Effects of remifentanil maintenance during recovery on emergence delirium in children with sevoflurane anesthesia

Choi, Eun Kyung; Lee, Shiback; Kim, Won Jae; Park, Sang-Jin

doi:10.1111/pan.13446

Cited by 18 publications

(20 citation statements)

References 22 publications

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“…Patients with persistent severe postoperative delirium have negative implications and experience less satisfaction, as do their families, due to the potential for self-injury and other injurious behaviors, being a burden on nursing staff. It has been shown that low-dose fentanyl (an induced dose of less than 1 µg/kg) used in children after sevoflurane-based anesthesia can reduce the incidence of emergence delirium without prolonged hospital stay [ 20 , 21 ] . Sufentanil, as a derivative of fentanyl, is a lipophilic opioid agonist that can easily pass through the blood-brain barrier and bind to plasma proteins at a higher rate than fentanyl [ 22 ] .…”

Section: Discussionmentioning

confidence: 99%

Sufentanil Reduces Emergence Delirium in Children Undergoing Transthoracic Device Closure of VSD After Sevoflurane-Based Cardiac Anesthesia

Xu¹,

Chen²,

Huang³

et al. 2020

Braz J Cardiovasc Surg

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Objective The aim of this study was to evaluate whether sufentanil can reduce emergence delirium in children undergoing transthoracic device closure of ventricular septal defect (VSD) after sevoflurane-based cardiac anesthesia. Methods From February 2019 to May 2019, 68 children who underwent transthoracic device closure of VSD at our center were retrospectively analyzed. All patients were divided into two groups: 36 patients in group S, who were given sufentanil and sevoflurane-based cardiac anesthesia, and 32 patients in group F, who were given fentanyl and sevoflurane-based cardiac anesthesia. The following clinical data were recorded: age, sex, body weight, operation time, and bispectral index (BIS). After the children were sent to the intensive care unit (ICU), pediatric anesthesia emergence delirium (PAED) and face, legs, activity, cry, consolability (FLACC) scale scores were also assessed. The incidence of adverse reactions, such as nausea, vomiting, drowsiness and dizziness, was recorded. Results There was no significant difference in age, sex, body weight, operation time or BIS value between the two groups. Extubation time (min), PEAD score and FLACC scale score in group S were significantly better than those in group F ( P <0.05). No serious anesthesia or drug-related side effects occurred. Conclusions Sufentanil can be safely used in sevoflurane-based fast-track cardiac anesthesia for transthoracic device closure of VSD in children. Compared to fentanyl, sufentanil is more effective in reducing postoperative emergence delirium, with lower analgesia scores and greater comfort.

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Section: Discussionmentioning

confidence: 99%

Sufentanil Reduces Emergence Delirium in Children Undergoing Transthoracic Device Closure of VSD After Sevoflurane-Based Cardiac Anesthesia

Xu¹,

Chen²,

Huang³

et al. 2020

Braz J Cardiovasc Surg

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“…It is not easy to separate ED from pain-related agitation, as there is an overlap in the parameters assessing the two conditions. Therefore, the control of postoperative pain is highly recommended to reduce ED in pediatrics (14). In our study, two children in group I and one in group II needed rescue analgesics.…”

Section: Discussionmentioning

confidence: 70%

Comparative Effects of Total Intravenous Anesthesia with Propofol and Remifentanil Versus Inhalational Sevoflurane with Dexmedetomidine on Emergence Delirium in Children Undergoing Strabismus Surgery

Oriby

Elrashidy

2020

Anesth Pain Med

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Background: Emergence delirium (ED) is common after strabismus surgery due to postoperative visual disturbance, vomiting, and pain. Total intravenous anesthesia (TIVA) has many advantages like smooth emergence from anesthesia, decreased incidence of postoperative nausea and vomiting (PONV), and postoperative analgesia. Objectives: Our study aimed to compare the incidence of ED using inhalational sevoflurane with dexmedetomidine (DEX) versus TIVA with remifentanil. Methods: Eighty-four patients aged 3 - 11 years scheduled for strabismus surgery under general anesthesia were randomly allocated into two groups. Patients in group I received sevoflurane and DEX (group I, n = 42), while group II patients received TIVA with propofol and remifentanil infusion (group II, n = 42). Mean arterial pressure (MAP), heart rate (HR), and pulse oximetry (SpO2) were monitored before induction, at induction, and every 10 minutes during the surgery. In the postanesthetic care unit (PACU), pediatric anesthesia emergence delirium (PAED), face, legs, activity, cry, and consolability (FLACC), need for rescue analgesics, recovery time, level of parents’ satisfaction, and PONV were recorded. Results: Based on the results, HR and MAP significantly decreased 10 and 20 min after induction compared to baseline in group I after infusion of DEX. The incidence of PONV was significantly lower in group II than in group I, while the recovery time was significantly shorter in group I. The incidence of emergence delirium decreased in both groups. Conclusions: The use of either total intravenous anesthesia with propofol and remifentanil or sevoflurane inhalational anesthesia with dexmedetomidine resulted in a lower incidence of emergence delirium, although dexmedetomidine resulted in hypotension, bradycardia, and PONV.

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“…Remifentanil was administered until specific discharge criteria were met (modified Aldrete post-anesthesia recovery score > 9). The authors found a significant reduction of ED incidence using The Cole five-point scale (33.3% vs 68.3%; P = 0.002) and PAED scale for scores > 12 (5.1% vs 34.0%; P = 0.001), while length of stay in the PACU remained similar to the control group [33].…”

Section: Opioidsmentioning

confidence: 87%

Postoperative emergence delirium in children: a narrative review of recent publications

Grotmol

Nesarajah

Hansen

2021

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Background: Emergence delirium is a challenge in pediatric anesthesiology, with important unanswered questions concerning incidence, causation, diagnosis, treatment, and sequelae. In this review, we will present the recent research with a particular focus placed on treatment and prevention options. Methods: A wide literature search was conducted across MEDLINE and other databases using PubMed, Embase, Ovid, and the Cochrane Library (latest access: 23 November 2020). The collected publications were assessed for relevance. Only randomized controlled trials and observational studies on postoperative emergence delirium in children were included. Exclusion criteria were articles published before 2018, and studies comprising children older than 12 years of age, mental retardation, or chronic diseases. Results: The final number of studies included in this review was 44. Risk factors identified for emergence delirium were volatile inhalation anesthetics, young age, child temperament, preoperative anxiety, male gender, and specific surgical procedures. Preventive and/or intervention measures were pharmacological (e.g. TIVA, α2-adrenergic agonists (particularly dexmedetomidine), ketamine, propofol, midazolam, opioids (fentanyl)) and non-pharmacological measures (e.g. video or tablet distraction, familiarization with the operating environment, use of mother’s voice, visual preconditioning in eye surgery). Conclusion: ED should be considered a “vital sign” and recorded and documented in all children in the PACU. There is an urgent need for future research to fill in missing gaps of knowledge regarding ED. Implementation of a standardized and validated screening tool for ED are high priorities as is the impact of perioperative monitoring of children at risk to prevent ED.

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Effects of remifentanil maintenance during recovery on emergence delirium in children with sevoflurane anesthesia

Abstract: Maintaining a low dose of remifentanil (0.05 μg/kg/min) throughout the recovery phase attenuated the incidence of emergence delirium in children undergoing strabismus surgery under sevoflurane anesthesia.

Cited by 18 publications

References 22 publications

Sufentanil Reduces Emergence Delirium in Children Undergoing Transthoracic Device Closure of VSD After Sevoflurane-Based Cardiac Anesthesia

Sufentanil Reduces Emergence Delirium in Children Undergoing Transthoracic Device Closure of VSD After Sevoflurane-Based Cardiac Anesthesia

Comparative Effects of Total Intravenous Anesthesia with Propofol and Remifentanil Versus Inhalational Sevoflurane with Dexmedetomidine on Emergence Delirium in Children Undergoing Strabismus Surgery

Postoperative emergence delirium in children: a narrative review of recent publications

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