in pediatric patients who received sevoflurane anesthesia is a common postoperative problem. Purpose This study aimed to compare the efficacy of propofol versus fentanyl to decrease the incidence of EA using an emergence behavior scale - pediatric agitation emergence delirium (PAED). Patients and methods This study was performed on three patient groups undergoing the same surgical procedure, under sevoflurane anesthesia: the first received saline as a control, the second received propofol, and the third received fentanyl. Thereafter, we compared the efficacy on incidence and severity of EA using an emergence behavior scale - PAED. Results Regarding the frequency of agitation, the highest frequency was observed in the control group followed by the propofol group and then the fentanyl group (46.9, 18.8, and 12.5%, respectively). The onset of agitation was delayed in the propofol and fentanyl groups when compared with the control group ( P P = 0.239), but a highly significant difference between both of them and the control group was found ( P Conclusion Both propofol and fentanyl decrease the incidence and the severity of EA, but there is no reliable significance when comparing both drugs. We recommend further studies to declare other drugs that have potency to decrease the incidence and to treat the EA.

Dexmedetomidine infusion for prevention of emergence agitation from anesthesia in pediatric ophthalmic surgery

Objective To investigate the security and effectiveness of dexmedetomidine infusion for prevention of emergence agitation from intravenous anesthesia in ophthahmic surgery.Methods 60 operations of pediatric ocular trauma were randomly divided into two groups:The dexmedetomidine group (group A,n =30) and the control group(group B,n =30)).When anesthesia induction was administrated,normal saline 20 ml or dexmedetomidine 0.5 μg/kg diluted to 20 ml was intravenously infused in 10 minutes.The difference between the mean artery pressure(MAP),heart rate(HR) and SpO2 before injection(T0),5 minutes after injection(T1),awakening(T2),5 minutes after extubation(T3),10 minutes after extubation (T4) and the agitation scale were observed in two groups.Results There was no significant difference between the two groups in sex,age,weight,time of operation and SpO2 in T0 to T4 (x2 =0.082,t =0.398,0.296,0.765,P ＞0.05).Compared with group B,the HR of T1,the MAP,HR and agitation scale of T2,T3 and T4 were lower in group A (t =5.651,12.438,10.928,14.247,13.819,17.717,15.141,2.321,8.797,8.797,x2 =5.963,8.365,6.667,P ＜ 0.05) in two groups.Conclusion Dexmedetomidine of 0.5 μg/kg was intravenously infused 10 min before anesthesia induction can safely and effectively reduce the occurrence of emergence agitation from anesthesia in pediatric ophthalmic surgery. Key words: Dexmedetomidine ; Surgery, ophthalmic, pediatric ; Anesthesia, intravenous ; Agitation, emergence

Comparative study of emergence agitation between isoflurane and propofol anesthesia in adults after closed reduction of distal radius fracture

Distal radius fracture is a common wound. It is reduced by surgery under anesthesia. Emergence agitation can often occur after anesthesia. It is associated with increased morbidity and hospital costs. However, there have been almost no reports in the medical literature on the occurrence of emergence agitation in adults. This study aimed to compare emergence agitation between isoflurane and propofol anesthesia in adults after closed reduction of distal radius fracture. Forty adults (ASA I-II) undergoing closed reduction of distal radius fracture were randomly assigned to either the isoflurane or propofol group and anesthesia was maintained with isoflurane or propofol. The bispectral index was monitored and maintained within 40-60. After reduction of fracture and fixation with plaster, patients were transported to the post-anesthetic care unit (PACU) and agitation state scale was checked by Aono's four-point scale (AFPS). AFPS score of 3 or 4 was considered to be emergence agitation. Pain scores were measured by the numeric rating scale (NRS) on arrival and at peak value at PACU. Eight (40.0%) patients in the isoflurane group and 2 (10.0%) patients in the propofol group developed emergence agitation (P = 0.031). There was no correlation between peak NRS and AFPS. Propofol may decrease the incidence of emergence agitation compared to isoflurane in adults undergoing closed reduction of distal radius fracture.

Effects of dexmedetomidine or dezocine alone or combination of the two agents on emergence agitation in patients undergoing thoracic surgery

Objective To evaluate the effects of dexmedetomidine or dezocine alone or the combination of the two agents on the emergence agitation in patients undergoing thoracic surgery.Methods Eighty ASA Ⅰ or Ⅱ patients,aged 18-64 yr,weighing 48-75 kg,scheduled for elective thoracic surgery under general anesthesia,were randomly divided into 4 groups (n =20 each):control group (group C),dexmedetomidine group (group DEX),dezocine group (group DEZ) and dexmedetomidine + dezocine group (group DEX + DEZ).In group DEX,dexmedetomidine 0.5 μg/kg was injected intravenously at 15 min before induction of anesthesia,followed by continuous infusion of dexmedetomidine at 0.4 μg· kg-1 · h-1 until beginning of chest closure.Dezocine 0.1 mg/kg was injected intravenously after beginning of chest closure in group DEZ.In group DEX + DEZ,dexmedetomidine 0.5 μg/kg was injected intravenously at 15 min before induction of anesthesia,followed by continuous infusion of dexmedetomidine at 0.4 μg·kg-1 ·h-1 until beginning of chest closure and then dezocine 0.1 mg/kg was injected intravenously.While the equal volume of normal saline was given instead in group C.Flurbiprofen axetil 50 mg was injected intravenously at beginning of skin closure in each group.Venous blood samples were collected for determination of plasma C-reactive protein (CRP),TNF-α and IL-10 levels at 10 min before induction of anesthesia (T1),before skin closure (T2),immediately after extubation (T3) and 15 min after extubation (T4).Side effects such as agitation during emergence from anesthesia were recorded.Sedation was assessed using Ramsay score.Results Compared with group C,the levels of plasma CRP and TNF-α at T2-4 and ratio of TNF-α/IL-10 were significantly decreased,the levels of IL-10 were increased at T2-4,the degree and incidence of agitation were decreased,and Ramsay score was increased in the other three groups (P ＜ 0.05).Compared with groups DEX and DEZ,the levels of plasma CRP and TNF-α at T2_4 and ratio of TNF-α/IL-10 were significantly decreased,the levels of IL-10 were increased at T2-4,and the degree and incidence of agitation were decreased in group DEX + DEZ (P ＜0.05).No side effects such as hypotension,bradycardia,respiratory depression,nausea and vomiting were observed in the four groups.Conclusion Dexmedetomidine or dezocine alone or combination of the two agents can decrease the degree and occurrence of emergence agitation and inhibit the inflammatory response simultaneously,and the combination of the two agents provides better efficacy than either alone in patients undergoing thoracic surgery. Key words: Dexmedetomidine; Analgesics, opioid; Anesthesia recovery period; Psychomotor agitation

Dexmedetomidine reduces emergence agitation after tonsillectomy in children by sevoflurane anesthesia: A case-control study

ObjectiveTo evaluate the efficacy and safety of dexmedetomidine for emergence agitation after tonsillectomy in children. Methods120 ASA physical status I and II children, aged 5–14 years, undergoing anesthesia for tonsillectomy, were randomly divided into 3 groups: Placebo group, the low dexmedetomidine concentration group and the high dexmedetomidine concentration group. Before the entrance of the operating room (OR), all of the children received intravenous injection 40μgkg−1 midazolam to reduce anxiety at first, and then dexmedetomidine was given intravenously at an initial loading dose of 0.5μgkg−1 or 1μg/kg over a 10-min period via a computer controlled infusion pump followed by a maintenance infusion of 0.2μgkg−1h−1 or 0.4μgkg−1h−1over the surgery. The heart rate, SpO2 and mean arterial blood pressure were recorded for each patient in both operation room and PACU. The designated time points: at the start of the anesthetic induction, at the discontinuation of inhalational agents, at first opening of eyes, at time to remove endotracheal tube were recorded. After patient arrival at the PACU, VAS score, RSS, the occurrence of emergence agitation were recorded every 5min for the first 30min and every 10min for the next 30min after endotracheal tube was removed. ResultsThere was significant difference in the incidence of emergence agitation between Placebo group and the high concentration group when endotracheal tube was removed (P<0.05). There was significant difference in the VAS pain scores and in the RSS between three groups at the time of extubation, as well as 5min and 10min after extubation (P<0.05). ConclusionsDexmedetomidine appears to be safe and effective to reduce the incidence of early emergence agitation in children after tonsillectomy. Initial loading dose of 1.0μgkg−1 followed by a maintenance infusion of 0.4μgkg−1h−1 is better choice for children received tonsillectomy.

Effect of dexmedetomidine on postoperative analgesia and sedation in pediatric patients undergoing cleft lip and palate repair

To explore the effect of different doses of dexmedetomidine on the sedation of recovery period and the postoperative early pain scores in pediatric patients undergoing cleft lip and palate repair. A total of 100 American Society of Anesthesiologists (ASA) I-II pediatric patients undergoing cleft lip and palate repair were randomly divided into 5 groups (D1, D2, D3, D4 and C, n = 20 each). Groups D1-D4 received a continuous pump infusion of dexmedetomidine at 0.25, 0.5, 0.75, 1.0 µg × kg(-1)× h(-1) respectively for 1 h before the completion of operation. Then an intravenous injection of 1 µg/kg was prescribed over 10 min as a loading dose. Group C, taken as control, received an equal volume of normal saline. Propofol 2 mg/kg was added for the occurrence of emergence agitation. Mean arterial pressure (MAP), heart rate (HR), respiratory rate (RR), partial pressure of end-tidal carbon dioxide (P(ET)CO(2)), Riker sedation-agitation scale, times of additional propofol requirements, times of additional artificial ventilation, extubation time, discharge time, side effects and face, legs, activity, cry and consolability (FLACC) scale were observed and recorded. The Riker sedation-agitation scale were 5.3 ± 0.9, 4.3 ± 0.8, 3.5 ± 0.8, 2.6 ± 0.6 and 6.1 ± 0.7, times of additional propofol requirements were 4.7 ± 1.7, 2.5 ± 1.4, 0.8 ± 0.9, 0.1 ± 0.4 and 5.7 ± 0.7 in groups D1, D2, D3, D4 and C respectively. In short, group D4 ≈ group D3 < group D2 < group D1 < group C (P < 0.05). As compared with group D4, the extubation time and discharge time significantly increased in groups D1, D2, D3 and C (P < 0.05). The FLACC scales in groups D2, D3 and D4 were lower than those in groups D1 and C. Side effects: 2 cases developed sinus bradycardia in group D4 and heart rate returned to normal after treatment. At a load dosage of 1 µg/kg and a maintenance dosage of 0.75 µg × kg(-1)× h(-1), dexmedetomidine shows excellent effects on the recovery period of cleft lip and palate repairing in pediatric patients. The FLACC scale decreases with fewer side effects, but extubation time and discharge time increase.

A comparative study of emergence agitation between sevoflurane and propofol anesthesia in adults after closed reduction of nasal bone fracture

BackgroundEmergence agitation is associated with increased morbidity and hospital costs. However, there have been few reports in the medical literature on the occurrence of emergence agitation in adults. The aim of this study was to compare emergence agitation between sevoflurane and propofol anesthesia in adults after closed reduction of nasal bone fracture.MethodsForty adults (ASA I-II, 20-60 yr) undergoing closed reduction of nasal bone fracture were randomly assigned to either sevoflurane or propofol group and anesthesia was maintained with sevoflurane or propofol. The bispectral index (BIS) was monitored and maintained within 40-60. At the end of surgery, patients were transported to the post anesthetic care unit (PACU) and agitation state scale was checked by Aono's four-point scale (AFPS). Emergence agitation was defined as and AFPS score of 3 or 4. Pain score were measured by numeric rating scale (NRS) on arrival and peak value at PACU.ResultsNine (45.0%) patients in the sevoflurane group and 2 (10.0%) patients in the propofol group developed emergence agitation in the PACU (P = 0.031). There was no correlation between peak NRS and Aono's four-point scale.ConclusionsPropofol may decrease incidence of emergence agitation compared to sevoflurane in adults undergoing closed reduction of nasal bone fracture.

Complications of sevoflurane–fentanyl versus midazolam–fentanyl anesthesia in pediatric cleft lip and palate surgery: a randomized comparison study

Careful choice of anesthetic agents in pediatric patients reduces the frequency of anesthesia-related complications. The frequency and type of intraoperative and postoperative complications of sevoflurane-fentanyl versus midazolam-fentanyl anesthesia were compared in 140 consecutive children (aged 3 months to 10 years) undergoing cleft lip and palate repair. Midazolam-fentanyl anesthesia was induced with midazolam (0.05 mg/kg), fentanyl (0.005 mg/kg) and vecuronium (0.1mg/kg), and maintained with the same agents according to the defined parametars. Sevoflurane-fentanyl anesthesia was induced and maintained with sevoflurane (5-8 vol% and 0.8-1 vol%, respectively) in an oxygen/air mixture and supplemented with fentanyl (0.005 mg/kg). Both groups were comparable in basic demographic data, hemodynamic and respiratory parameters. Difficult intubation occurred in 6 of 76 children (midazolam-fentanyl group) and 4 of 64 children (sevoflurane-fentanyl group) (P=0.754). Ventricular extrasystole and bronchospasm occurred in one patient each in the sevoflurane-fentanyl group. Postoperatively, emergence agitation was observed in the sevoflurane-fentanyl group (17 cases; P<0.001); postoperative nausea and vomiting occurred in 2 children (midazolam-fentanyl group) and 3 children (sevoflurane-fentanyl group) (P=0.660). Midazolam-based anesthesia in children is safer than sevoflurane-based anesthesia regarding occurrence of emergence agitation.

The effects of low-dose fentanyl on emergence agitation and quality of life in patients with moderate developmental disabilities

Study Objective To analyze whether emergence agitation could be reduced by using a low dosage of fentanyl without causing an increase in postoperative adverse effects and/or affecting the patient's quality of life after discharge. Design Randomized, controlled crossover trial. Setting University medical center. Patients One hundred ten ASA physical status I and II ambulatory patients with moderate developmental disabilities who received anesthesia for dental care. Interventions During their first visit, patients were randomly treated either with a placebo or a 1- to 1.5- μg/kg dose of fentanyl before inserting a reinforced laryngeal mask airway and treated with the remaining method during their second visit 6 to 12 months later. Measurements Measured variables included anesthetic and emergence period, the occurrence of emergence agitation, and postanesthetic adverse effects such as nausea and vomiting. After discharge, the patient's quality of life was evaluated based on disturbances in daily activity, eating habit, and sleeping behavior. Results were analyzed by Student t test and McNemar test ( P < 0.05). Main Results Between the two treatments, there was a significant difference in the frequency of emergence agitation ( P = 0.04) but no postoperative adverse effects such as postoperative nausea and vomiting. We also found no significant disturbances in the patient's quality of life according to daily activity, eating habits, or sleeping behavior. Conclusion Emergence agitation may be reduced by using 1 to 1.5 μg/kg of fentanyl during induction while maintaining anesthesia by sevoflurane in patients with moderate developmental disabilities undergoing dental care, without causing an increase in postoperative adverse effects and affecting the patient's life quality after discharge.