Comparing incidence of emergence delirium between sevoflurane and desflurane in children following routine otolaryngology procedures

Driscoll, Jeremy N.; Bender, Brian M.; Archilla, Carlos A.; Klim, Carol M.; Hossain, Jobayer; Mychaskiw, George; Wei, Julie L.

doi:10.23736/s0375-9393.16.11362-8

Cited by 24 publications

(10 citation statements)

References 25 publications

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“…However, a difference observed in Sethi’s study 6 was that they observed no correlation between preoperative anxiety and ED in their population. The incidence of ED in our study and that from India 6 appears to be generally less than seen in those studies reported from United States, Australia, and Europe 17 - 19 but a direct comparison is difficult due to methodological differences.…”

Section: Discussioncontrasting

confidence: 89%

“…Much work has been done on ED in children from United States, Australia, and Europe. 17 - 19 Driscoll et al 17 from United States reported an incidence of 43% with sevoflurane and 34% with desflurane anaesthesia in children undergoing otolaryngology procedures. 17 Costi et al 18 from Australia reported an incidence of 29% following sevoflurane anaesthesia in children undergoing MRI scan.…”

Section: Discussionmentioning

confidence: 99%

“… 17 - 19 Driscoll et al 17 from United States reported an incidence of 43% with sevoflurane and 34% with desflurane anaesthesia in children undergoing otolaryngology procedures. 17 Costi et al 18 from Australia reported an incidence of 29% following sevoflurane anaesthesia in children undergoing MRI scan. Both studies used a cut-off score of ≥12 on PAED scale to detect ED.…”

Section: Discussionmentioning

confidence: 99%

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Emergence Delirium and Its Association with Preoperative Anxiety in Paediatric Patients Undergoing Infra Umbilical Surgery Under Combined General and Caudal Anaesthesia: An Observational Study from a Tertiary Care Centre in a South Asian Country

Khan¹

2022

Turk J Anaesthesiol Reanim

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Objective: The objective of this observational study was to determine the incidence of emergence delirium (ED) and its association with preoperative anxiety using the modified Yale preoperative anxiety scale and paediatric anaesthesia emergence delirium scale, in a tertiary care institution in South Asia. Methods: A total of 250 children of 2–8 years of age (of either gender, American Society of Anaesthesiology classification I or II, undergoing infra umbilical surgery, using caudal block for analgesia) were enrolled and the study was completed. The primary outcome measure was the presence of ED using the paediatric anaesthesia emergence delirium score. A cut-off value equal to or more than 12 at any time point was taken as ED. The secondary measure was preoperative anxiety, measured using the modified Yale preoperative anxiety scale at 30 minutes before going into the operating room. A cut-off score of 30 was used. Results: The median age of the children was thirty-six months IQR (24–60). There were 230 (91%) males and 20 (9%) females. Twenty-two percent of the children experienced emergence delirium. One-point increase of modified Yale preoperative anxiety scale anxiety score was significantly associated with 1.23 times the odds of emergence delirium OR =1.23 (1.16–1.29) as compared with those without emergence delirium. Conclusions: The incidence of emergence delirium in our cohort was 22.4%, and there was a significant association between preoperative anxiety and emergence delirium.

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Section: Discussioncontrasting

confidence: 89%

Section: Discussionmentioning

confidence: 99%

Section: Discussionmentioning

confidence: 99%

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Emergence Delirium and Its Association with Preoperative Anxiety in Paediatric Patients Undergoing Infra Umbilical Surgery Under Combined General and Caudal Anaesthesia: An Observational Study from a Tertiary Care Centre in a South Asian Country

Khan¹

2022

Turk J Anaesthesiol Reanim

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“…In the present study, the prevalence of ED was 1.3% in children undergoing T&A. ED is a very common PACU occurrence in children undergoing general anesthesia with an overall incidence of 10% to 80% in children undergoing anesthesia for a variety of procedures [ 1 – 7 , 23 , 31 , 32 ]. The rate of ED ranges from 13% to 26% in children undergoing otolaryngologic procedures [ 5 , 33 ]. Earlier studies have reported that ED is associated with various patient and procedural risk factors, including younger age, volatile anesthetic use, and type of surgery including otorhinolaryngology procedures [ 1 , 5 , 34 – 36 ].…”

Section: Discussionmentioning

confidence: 99%

Prevalence of Emergence Delirium in Children Undergoing Tonsillectomy and Adenoidectomy

Liu

Ulualp

2022

Anesthesiology Research and Practice

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Objective. Emergence delirium (ED) is associated with behavioral disturbances and psychomotor agitation, increased risk of selfinjury, delayed discharge, and parental dissatisfaction with quality of care. Otolaryngology procedures are associated with an increased risk of ED. The aims of this study were to determine the prevalence of ED in children who had tonsillectomy and adenoidectomy (T&A), assess the characteristics of children who had ED, and ascertain the recovery times of patients with ED. Methods. Charts of patients who had tonsillectomy and adenoidectomy between Jan 1, 2018 and March 26, 2020 at a tertiary children’s hospital were reviewed. Data collection included demographics, body mass index, indication for T&A, Pediatric Anesthesia Emergence Delirium (PAED) score, American Society of Anesthesiologists (ASA) physical status classification, total anesthesia time, postanesthesia care phase I time, and postanesthesia care phase II time. Results. Of the 4974 patients who underwent T&A, ED occurred in 1.3% of patients. Toddlers (2.9%) and male children (1.6%) had a significantly higher prevalence of ED. Prevalence of ED was similar amongst patients with recurrent tonsillitis, patients with obstructive sleep disordered breathing, and patients with both obstructive sleep apnea (OSA) and recurrent tonsillitis. The prevalence of ED was not different amongst ASA I, ASA II, and ASA III. Males with ED had longer total anesthesia times (41 v . 34 minutes, p = 0.02 ) and ASA I patients with ED had longer phase I times ( p = 0.04 ) in the postanesthesia care unit (PACU). There was no significant difference in total anesthesia time, phase I time, or phase II time when compared across the subgroups of gender, age, indication for T&A, severity of obstructive sleep apnea (OSA), and ASA score. Conclusions. Males, toddlers, and preschool-age children were more likely to have ED. Males with ED had longer total anesthesia times. ED was associated with longer phase I times in ASA I patients.

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“…EA in children is usually a short-lived phenomenon with no aftereffect. And, it is potentially dangerous because it can make the children fall out of bed and remove the surgical dressings and intravenous catheters, which increased the extra medical cost (Dahmani et al, 2014;Driscoll et al, 2017;Choi et al, 2018;Abbas et al, 2019).…”

Section: Introduction/backgroundmentioning

confidence: 99%

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

et al. 2022

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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.

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Comparing incidence of emergence delirium between sevoflurane and desflurane in children following routine otolaryngology procedures

Cited by 24 publications

References 25 publications

Emergence Delirium and Its Association with Preoperative Anxiety in Paediatric Patients Undergoing Infra Umbilical Surgery Under Combined General and Caudal Anaesthesia: An Observational Study from a Tertiary Care Centre in a South Asian Country

Emergence Delirium and Its Association with Preoperative Anxiety in Paediatric Patients Undergoing Infra Umbilical Surgery Under Combined General and Caudal Anaesthesia: An Observational Study from a Tertiary Care Centre in a South Asian Country

Prevalence of Emergence Delirium in Children Undergoing Tonsillectomy and Adenoidectomy

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

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