Sevoflurane Anesthesia In Children Research Articles

The effect of post-anesthetic administration of dexmedetomidine versus remifentanil on postoperative agitation of strabismus surgery in children: a randomized double-blind clinical trial

ABSTRACT Introduction: Postoperative agitation is a common complication of sevoflurane anesthesia in children and might lead to self-harm and recovery disruption. This study aimed to compare the prophylactic effect of dexmedetomidine and remifentanil on postoperative agitation after anesthesia with sevoflurane. Methods: In this clinical trial, 60 children aged 2 to 7 years with ASA class І, II, candidates for elective strabismus surgery, were randomly assigned to three groups using block randomization. Patients in the first group D received 0.5 µgr/kg dexmedetomidine, the second group R received 0.1 µgr/kg remifentanil, and another group C received normal saline at the end of anesthesia. Children’s agitation degree was measured by the Pediatric Anesthesia Emergence Delirium (PAED) scales and the 4-point agitation scale at the time of extubation, entering the recovery room, 10, 20, and 30 minutes after entrance. Data analysis was performed using descriptive and inferential statistical tests. Results: The postoperative agitation and pain were significantly lower among children who received dexmedetomidine compared with those in remifentanil and the control group (p < .001). It was observed that the administration of dexmedetomidine at the end of anesthesia significantly decreased the incidence of postoperative agitation (p < .001). None of the patients in group D had a PAED score of over 12. Conclusion: Based on PAED and the 4-point scales, none of the cases in group D had experienced postoperative agitation; this made a significant statistical difference compared with groups C and R (p-value <. 001). Although both dexmedetomidine and remifentanil can prevent and attenuate postoperative agitation, dexmedetomidine administration seems significantly more effective.

The effect of low dose nalbuphine or ketamine in the prevention of emergence agitation after sevoflurane anesthesia in children undergoing tonsillectomy with or without adenoidectomy

ABSTRACT Background Children’s agitation increases following sevoflurane anaesthesia. With indefinite results, nalbuphine and midazolam have been used as preventative treatments. Patients and Methods This study involved 90 children with American Society of Anesthesiologists score I-II and aged 4–10 who had sevoflurane-based adenotonsillectomy. Each child was randomly assigned to one of three groups; group N, group K, and group S. Nalbuphine was given to Group N at 0.1 mg/kg, ketamine was given to Group K at 0.25 mg/kg, and saline was given to Group S at equivalent volume. Sevoflurane was discontinued after the procedure, and the study drugs were given. The emergence agitation (EA) scale was used in the post-anesthesia care unit (PACU) to measure agitation upon admission (T0), after 5 min (T5), 10 min (T10), 15 min (T15), 20 min (T20), 25 min (T25), and 30 min (T30). Clinical trials. gov ID: NCT05176119. Results In the PACU, the incidence of EA was significantly lowered in N (6.6%) and K Group (16.6%) compared to S group (33%) with (p = 0.044), the duration in PACU was significantly prolonged in S in comparison to K and N groups (p-value = 0.011), more patients experienced postoperative pain in S group compared to N group and K group (p-value < 0.001). Conclusion Children who had sevoflurane-induced adenotonsillectomy can avoid emergence agitation with ketamine 0.25 mg/kg or nalbuphine 0.1 mg/kg.

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

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

Effects of Pharmacological Intervention on Recovery After Sevoflurane Anesthesia in Children: a Network Meta-analysis of Randomized Controlled Trials.

Sevoflurane, commonly administered to children as anesthesia, often leads to emergence delirium (ED). Currently, a consensus is lacking among clinicians regarding pharmacological interventions to improve recovery. To determine an effective approach, we compared the effects of several drugs in lowering the incidence of ED after sevoflurane anesthesia in children.We searched online databases for relevant randomized controlled trials (59 studies selected; 5199 NMA-eligible participants) and performed a frequentist network meta-analysis (NMA). This study was registered on PROSPERO (number CRD: 42022329939).All included studies had a low to moderate risk of overall bias. The incidence of ED after sevoflurane anesthesia in children differed according to other drugs administered, and were ranked from high to low according to the surface under the cumulative ranking curve (SUCRA).Sufentanil (91.2%) and dexmedetomidine (77.6%) were more likely to reduce the incidence (SUCRA value) of ED, whereas the placebo (6.5%), ramelteon (11.1%), and magnesium (18%) were less likely to reduce the incidence of ED. Remifentanil (89.3%) ranked first in shortening emergence time, followed by placebo (82.4%) and ketamine (69.7%). Placebo shortened extubation time, followed by remifentanil (66.5%) and alfentanil (61.4%).Sufentanil and remifentanil lowered sevoflurane-induced ED incidences among children and shortened the emergence time more effectively than other drugs. Most adjuvant drugs that are combined with sevoflurane either do not change or may even prolong extubation time. Further research and clinical trials are required to support and update these conclusions.

Association of volatile anesthesia exposure and depth with emergence agitation and delirium in children: Prospective observational cohort study.

Sevoflurane anesthesia is widely used in pediatric ambulatory surgery. However, emergency agitation (EA) and emergency delirium (ED), as major complications following sevoflurane anesthesia in children, pose risks to surgery and prognosis. Identifying the high risk of EA/ED, especially anesthesia exposure and the depth of anesthesia, may allow preemptive treatment. A total of 137 patients were prospectively enrolled in this single-center observational cohort study to assess the incidence of EA or ED. Multivariable logistic regression analyses were used to test the association between volatile anesthesia exposure and depth with EA or ED. The Richmond Agitation and Sedation Scale (RASS), Pediatric Anesthesia Emergence Delirium Scale (PAED) and Face, Legs, Activity, Cry, and Consolability (FLACC) behavioural pain scale was used to assess the severity of EA or ED severity and pain. Bispectral index (BIS) to monitor the depth of anesthesia, as well as TimeLOW-BIS/TimeANES %, EtSevo (%) and EtSevo-time AUC were included in the multivariate logistic regression model as independent variables to analyze their association with EA or ED. The overall prevalence of EA and ED was 73/137 (53.3%) and 75/137 (54.7%) respectively, where 48/137 (35.0%), 19/137 (13.9%), and 6/137 (4.4%) had mild, moderate, and severe EA. When the recovery period was lengthened, the prevalence of ED and extent of FLACC decreased and finally normalized within 30 min in recovered period. Multivariable logistic regression demonstrated that intraoperative agitation [2.84 (1.08, 7.47) p = 0.034], peak FLACC [2.56 (1.70, 3.85) p < 0.001] and adverse event (respiratory complications) [0.03 (0.00, 0.29) p = 0.003] were independently associated with higher odds of EA. Taking EtSevo-time AUC ≤ 2,000 as a reference, the incidence of EA were [15.84 (2.15, 116.98) p = 0.002] times and 16.59 (2.42, 113.83) p = 0.009] times for EtSevo-time AUC 2,500-3,000 and EtSevo-time AUC > 3,000, respectively. Peak FLACC [3.46 (2.13, 5.62) p < 0.001] and intraoperative agitation [5.61 (1.99, 15.86) p = 0.001] were independently associated with higher odds of developing ED. EtSevo (%), intraoperative BIS value and the percentage of the duration of anesthesia at different depths of anesthesia (BIS ≤ 40, BIS ≤ 30, BIS ≤ 20) were not associated with EA and ED. For pediatrics undergoing ambulatory surgery where sevoflurane anesthesia was administered, EA was associated with surgical time, peak FLACC, respiratory complications, and "EtSevo-time AUC" with a dose-response relationship; ED was associated with peak FLACC and intraoperative agitation.

Emergence excitation, agitation and delirium following sevoflurane anesthesia in children

Emergence excitation, agitation and delirium following sevoflurane anesthesia in children

Prevention of agitation associated with sevoflurane anesthesia in children outside the operating theatre: a prospective study

Prevention of agitation associated with sevoflurane anesthesia in children outside the operating theatre: a prospective study

Efficacy of propofol for the prevention of emergence agitation after sevoflurane anaesthesia in children: A meta-analysis.

BackgroundEmergence agitation (EA) is a common postoperative behavioral disorder, predominantly in pediatric patients, after sevoflurane general anesthesia. This study was aimed at assessing propofol's efficacy and clinical conditions established for preventing EA in children under sevoflurane anesthesia.MethodsRandomized controlled trials (RCTs) that comparatively investigated propofol and control treatment in terms of efficacy and safety on administration at the end of surgery and examinations to prevent EA in children under sevoflurane anesthesia were searched. The sources accessed included PubMed, Embase, Cochrane Central Register of Controlled Trials, and ClinicalTrials.gov. Furthermore, manual searches were performed to identify studies; the last review was conducted on March 21, 2022. When the risk of bias assessment of trials was performed with the Cochrane Risk of Bias Tool, we calculated risk ratios (RRs) with 95% confidence intervals (CIs) for EA incidence and mean differences (MDs) with 95% CI for continuous data.ResultsWe included 12 RCTs with 1103 children. EA incidence (RR: 0.51, 95% CI: 0.39 to 0.67) and Pediatric Anesthesia Emergence Delirium scores (MD: −3.14, 95% CI: −4.37 to −1.92) were lower in the propofol group. Subgroup analyses showed lower EA incidences with 3 mg/kg propofol (RR: 0.22, 95% CI: 0.13 to 0.38) without extension of the PACU time (MD: 4.97, 95% CI: −0.84 to 10.78) in the laryngeal mask airway (LMA; RR: 0.52, 95% CI: 0.36 to 0.77) and spontaneous breathing (RR: 0.36, 95% CI: 0.21 to 0.62) groups.DiscussionWe confirmed that a prophylactic dose of propofol prevented EA and decreased its severity in children under sevoflurane anesthesia. Furthermore, several conditions such as 3 mg/kg propofol, LMA, and spontaneous breathing, potentially contributed to EA prevention. Systematic Review Registrationhttps://www.crd.york.ac.uk/prospero/display_record.php?RecordID=274692, identifier: PROSPERO (No. CRD42021274692).

Epileptiform EEG discharges during sevoflurane anesthesia in children: A meta-analysis

ObjectiveTo investigate the overall incidence and associated factors of epileptiform discharges in children during sevoflurane anesthesia. MethodsOur group systematically searched the PubMed, Cochrane library (Central) and EMBASE for the relevant trials from their inception until September 2020. The primary endpoint was the incidence of epileptiform discharges during sevoflurane induction. The secondary endpoints were the incidence of different types of epileptiform discharges, factors associated with these epileptiform events, and other adverse events such as seizure-like movements. ResultsAfter screening of 713 records, eleven studies involving 448 participants were included into the final analysis. Meta-analysis indicated that the overall incidence of Epileptiform EEG discharges was 38.1% (95%confidence interval [CI], 19.1%-59.2%) during sevoflurane anesthesia in children. Subgroup analysis showed that the incidence of these EEG patters was lower when participants were inducted by using the low initial concentration of sevoflurane, compared with the high initial concentration sevoflurane (1.7%, 95%CI, 0.0% to 8.4% versus 47.7%, 95%CI, 25.5% to 70.3%, P < 0.05). The longer exposure (>3 min) of high concentration sevoflurane during induction showed higher rate of epileptiform discharges than a shorter exposure (≤3 min) (48.4%, 95%CI, 20.1% to 77.3% versus 5.7%, 95%CI, 0.00% to 23.5%; P < 0.05). No significant difference for the incidence of epileptiform discharges was observed in subgroup analysis of addition of nitrous oxide (69.2%, 95%CI, 34.0% to 95.7% versus 41.3%, 95%CI, 15.6% to 69.7%, P﹥0.05) and type of EEG monitoring (26.9%, 95%CI, 3.8% to 60.7% versus 53.1%, 95%CI, 25.4% to 79.8%, P﹥0.05). ConclusionsThe incidence of epileptiform EEG events in children during sevoflurane anesthesia varied from 19.1%-59.2%. The low initial concentration technique and shorter exposure time of high concentration sevoflurane may be associated with a decreased incidence of these epileptiform discharges in EEG. SignificanceEpileptiform EEG discharges during sevoflurane anesthesia in children should arouse clinicians’ attention. The use of low initial concentration technique and shorter exposure time of high concentration sevoflurane may be associated with a lower occurrence of these paradoxical events.

Usefulness of bispectral index and patient state index during sevoflurane anesthesia in children: A prospective observational study.

Cortical electroencephalography-based devices are used to monitor the depth of anesthesia. In this study, we evaluated the values of bispectral index (BIS) and patient state index (PSI) during sevoflurane anesthesia in children. The ability/accuracy of BIS and PSI to predict the maintenance and recovery state of anesthesia was evaluated based on prediction probability (Pk) values and the secondary outcomes were agreement and correlation of 2 monitors.Fifty children (3–12 years old) were enrolled and the patients received sevoflurane anesthesia with remifentanil followed by propofol administration. Before the induction of anesthesia, BIS and PSI sensors were simultaneously placed on the forehead, and data were collected until the end of anesthesia. Maintenance state was defined as the period following intubation until the cessation of sevoflurane, while recovery state was defined as the period following the cessation of sevoflurane until awake. Pk, agreement or correlation of BIS and PSI in different anesthesia state were calculated.Anesthesia reduced mean BIS and PSI values. Pk of BIS (95% confidential interval [CI]: 0.78–0.91) and PSI (95% CI: 0.82–0.91) for anesthesia were 0.85 and 0.87, respectively. Agreement was 0.79 for recovery state and 0.73 for maintenance state. Pk values were comparable for BIS and PSI.Agreement between BIS and PSI measurements in the same state was relatively good. Therefore, these monitors are appropriate for monitoring for different state of anesthesia in pediatric population.

A systematic review and meta-analysis on the efficacy and safety of dexmedetomidine combined with sevoflurane anesthesia on emergence agitation in children.

BackgroundThe incidence of restlessness in the wake-up period of sevoflurane inhalation anesthesia is high. Although many studies have explored the relationship between dexmedetomidine and restlessness in the wake-up period of sevoflurane anesthesia in children, they can’t keep consistent conclusions and lack evidence-based medical evidence. Meta-analysis was conducted to explore the efficacy and safety of dexmedetomidine in the treatment of restlessness during the recovery period of sevoflurane anesthesia in children, and to provide reference for clinic.MethodsRelevant articles were retrieved from PubMed, Embase, MEDLINE, Science Direct, The Cochrane Library, the Chinese National Knowledge Infrastructure (CNKI), Wanfang Database, the Chinese Science and Technology Periodical Database, and the Chinese BioMedical Literature Database (CBM). The Chinese and English search keywords included “dexmedetomidine”, “children”, “sevoflurane”, and “emergence agitation”. The articles included were independently evaluated and cross-checked by 2 professionals in strict accordance with the 5 evaluation criteria for randomized controlled trials (RCTs) in the Cochrane Handbook for Systematic Reviews of Interventions (version 5.0.1).ResultsA total of 16 articles were included in this meta-analysis. Of the 16 RCTs, 14 described the generation of random sequences in detail, 8 described allocation concealment in detail, no patient blinding was described due to different surgical methods, 8 articles used operator blinding, and all 16 articles had complete outcome measures. The incidence of emergence agitation in the 0.5 µg/kg dexmedetomidine group was significantly lower than that in the control group, and the difference was statistically significant [odds ratio (OR) =0.22, 95% CI: 0.13, 0.40, P<0.00001]. The incidence of analgesic rescue in the experimental group was significantly lower than that in the control group, and the difference was statistically significant (OR =0.29, 95% CI: 0.13, 0.63, Z =3.13, P=0.002). The incidence of postoperative nausea and vomiting in the experimental group was significantly lower than that in the control group, and the difference was statistically significant (OR =0.33, 95% CI: 0.20, 0.55, Z =4.29, P<0.0001).DiscussionThe results of this meta-analysis confirmed that dexmedetomidine could reduce the incidence of emergence agitation, postoperative analgesic rescue, and nausea and vomiting in children after sevoflurane anesthesia.

Effect of Intranasal versus Intravenous Fentanyl on the Emergence Agitation after Sevoflurane Anesthesia in Children Undergoing Bilateral Myringotomy: A Prospective Randomized Controlled Double-Blinded Study

Effect of Intranasal versus Intravenous Fentanyl on the Emergence Agitation after Sevoflurane Anesthesia in Children Undergoing Bilateral Myringotomy: A Prospective Randomized Controlled Double-Blinded Study

Efficacy and Safety of Intranasal Dexmedetomidine During Recovery From Sevoflurane Anesthesia in Children: A Systematic Review and Meta-analysis.

Intranasal drip of dexmedetomidine in children with sevoflurane anesthesia can reduce anesthesia and restlessness. However, there is still some controversy. We conducted a meta-analysis to explore the effect of intranasal infusion of dexmedetomidine on the quality of recovery during the recovery period, to provide certain guidance for clinical application. Web of Science, PubMed, Embase, and the Cochrane Library were used for literature search. Systematic reviews were based on PRISMA (the Preferred Reporting Items for Systematic Reviews and Meta-Analysis). A total of 14 articles and 1123 patients were included. The results of the meta-analysis showed that the incidence of emergence agitation [risk ratio (RR), 0.32; 95% confidence interval (CI), 0.20-0.50; P < 0.0001], satisfactory sedation at parent separation (RR, 1.41; 95% CI, 1.031-93; P = 0.034), incidence of nausea and vomiting (RR, 0.41; 95% CI, 0.21-0.78; P = 0.007), and incidence of laryngospasm (RR, 0.23; 95% CI, 0.08-0.65; P = 0.006) of the intranasal dexmedetomidine group were different compared with the control group. However, the satisfactory sedation at mask induction in the intranasal dexmedetomidine group (RR, 1.16; 95% CI, 0.87-1.54; P = 0.319), postanesthesia care unit (PACU) stay time (standardized mean deviation, 0.51; 95% CI, -0.11 to 1.12; P = 0.107), and extubation time (standardized mean deviation, 1.64; 95% CI, -1.07 to 4.35; P = 0.235) were not statistically significant compared with those of the control group. Intranasal dexmedetomidine anesthesia with sevoflurane in children can reduce the incidence of emergence agitation, provide more satisfactory sedation when the parents are separated, reduce the incidence of nausea and vomiting, and reduce the incidence of laryngospasm. In addition, the 2 μg/kg dose of dexmedetomidine may be the best dose for clinical application.

Determination of the optimal dose of ephedrine in the treatment of arterial hypotension due to general anesthesia in neonates and infants below 6\u2009months old: the ephedrine study protocol for a randomized, open-label, controlled, dose escalation trial

BackgroundArterial hypotension induced by general anesthesia is commonly identified as a risk factor of morbidity, especially neurological, after cardiac or noncardiac surgery in adults and children. Intraoperative hypotension is observed with sevoflurane anesthesia in children, in particular in neonates, infants younger than 6 months, and preterm babies. Ephedrine is commonly used to treat intraoperative hypotension. It is an attractive therapeutic, due to its dual action on receptors alpha and beta and its possible peripheral intravenous infusion. There are few data in the literature on the use of ephedrine in the context of pediatric anesthesia. The actual recommended dose of ephedrine (0.1 to 0.2 mg/Kg) frequently leads to a therapeutic failure in neonates and infants up to 6 months of age. The use of higher doses would probably lead to a better correction of hypotension in this population.The objective of our project is to determine the optimal dose of ephedrine for the treatment of hypotension after induction of general anesthesia with sevoflurane, in neonates and infants up to 6 months of age.MethodsThe ephedrine study is a prospective, randomized, open-label, controlled, dose-escalation trial. The dose escalation consists of 6 successive cohorts of 20 subjects. The doses studied are 0.6, 0.8, 1, 1.2, and 1.4 mg/kg. The dose chosen as the reference is 0.1 mg/kg, the actual recommended dose. Neonates and infants younger than 6 months, males and females, including preterm babies who undergo a surgery with general anesthesia inducted with sevoflurane were eligible. Parents of the subject were informed. Then, the subjects were randomized if presenting a decrease in mean blood pressure superior to 20% of their initial mean blood pressure (before induction of anesthesia), despite a vascular filling with sodium chloride 0.9%. The primary outcome is the success of the therapy defined as an mBP superior to 80% of the baseline mBP (prior to anesthesia) within 10 min post ephedrine administration. The subjects were followed-up for 3 days postanesthesia.DiscussionThis study is the first randomized, controlled trial intending to determine the optimal dose of ephedrine to treat hypotension in neonates and infants below 6 months old.Trial registrationClinicalTrials.gov NCT02384876. Registered on March 2015.

Effect of intraoperative iv dexmedetomidine on emergence agitation after sevoflurane anaesthesia in children undergoing tonsillectomy with or without adenoidectomy

Introduction: Sevoflurane, a popular inhalational anaesthetic agent for paediatric anaesthesia is associated with high incidence of emergence agitation (up to 80%). This study aims to evaluate the effects of intraoperative dexmedetomidine on incidence and severity of emergence agitation (EA) in children after tonsillectomy with or without adenoidectomy under sevoflurane anaesthesia. Materials and Methods: This prospective, randomized double blind study included 70 patients aged 2-10 years with ASA physical status I and II who were randomly allocated into two groups. Group D (n = 35) received intravenous dexmedetomidine 0.3 µg/kg and Group C (n = 35) received normal saline, both given post intubation over 10 min. After extubation, emergence agitation (EA) was assessed using the Pediatric Anesthesia Emergence Delirium (PAED) score, the Children's Hospital of Eastern Ontario Pain Scale (CHEOPS) for evaluating postoperative pain and modified Aldrete score for PACU discharge time were noted. Results: Demographic profile was comparable between two groups. Incidence of emergence agitation was significantly less in Group D than Group C (20% vs 42.86%). Postoperative pain was significantly less in Group D in comparison of Group C (14.3% vs 37.15%). Emergence time, extubation time and PACU discharge time were significantly longer in Group D in comparison to Group C (8.1 ± 1.4 vs 7.1 ± 1.4 min, 9.06 ± 1.59 vs 8.06 ± 1.39 min and 23.1 ± 7.6 vs 18.1 ± 8.2 min respectively). No complications were observed between two groups except vomiting. Conclusion: Dexmedetomidine 0.3 µg/kg) given intravenously just after intubation may be considered as an effective drug to reduce emergence agitation after sevoflurane anaesthesia in children undergoing tonsillectomy with or without adenoidectomy. Keywords: Dexmedetomidine, Intraoperative, Emergence agitation, Sevoflurane, Tonsillectomy.

The effect of bispectral index guided anesthesia versus standard practice on recovery after sevoflurane anesthesia in children: a prospective randomized double-blind clinical trial

ABSTRACT Background and aim Using bispectral index (BIS) guided anaesthesia may affect the quality of recovery and consumption of inhalational anaesthetic agents. The target of our study aimed to evaluate the impact of BIS-guided anaesthesia when compared with standard clinical practice to investigate the quality of recovery and sevoflurane concentration. Patients and method 54 children (aged3-12 years) go through ambulatory surgery that they randomized to receive sevoflurane anaesthesia controlled either merely by clinical parameters (controlled group), BIS-guided group within the BIS range of 40–60 (BIS group). The primary outcome has recorded the recovery time. The secondary outcome recorded the quality of recovery, which was measured by the Pediatric Anesthesia Emergence Delirium score. Results There were no statistically significant differences between Group C and Group BIS as regard age, weight, time of surgery, Time of anaesthesia, sex, ASA, type of surgery, mean value of PAED score at 20,25 and 30 min., heart rate and MAP. On the other hand, there were statistically significant differences between Group C and Group BIS as regarding Time for removal of the laryngeal mask, discharge to PACU, PACU time, PAED score at Baseline, 5, 10 and 15 min., and end-tidal sevoflurane concentration. Conclusion Sevoflurane anaesthesia guided by BIS results in decreased recovery and decreased sevoflurane concentration without affecting the quality of recovery in children go through ambulatory surgery.

Epileptiform EEG discharges and sevoflurane in children: Protocol of a systematic review and meta-analysis.

Background:Epileptiform discharges in electroencephalogram (EEG) have been frequently reported in children undergoing sevoflurane mask induction. However, the incidence, characteristics and risk factors of these epileptiform patterns during sevoflurane anesthesia in children are poorly understood. The aim of this study is to systematically review the epileptic potential of sevoflurane in children with the EEG monitoring.Methods:PubMed, EMBASE, Cochrane library (Central) will be systematically searched from inception to December 2018. The effect of sevoflurane on epileptic EEG patters in children will be studied. The primary outcome will be the incidence of epileptic discharges, the characteristics and risk factors of these epileptic discharges. Meta-analysis will be calculated using R software 3.5.1.Results:This study will offer new evidence of the incidence, characteristics and risk factors of EEG epileptic discharges during sevoflurane anesthesia.Conclusion:The conclusion drawn from this systematic review will benefit the children with or without epilepsy undergoing sevoflurane anesthesia.Ethics and dissemination:Ethics approval is unnecessary because data of individual patients will not be included and no privacy will be involved. The results of this review will be published in a peer-reviewed journal or a conference report. Amendments of the basic protocol will be documented in the comprehensive review.PROSPERO registration number:PROSPERO CRD 42019122008.

Safety and Analgesic Efficacy of Spinal Versus Caudal Block in Pediatric Infra-Umbilical Surgery

AbstractBackground: Neuraxial analgesia may improve post-operative outcomes for high-risk children who are susceptible to respiratory complications (e.g. post-operative apnea). The use of spinal anesthesia in infants and children requiring surgeries of sub-umbilical region is gaining considerable popularity worldwide. Caudal analgesia along with general anesthesia is a very popular regional technique for prolonged post-operative analgesia in different pediatric surgical proce-dures where the surgical site is sub-umbilical. Bupivacaine has been thoroughly studied, and a large global experience exists.Aim of Study: Was to investigate the safety and analgesic efficacy of spinal versus caudal bupivacaine combined with sevoflurane anesthesia in children undergoing infra-umbilical surgeries.Material and Methods: One hundred thirty patients of either sex aged between 2-7 years, (ASA I or II) were randomly assigned into two groups of 65 subjects each; Group A (caudal bupivaciane group) and Group B (spinal bupivaciane group). Group A received caudal isobaric bupivacaine, Group B received spinal hyper baric bupivacaine. Both after anesthesia induction and before surgery. Assessment parameters included; time to 1st oral rescue analgesics, post-operative (FLACC scale), post-operative agitation, post-operative motor block component, haemodynamics, perioperative adverse effect.Results: There were no significant differences between the two studied groups in the mean post-operative FLACC scores at any time except in the second post-operative hour in the spinal group (0.84±0.07 Vs. 1.13±0.08, p<0.01). The time to first request for rescue analgesia was significantly lower in the spinal group (6.60±1.82 Vs. 9.23±2.47, p<0.00), compared with the caudal group. There were no differences between the two studied groups in the total IV paracetamol consumption in the 1st 24h post-operatively (p=0.0674). There were no significant differences in the mean post-operative modified bromage scale scores between the two studied groups at any time. The block was associated with few complications in both groups.Conclusion: This study demonstrated that the spinal analgesia is fairly comparable to caudal analgesia in pediatric patients undergoing sub-umbilical surgeries. And we recom-mend the addition of an adjuvant to the intrathecal bupivacaine to prolong its analgesic effect making spinal analgesia a suitable alternative to caudal analgesia.

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.