Prevention Of Emergence Agitation Research Articles

Dexmedetomidine: Applications in pediatric critical care and pediatric anesthesiology

To provide a general descriptive account of the end-organ effects of dexmedetomidine and to provide an evidence-based review of the literature regarding its use in infants and children. A computerized bibliographic search of the literature regarding dexmedetomidine. The end-organ effects of dexmedetomidine have been well studied in animal and adult human models. Adverse cardiovascular effects include occasional episodes of bradycardia with rare reports of sinus pause or cardiac arrest. Hypotension has also been reported as well as hypertension, the latter thought to be due to peripheral alpha2B agonism with peripheral vasoconstriction. Although dexmedetomidine has no direct effects on myocardial function, decreased cardiac output may result from changes in heart rate or increases in afterload. There are somewhat conflicting reports in the literature regarding its effects on ventilatory function, with some studies (both human and animal) suggesting a mild degree of respiratory depression, decreased minute ventilation, and decreased response to CO2 challenge whereas others demonstrate no effect. The central nervous system effects include sedation and analgesia with prevention of recall and memory at higher doses. Dexmedetomidine may also provide some neuroprotective activity during periods of ischemia. Applications in infants and children have included sedation during mechanical ventilation, prevention of emergence agitation following general anesthesia, provision of procedural sedation, and the prevention of withdrawal following the prolonged administration of opioids and benzodiazepines. The literature contains reports of the use of dexmedetomidine in approximately 800 pediatric patients. Given its favorable sedative and anxiolytic properties combined with its limited effects on hemodynamic and respiratory function, there is growing interest in and reports of its use in the pediatric population in various clinical scenarios.

The Prevention of Emergence Agitation With Tropisetron or Clonidine After Sevoflurane Anesthesia in Small Children Undergoing Adenoidectomy

The Prevention of Emergence Agitation With Tropisetron or Clonidine After Sevoflurane Anesthesia in Small Children Undergoing Adenoidectomy

Clinical uses of dexmedetomidine in pediatric anesthesiology and critical care

Dexmedetomidine (Precedex®) is an α2-adrenergic agonist which is currently FDA-approved for the short-term (less than 24 hours) sedation of adult ICU patients. Its clinical effects include sedation, anxiolysis, analgesia, a decrease of the minimum alveolar concentration of inhalational anesthetic agents, blunting of the sympathetic nervous response to surgery, and lowering of heart rate and blood pressure. These beneficial physiologic effects combined with its relatively low incidence of adverse hemodynamic and respiratory effects have led to its use in the pediatric-aged patient in various applications including sedation during mechanical ventilation, prevention of emergence agitation following general anesthesia with sevoflurane or desflurane, provision of procedural-sedation, and to prevent withdrawal following the prolonged use of opioids and benzodiazepines. The following article reviews the reports of the use of dexmedetomidine in pediatric patients including dosing regimens and adverse effects. Its potential applications in the practice of pediatric anesthesiology and critical care are explored.

The Prevention of Emergence Agitation With Tropisetron or Clonidine After Sevoflurane Anesthesia in Small Children Undergoing Adenoidectomy

Postoperative agitation is a common problem after sevoflurane anesthesia in children. In the present study, we evaluated if tropisetron or clonidine could reduce the incidence of postoperative agitation after day case adenoidectomy in small children. We included 75 unpremedicated children aged 1-7 yr who were randomly assigned to receive either placebo, tropisetron (0.1 mg/kg) or clonidine (1.5 microg/kg) after anesthesia induction. Anesthesia was induced and maintained with sevoflurane. Patients also received alfentanil (20 microg/kg) and diclofenac (1 mg/kg). Postoperative pain was treated with IV oxycodone (0.05 mg/kg). Time to achieve discharge criteria was recorded. Modified pain/discomfort scale was used assess the postoperative behavior. The incidence of postoperative agitation was significantly less (32%, 8/25 patients) in the tropisetron group compared with placebo (62%, 16/26 patients), P < 0.05). Clonidine could not prevent agitation (incidence 54%, 13/24). No adverse effects were noted during the study. Discharge times were similar between the groups (between 80 and 99 min on average). In conclusion, tropisetron 0.1 mg/kg significantly reduced the incidence of postoperative agitation after sevoflurane anesthesia. Clonidine 1.5 microg/kg did not differ from placebo with respect to postoperative agitation.

Prevention of Emergence Agitation After Sevoflurane Anesthesia for Pediatric Cerebral Magnetic Resonance Imaging by Small Doses of Ketamine or Nalbuphine Administered Just Before Discontinuing Anesthesia

Magnetic resonance imaging (MRI) requires long-lasting immobilization that frequently can only be provided by general anesthesia in pediatric patients. Sevoflurane provides adequate anesthesia but many patients experience emergence agitation. Small doses of ketamine and nalbuphine provide moderate sedation but their benefits have subsided at the time of emergence. We hypothesized that delaying their administration until the end of the procedure would prevent emergence agitation without prolonging patient wake-up and discharge times from the postanesthesia care unit. We performed a double-blind study involving 90 patients (aged 6 mo to 8 yr) randomly allocated to 1 of 3 groups receiving either saline (S-group), ketamine (0.25 mg/kg) (K-group), or nalbuphine (0.1 mg/kg) (N-group) at the end of an MRI procedure under sevoflurane anesthesia. We evaluated emergence conditions, sedation/agitation status and completion of discharge criteria at 30 min. The three groups were comparable in age, sex ratio, physical status, and associated medical disorders. Emergence conditions did not differ significantly. There were significantly more agitated children, at all times, in the S-group and more obtunded patients at early times (5 and 10 min) in both K- and N-groups. All patients met discharge criteria at 30 min but significantly more children were awake and quiet in the K-group and still more in the N-group. In conclusion, small doses of ketamine or nalbuphine administered at the end of an MRI procedure under sevoflurane anesthesia reduce emergence agitation without delaying discharge. Nalbuphine provided better results than ketamine.

Appropriate Dose of Fentanyl for the Prevention of Emergence Agitation after Sevoflurane Anesthesia in Pediatric Patients undergoing Tonsillectomy

Background: We designed this study to find the appropriate dose of fentanyl for the prevention of emergence agitation in pediatric tonsillectomy patients under sevoflurane anesthesia. Methods: Sixty pediatric patients receiving sevoflurane anesthesia for tonsillectomy was assigned to 3 groups. Fentanyl 0.5/kg(group 1), 1.0/kg (group 2), or 1.5/kg (group 3) was administered intravenously 10 min before the end of surgery. Agitation score was checked at the postanesthesia care unit. Results: The results showed a lower incidence of severe agitation in groups 2 and 3 than in group 1. There was no difference between groups 2 and 3. Conclusions: For preventing emergence agitation after sevoflurane anesthesia, we recommend using fentanyl in a dose of more than 1.0/kg.