Prevention Of Emergence Agitation Research Articles

The Effects of Different Doses of Alfentanil and Dexmedetomidine on Prevention of Emergence Agitation in Pediatric Tonsillectomy and Adenoidectomy Surgery.

Background: Emergence agitation (EA) is a common problem often observed in children after sevoflurane anesthesia, which can be prevented by dexmedetomidine and alfentanil. This study aims to compare the effectiveness of dexmedetomidine alone and with different doses of alfentanil in preventing EA in children under sevoflurane anesthesia. Materials and Methods: In a double-blind trial, 80 children (ASA I or II, 3–7 years old) undergoing tonsillectomy alone and adenotonsillectomy with sevoflurane anesthesia were randomly assigned into four groups: the control group, dexmedetomidine (DEX) group, dexmedetomidine plus 10 μg/kg alfentanil group (DEX + Alf1), and dexmedetomidine plus 20 μg/kg alfentanil group (DEX + ALf2). The incidence of EA was assessed with the Aono’s scale, and the severity of EA was evaluated with the Pediatric Anesthesia Emergence Delirium (PAED) scale. The time of tracheal extubation and time of wake were recorded. Postoperative pain and complications such as nausea and vomiting, cough, laryngospasm, and bradycardia were recorded. Results: The incidence of EA was 50% in the control group, 25% in the DEX group, and 5% in the DEX + Alf1 group, and it never happened in the DEX + Alf2 group. The Aono’s scale, the PAED scale, and the FLACC scale in the control group and the DEX group were significantly more than those in the DEX + Alf1 group and the DEX + Alf2 group after the tracheal extubation (p < 0.05). The time of tracheal extubation of the control group and the DEX group were significantly shorter than those in the DEX + Alf1 group and the DEX + Alf2 group (p < 0.05). The awakening time of the DEX + Alf2 group is significantly longer than those in other groups (p < 0.05). The case of postoperative nausea and vomiting in the DEX + Alf1 group was fewer than those in the other groups (p < 0.05). And, the cases of cough and laryngospasm and bronchospasm in the DEX + Alf1 group and the DEX + Alf2 group were significantly less than those in the control group and the DEX group after the tracheal extubation (p < 0.05). Conclusion: The combined administration of alfentanil and dexmedetomidine can reduce EA in children undergoing tonsillectomy alone and adenotonsillectomy with sevoflurane anesthesia. Dexmedetomidine plus 10 μg/kg alfentanil seems to be more appropriate than other dose combinations as it reduced EA and postoperative nausea and vomiting but did not prolong the time to awake.

The effect of two different doses of dexmedetomidine to prevent emergence agitation in children undergoing adenotonsillectomy: a randomized controlled trial

ObjectiveTo evaluate different doses of dexmedetomidine for the prevention of emergence agitation in children undergoing adenotonsillectomy. MethodOne hundred and thirty children aged 3–10 years scheduled for adenotonsillectomy were randomly assigned to two groups. Anesthesia was induced with 0.5 μg.kg-1 dexmedetomidine (DEX 0.5 group) or 1 μg.kg-1 dexmedetomidine (DEX 1 group) at the beginning of surgery. Observers who recorded the data in the postanesthesia care unit were blinded to the allocation. The primary outcome was the percentage of emergence agitation. The times to spontaneous breath, awake, extubate, and postanesthesia care unit stay were also recorded. ResultsOne hundred twenty four children were randomized into two groups. Five children were excluded because of adverse events and dropout (DEX 0.5 group, n = 58; DEX 1 group, n = 62). No significant differences were noted in the percentage of emergence agitation between the two groups. The times to extubation (p = 0.003), awake, and postanesthesia care unit stay in DEX 0.5 group were shorter than those in DEX 1 group (p < 0.0001). There was no significant difference between the two groups in the time to spontaneous breath. Approximately 8% of patients in DEX 0.5 group and 18% patients in DEX 1 group presented low SpO2, showing a significant difference between the two groups (p = 0.043). ConclusionsA dose of 0.5 μg.kg-1 dexmedetomidine was equally effective as 1 μg.kg-1 dexmedetomidine in preventing emergence agitation. Trial registration: The trial is currently completed recruitment, registered in ClinicalTrials.gov (ID:NCT03760809). Inclusion began on 4 January, 2019.

Perioperative dexmedetomidine reduces emergence agitation without increasing the oculocardiac reflex in children: A systematic review and meta-analysis.

Background:Intravenous dexmedetomidine (DEX) has been used to prevent emergence agitation (EA) in children. The aim of this meta-analysis was to evaluate whether DEX decreases EA incidence without augmenting oculocardiac reflex (OCR) in pediatric patients undergoing strabismus surgery.Methods:We searched PubMed, EMBASE, Chinese National Knowledge Infrastructure (CNKI), Wan Fang, and the Cochrane Library to collect the randomized controlled trials (RCTs) investigating the effects of intraoperative DEX in children undergoing strabismus surgery from inception to October 2019. Postoperative Pediatric Agitation and Emergence Delirium (PAED) score, postoperative EA, extubation or laryngeal mask airway (LMA) removal time, postanesthetic care unit (PACU) stay time, OCR, and postoperative vomiting (POV) were evaluated.Results:11 RCTs including 801 patients were included in this study. Compared with control group, intravenous DEX significantly reduced postoperative PAED score (WMD, 3.05; 95% CI: -3.82 to -2.27, P = .017) and incidences of postoperative EA 69% (RR, 0.31; 95% CI: 0.17 to 0.55, P < .00) and POV (RR, 0.28; 95% CI: 0.13 to 0.61, P = .001). Furthermore, the use of DEX significantly delayed extubation or LMA removal time (WMD, 2.11; 95% CI: 0.25 to 3.97, P < .001). No significant difference was found in the incidence of ORC and PACU stay time.Conclusion:Intravenous DEX reduced the incidences of EA without increasing OCR in pediatric patients undergoing strabismus surgery. Meanwhile, DEX infusion decreased the incidence of POV in children.

Efficacy of dexmedetomidine on postoperative analgesia &amp;amp; sedation in children undergoing adenotonsillectomy

Background: Adenotonsillectomy is a common surgical procedure in pediatric population, but post-operative pain management is a challenging concern for anaesthetist. The present study was designed to assess the efficacy of dexmedetomidine on post-operative sedation and analgesia in paediatric cases undergoing adenotonsillectomy. Materials and methods: A total 80 pediatric cases undergoing adenotonsillectomy between age group 4-9 years belong to ASA grade I and II were recruited. Study consists of two groups i.e. group 1 with 1mcg/kg Dexmeditomidine and group 2 with 2 mcg/kg fentanyl. Parameters like heart rate, systolic blood pressure (SBP), diastolic blood pressure (DBP), requirement of post-operative analgesia and sedation assessed by Ramsay sedation score & CHEOPS score and emergence agitation were assessed. Results: The mean heart rate was significant between two study groups at the beginning, 5 min, 15 min, 20 min and at 25 min (p<0.005). The mean SBP in group 1 was high at the beginning, later the values were decreased when compared group 2. However, the mean DBP in group 1 was low when compared to the group 2 at all-time intervals. The mean Ramsay sedation score difference was statistically significant among two study groups at the beginning, 5 min, 10 min, 15 min and 45 min (p<0.005). The requirement of additional rescue doses were noticed more in group 2. Conclusion: Dexmedetomidine was effective in maintaining intraoperative heart rate, systolic blood pressure and diastolic blood pressure. Dexmedetomidine is an effective and safe analgesic substitute to fentanyl intra-operatively and reduces the requirement of postoperative rescue opioid. Dexmedetomidine was more effective in preventing emergence agitation, avoiding severe pain and reducing incidence of postoperative nausea and vomiting.

Effective Intravenous Administration of Dexmedetomidine to Prevent Emergence Agitation after General Anesthesia in a Pediatric Patient with Osteogenesis Imperfecta

Effective Intravenous Administration of Dexmedetomidine to Prevent Emergence Agitation after General Anesthesia in a Pediatric Patient with Osteogenesis Imperfecta

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Dexmedetomidine versus nalbuphine in prevention of emergence agitation following adenotonsillectomy in pediatrics

ABSTRACT Background: Adenotonsillectomy is considered one of the most common surgical procedures in preschool age children. Postoperative emergence agitation (EA) is a major problem that faces anesthesiologist and can be managed by different drugs as opioids, sedatives and propofol. The present prospective, randomized double blinded study was designed to evaluate the effect of intraoperative 0.5 µg/kg dexmedetomidine infusion versus 0.1 mg/kg nalbuphine IV for prevention of postoperative emergence agitation. Methods: After ethical committee’s approval and written informed consent, 160 patients were enrolled in the study, 80 in each group. Patients enrolled in the study were randomized into dexmedetomidine 0.5 µg/kg infusion (DEX group) or nalbuphine 0.1 mg/kg IV (NAL group). Both groups were under standard anesthetic regimen with sevoflurane anesthesia. Postoperative measurements included pediatric anesthesia emergence delirium (PAED) score, Ramsay sedation score, hemodynamic changes at arrival to post anesthesia care unit (PACU) 5, 10 minutes then every 10 minutes till discharge from PACU. Results: After ethical committee approval and written informed consent, 160 patients were enrolled in the study, 80 in each group. PAED score was significantly higher in NAL group than DEX group (13(12–16) vs. 12(11–13), respectively (p value <0.001). Number of patients needed rescue sedation was statistically higher in NAL than DEX group (12 vs. 3), respectively (p value 0.027). Ramsay sedation score was statistically higher in DEX group than NAL group at 10 and 20 minutes at PACU (p value <0.001). Both groups had similar length of stay in PACU. Conclusion: Dexmedetomidine is better than nalbuphine in prevention of postoperative EA in preschool children, with more postoperative sedation and similar stay in PACU.

Incidence and associated factors of emergence agitation after general anesthesia and surgery among pediatric patients: A prospective follow-up study

IntroductionEmergence agitation is one of the significant anesthetic and surgery-related complications. It is usually short-lived but causes self-injury during agitation and it led to parental anxiety. This study was aimed to assess incidence and factors associated with emergence agitation after general anesthesia and surgery among pediatric patients at University of Gondar specialized hospital. MethodsA prospective follow-up study conducted on 153 pediatric patients aged 2–9 years who were operated from first February to April 30, 2019. Emergence agitation was recorded by the pediatrics anesthesia emergence delirium scale. Descriptive statistics performed to determine the incidence. To identify the associated factors multi-variable binary logistic regression was held, and a p-value <0.05 was considered as significant. ResultsEmergence agitation was experienced on eighty (52.3%) children with a mean and standard deviation of 12 ± 5.9 min of duration. Among agitated children, 8 (10%) of them developed adverse events related to agitation. Difficult parental separation behaviour (AOR = 2.688, 95% CI = 1.131–6.39), children aged 2–5 years (AOR = 2.688, 95% CI = 1.131–6.3925), isoflurane maintenance (AOR = 4.001, 95% CI = 1.733–9.234) and propofol administration after maintenance closure (AOR = 0.145, 95% CI = 0.030–0.695) were significantly associated with agitation. ConclusionBeing a preschool child, difficult parental separation and isoflurane maintenance were associated with emergence agitation. But propofol administration after maintenance closure was found to be protective. So, agitation should be assessed and detected in the postoperative period and efforts should apply to prevent emergence agitation.

Dexmedetomidine Versus Nalbuphine in Prevention of Emergence Agitation Following Adenotonsillectomy in Pediatrics

Dexmedetomidine Versus Nalbuphine in Prevention of Emergence Agitation Following Adenotonsillectomy in Pediatrics

Three minutes propofol after sevoflurane anesthesia to prevent emergence agitation following inguinal hernia repair in children: a randomized controlled trial.

BackgroundEmergence agitation (EA) is a common problem after sevoflurane anesthesia among children. There have been mixed results with control of EA using propofol 1 mg/kg bolus following sevoflurane anesthesia. An infusion of 3 mg/kg of propofol over 3 min following sevoflurane anesthesia has been found to be promising in children undergoing magnetic resonance imaging scans. However, no studies have been conducted during surgical procedures. We aimed to examine the efficacy of transition to propofol for 3 min after cessation of sevoflurane anesthesia in children undergoing inguinal hernia repair.MethodsIn this prospective randomized controlled trial, 64 children aged 1–12 years, scheduled for inguinal hernia repair, were randomized to receive either propofol 3 mg/kg over 3 min (propofol group) or no propofol (control group), after the cessation of sevoflurane anesthesia. EA was assessed using the Paediatric Emergence Anesthesia Delirium (PAED) scale and the Watcha scale. Emergence time and the duration of post-anesthesia care unit (PACU) stay were also recorded.ResultsThe incidence of ED was lower in the propofol group on both the PAED (81.3% vs. 15.6%, P < 0.001) and the Watcha (78.1% vs. 15.6%, P < 0.001) scales. The mean emergence time was 6.37 minutes longer in the propofol group with no significant difference in PACU times.ConclusionsTransition to propofol 3 mg/kg over 3 min following sevoflurane anesthesia reduces the incidence of EA and improves the quality of emergence. Although emergence times were longer, the duration of stay in the PACU was similar with propofol use.

Efficacy and safety of propofol in preventing emergence agitation after sevoflurane anesthesia for children.

Application of propofol in preventing emergence agitation after sevoflurane anesthesia in children was evaluated. Clinical data of 200 children who received sevoflurane anesthesia in Children's Hospital of Xuzhou Medical University were retrospectively analyzed. Among them, 120 patients who received inhaled sevoflurane for pediatric anesthesia and intravenous infusion of propofol (2 mg/kg) were included in observation group. The remaining 80 cases who were directly anesthetized by sevoflurane alone were the control group. T PAED scores, modified Aldrete scores, extubation time, PACU time and adverse reactions (gastrointestinal tract and respiratory response) were analyzed and compared between the control and observation group. PAED scores, extubation time, PACU time and incidence of adverse reactions were significantly lower in observation than in control group, and the modified Aldrete scores were higher in observation than in control group (P<0.05). Spearman's correlation analysis showed that the PAED scores were negatively correlated with modified Aldrete scores and positively correlated with extubation time. There was positive correlation between the PACU time and incidence of adverse reactions and between the PAED scores and extubation time. There was negative correlation between PACU time and incidence of adverse reactions and between Aldrete scores and extubation time (P<0.05). Therefore, we conclude that propofol can be used to prevent agitation after sevoflurane anesthesia in children.

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.

Unilateral electrical stimulation of the heart 7 acupuncture point to prevent emergence agitation in children: A prospective, double-blinded, randomized clinical trial

BackgroundEmergence agitation (EA) is a frequent phenomenon in children recovering from general anaesthesia and increases the risk of self-injury. Previously, our group reported that stimulating the heart 7 (HT7) acupuncture point bilaterally using two neuromuscular transmission monitoring devices (NTMs) decreased the incidence of EA. However, bilateral stimulation is a barrier to clinical use because two NTMs are needed for one patient.ObjectiveThe objective of this study was to examine the efficacy of unilateral electrical stimulation of HT7 using an NTM to prevent EA in children.DesignProspective, double-blinded, randomized clinical trial.SettingKanagawa Children’s Medical Centre, Yokohama, Japan.PatientsOne hundred children (ages 18–96 months) with ASA-PS I or II, who were scheduled to undergo inguinal hernia repair or orchiopexy under sevoflurane anaesthesia.InterventionPatients were randomly assigned to one of the following two groups: (1) HT7 group: unilateral (right side) stimulation of the HT7 acupuncture point using a single-twitch electrical stimulus (1 Hz, 50 mA) throughout the surgery, and (2) control group: electrodes alone were attached to the HT7 point on the right side; an electrical stimulus was not applied.Main outcome measuresThe primary outcome was the incidence of EA evaluated using the pediatric anaesthesia emergence delirium (PAED) scale. The secondary outcomes were the incidence of EA evaluated using Aono’s scale, the severity of EA, PACU stay duration, and postoperative pain.ResultsThere was no statistical difference between the incidence of EA in the HT7 and the control group (28.0% and 24.0%, respectively; P > 0.99). The risk ratio was 1.17 (95% confidence interval: 0.60–2.27).ConclusionsWe observed that there was no effect of unilateral single-twitch electrical stimulation to the HT7 on the incidence of EA, contrary to the findings with bilateral HT7 stimulation.

Effect of Midazolam and Propofol in Prevention of Emergence Agitation in Paediatric Patients Under Sevoflurane Based Anaesthesia: A Comparative Study

Effect of Midazolam and Propofol in Prevention of Emergence Agitation in Paediatric Patients Under Sevoflurane Based Anaesthesia: A Comparative Study

Usefulness of dexmedetomidine to prevent emergence agitation in a patient with Krabbe disease: a case report

BackgroundWe report the case of a child with Krabbe disease who underwent three repeated surgeries and anesthetic management, and we discuss the major concerns about Krabbe disease and the usefulness of a perioperative administration of dexmedetomidine to prevent emergence agitation and hypertension. The patient was scheduled to undergo bilateral orchiopexy, adenotonsillectomy, and knee flexor tendon lengthening under general anesthesia during a 2-year period.Case presentationAdenotonsillectomy was scheduled as the second operation when the patient was 4 years old. His height and body weight were 93 cm and 10.3 kg, respectively. Anesthesia was induced with 8% sevoflurane mixed with 6 L/min of O2 and maintained with N2O (3.5 L/min), O2 (1.5 L/min), and sevoflurane (1.5–2.0%). Upon completion of the right tonsillectomy, 1 h before the end of the surgery, a continuous infusion of dexmedetomidine (0.2 μg/kg/h) was started to prevent emergence agitation, irritability, resultant hypertension, and postoperative bleeding. Fentanyl (25 μg) was administered intravenously to reduce postoperative pain. The surgery was uneventful, and the patient’s emergence from general anesthesia was prompt. He exhibited no symptoms of emergence agitation or irritability. During his stay in the intensive care unit, 0.2–0.7 μg/kg/h of dexmedetomidine and 6.25 μg/h of fentanyl were continuously administered. The patient was discharged to the ward the following morning without complications.ConclusionsThe perioperative administration of dexmedetomidine was useful to prevent emergence agitation, hypertension, and resultant postoperative bleeding in a pediatric patient with Krabbe disease. Three repeated anesthetic management using inhalation anesthesia were completed uneventfully without muscle relaxants.

Appropriate dose of dexmedetomidine for the prevention of emergence agitation after general anesthesia for tonsillectomy in preschool children

Objective To evaluate the effective dose of dexmedetomidine (DEX) for prevention of emergence agitation (EA) after total intravenous anesthesia or sevoflurane anesthesia for preschool children undergoing a tonsillectomy. Methods 80 preschool children undergoing a selective tonsillectomy were randomly divided into 2 groups: intravenous group (total intravenous anesthesia, n=40) and inhalation group (sevoflurane inhaled anesthesias, n=40). According to the spot-slope method, intravenous group and inhalation group were randomly divided into 5 dose groups and given DEX in a geometric progression after induction. The EA, adverse effects, the pain score and the postoperative behavioral outcomes of each child in the two groups were recorded. Results The ED50s for prevention of EA were 0.28 μg/(kg·h) in intravenous group and 0.34 μg/(kg·h) in inhalation group. The duration of children′s staying post-anesthesia care unit (PACU) and the incidence of pain were significantly greater in those with EA than those without (P 0.05). No severe adverse reactions were observed in 95% confidence limits. Conclusions 0.28 (0.22-0.35) μg/(kg·h) and 0.34 (0.27-0.43) μg/(kg·h) of DEX are safe and reliable for prevention of EA after intravenous anesthesia and sevoflurane anesthesia for preschool children undergoing a tonsillectomy. Key words: Dexmedetomidine/AD; Tonsillectomy; Anesthesia recovery period; Mood disorders/PC; Child, preschool

Prevention of Emergence Agitation with Ketamine in Rhinoplasty.

Emergence agitation (EA), defined as restlessness, disorientation, excitation, and/or inconsolable crying, is a common phenomenon during early recovery from general anesthesia. In this study, we aimed to determine the (1) EA incidence after rhinoplasty operations in adults; (2) the effects of ketamine administered at sub-anesthetic doses just 20min before the end of the surgery in rhinoplasty operations on agitation level, postoperative pain, side effects, and complications; and (3) to determine the risk factors for EA in adults after rhinoplasty. Totally 140 patients scheduled to undergo elective rhinoplasty were enrolled in this prospective study. Patients were equally and randomly divided into two groups: saline group (control group) (n=70) and ketamine group (n=70). Twenty minutes before surgery completion, 1ml saline was administered via the intravenous (i.v.) route to the saline group, while 0.5mg/kg ketamine was administered via i.v. patients in the ketamine group. The emergence agitation level of the patients was evaluated using the Richmond Agitation-Sedation Scale just after extubation and in the post-anesthesia care unit (PACU). For postoperative pain evaluation, the Numerical Rating Scale (NRS) was scored (from 0 to 10) every 10min until the patients were discharged from PACU. EA incidence in the control group was as high as 54.3%, while in the ketamine group it was 8.6% just after extubation (p<0.001). In the PACU, EA incidence was 28.6% in the control group, while none of the patients had EA in the PACU in the ketamine group (p<0.001). Male gender, severe pain (NRS≥5), and smoking were defined as significant risk factors for EA both after extubation and during follow-ups in the PACU (p<0.001). Emergence agitation after rhinoplasty is a common complication, likely disturbing operative outcomes in adults. Ketamine at sub-anesthetic doses is highly effective in preventing EA. Further, larger-scale prospective studies are warranted to determine preventive measures for EA development in rhinoplasty. This journal requires that authors assign a level of evidence to each article. For a full description of these Evidence-Based Medicine ratings, please refer to the Table of Contents or the online Instructions to Authors www.springer.com/00266 .

Effects of intravenous fentanyl around the end of surgery on emergence agitation in children: Systematic review and meta‐analysis

Emergence agitation is a serious postoperative problem in children undergoing general anesthesia. The use of fentanyl around the end of surgery has been proposed to prevent emergence agitation. However, the efficacy and disadvantages of this method remain uncertain because previous results have not been consistent, depending on the variable assessed. In July 2016, the PubMed, Web of Science, Cochrane Central Register of Controlled Trials, Embase, and KoreaMed were searched for randomized controlled trials that compared fentanyl (1 μg/kg) and placebo administered around the end of surgery to prevent emergence agitation after general anesthesia in children between birth and 14 years of age. The collected outcomes included the incidence or score of emergence agitation, variables regarding anesthesia recovery, and adverse events (eg, postoperative nausea or vomiting). A total of 10 randomized controlled trials (718 patients, 357 receiving fentanyl) were included. Fentanyl around the end of surgery significantly decreased emergence agitation incidence (emergence agitation: relative risk 0.43, 95% confidence interval 0.35 to 0.53, I2 =0.0%; severe emergence agitation: relative risk 0.50, 95% confidence interval 0.31 to 0.81, I2 =0.0%). From subgroup analyses, fentanyl at the end of surgery was associated with a prolonged postanesthesia care unit stay and increased postoperative nausea or vomiting incidence (weighted mean difference 6.09, 95% confidence interval 2.77 to 9.41, I2 =58.6%; relative risk 2.61, 95% confidence interval 1.58 to 4.33, I2 =32.4%), whereas fentanyl at 10-20 minutes before the end of surgery did not increase postanesthesia care unit stay or postoperative nausea or vomiting risk (weighted mean difference -1.15, 95% confidence interval -5.15 to 2.85, I2 =89.0%; relative risk 1.32, 95% confidence interval 0.66 to 2.66, I2 =0.0%). The current analyses indicate that fentanyl around the end of surgery reduces the incidence of emergence agitation in children undergoing general anesthesia.

Effect of dexmedetomidine combined with sufentanil on preventing emergence agitation in children receiving sevoflurane anesthesia for cleft palate repair surgery.

The aim of the present study was to observe whether dexmedetomidine (DEX) combined with sufentanil decreased emergence agitation (EA) in children receiving sevoflurane anesthesia for cleft palate repair surgery. Children undergoing elective cleft palate repair surgery were randomly allocated into the DEX + sufentanil group (group DS; n=50) and the normal saline + fentanyl group (group SF; n=50). Patients in group DS were treated with 0.5 µg/kg DEX prior to induction of anesthesia, whereas patients in group SF received an equal volume of normal saline. Sufentanil (0.2 µg/kg) was administered to induce anesthesia, and 30 min before the end of surgery for patients in group DS. Fentanyl (2 µg/kg) was administered at the same time point for patients in group SF. Mean arterial pressure (MAP), heart rate (HR), duration of surgery and anesthesia, and the dosage of remifentanil were assessed. EA score, Pediatric Anesthesia Emergence Delirium (PAED) score and the Children and Infants Postoperative Pain Scale (CHIPPS) score were documented every 15 min in the post-anesthesia care unit (PACU). The number of cases requiring fentanyl (1 µg/kg) and the recovery profile data were analyzed. Compared with group DS (P<0.05) and the baseline (P<0.05), HR and MAP were significantly increased in group SF immediately following tracheal intubation and extubation. Mean values of maximum EA, PAED and CHIPPS scores were significantly reduced in group DS compared with group SF at 0 (P<0.01), 15 (P<0.05), and 30 min (P<0.05) after arrival at PACU. The incidence of EA in group SF was significantly increased compared with group DS (P<0.05). The dosage of remifentanil during the surgery and the number of cases requiring fentanyl (1 µg/kg) in group DS were significantly decreased compared with group SF (P<0.05). The findings of the present study suggested that DEX combined with sufentanil was able to effectively decrease the incidence of EA in children receiving sevoflurane anesthesia for cleft palate repair surgery.