Comparison of propofol and fentanyl for preventing emergence agitation in children

Abstract

Emergence agitation after sevoflurane anaesthesia in children Editor-We read with interest the article by Lee and colleagues comparing propofol and fentanyl for prevention of emergence agitation after sevoflurane anaesthesia in children. 1 We thank the authors for their work in this very common and often very distressing scenario. We would like to raise a few important questions regarding this study. Pain is one of the important causes for emergence agitation particularly in children, 2 and although the authors excluded the children in whom caudal analgesia had not worked, we think assessment of pain by appropriate scales would have been very helpful in addressing this confounding factor. Also considering the authors have used lidocaine for caudal analgesia and the patients had at least 60 min duration of anaesthesia and a further 40 min in Post Anaesthesia Care Unit (PACU), we consider assessment of pain in PACU would have been invaluable data in this study. Propofol was used as the rescue agent for severe agitation in PACU. Considering that propofol was one of the study drugs, we think that it introduces bias into the study. The starvation times used in this study were very long compared with the common clinical practice in the UK (where it is 6 h for solids and 2 h for clear fluids). We appreciate this could have been the standard protocol of the institution, but longer starvation periods would lead to more distress before induction, which possibly could have led to some exclusions from the study. Preoperative anxiety and distress is another significant contributing factor for emergence agitation in children. 2 3 Parental stay during recovery of anaesthesia is another factor influencing emergence agitation in children. 4 We understand the policy of the institution of not having parental presence in PACU influencing the study protocol, and we would like to commend the authors in acknowledging this factor for higher incidence of emergence agitation in Group S.

Does a prophylactic dose of propofol reduce emergence agitation in children receiving anesthesia? A systematic review and meta‐analysis

“…Many interventions aimed at reducing the incidence of EA have been tried, with the ultimate goal of reducing the potential for injury and distress among children and parents. Propofol is a readily available, short‐acting intravenous sedative‐hypnotic agent which can be used for induction and/or maintenance of anesthesia, but also can be used as a single dose before emergence from other anesthetic agents . Such ‘prophylactic’ use of propofol has shown promise for decreasing the incidence of EA among pediatric patients , but results have been mixed and the impact on clinical practice has been small.…”

Emergence agitation prevention in paediatric ambulatory surgery: A comparison between intranasal Dexmedetomidine and Clonidine

“…Among several medications,[ 6 7 8 9 10 11 ] tried for prevention of EA after sevoflurane-based anesthesia α 2 agonists has shown promising results.…”

“…Various pre-, intra-, and immediate postoperative pharmacological agents like-analgesics,[ 6 ] Dexa- methasone,[ 7 ] opioids,[ 8 ] propofol,[ 9 ] benzo- diazepines,[ 10 ] alpha-2 (α 2 ) agonists,[ 10 11 ] were used with the aim of reducing the occurrence of EA after sevoflurane-based anesthesia, with variable results.…”

The Effect of Alfentanil on Emergence Delirium Following General Anesthesia in Children: A Randomized Clinical Trial

“…ED is a very stressful experience for the patient, families, caregivers, and clinicians [9][10][11][12]. Pharmacological agents such as propofol, 2-adrenoreceptor agonists, and fentanyl are known to reduce the incidence of ED [5,9,[13][14][15][16][17][18]. Alfentanil is a synthetic, short-acting µ-opioid agonist associated with fewer adverse events, including less respiratory depression and postoperative nausea and vomiting (PONV), than fentanyl [19,20].…”