Postoperative emergence delirium in pediatric patients undergoing cataract surgery – a comparison of desflurane and sevoflurane

Sethi, Sameer; Ghai, Babita; Ram, Jagat; Jd, Wig

doi:10.1111/pan.12260

Cited by 47 publications

(36 citation statements)

References 24 publications

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“…16,17 Our results are consistent with these findings despite the fact that these previous studies differed in their use of nitrous oxide for anesthesia induction and maintenance. Nevertheless, few studies have compared anesthesia emergence times between desflurane and sevoflurane after volatile induction in adults.…”

Section: Discussionsupporting

confidence: 83%

“…This is most likely due to the young age of the participants in prior studies, which prevented precise measurements of recovery times. 16,17 The times in our study from discontinuation of volatile anesthetics to orientation to the patients' full name, date, and place were significantly shorter in the desflurane group than in the sevoflurane group, which suggests that changing from sevoflurane to desflurane permits faster recovery than sevoflurane anesthesia, even after sevoflurane induction. In addition, the time trend in recovery events differed between the two groups.…”

Section: Discussionmentioning

confidence: 72%

See 1 more Smart Citation

Effects of changing from sevoflurane to desflurane on the recovery profile after sevoflurane induction: a randomized controlled study

Mikuni

Harada

Yakushiji

et al. 2015

Can J Anesth/J Can Anesth

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Section: Discussionsupporting

confidence: 83%

Section: Discussionmentioning

confidence: 72%

Effects of changing from sevoflurane to desflurane on the recovery profile after sevoflurane induction: a randomized controlled study

Mikuni

Harada

Yakushiji

et al. 2015

Can J Anesth/J Can Anesth

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“…The literature has shown both supporting 5,7 and contradicting evidence 8,9 for an association between preoperative agitation and postoperative delirium. In the analysis we found a strong association between significant preoperative agitation and postoperative delirium (OR 3.54 95% CI 1.55-8.09: p = 0.003).…”

Section: Deliriummentioning

confidence: 99%

“…The association between agitation at induction and emergence delirium has not been clearly delineated with contradictory results being reported. [5][6][7][8][9] The incidence of POV in children has been reported as 34%.10 While preoperative anxiety and agitation have been implicated as possible risk factors for postoperative nausea and vomiting (PONV) in adults, [11][12][13][14][15] its role as a risk factor in children remains unclear. 16,17 Further, local South African data have suggested that adult African patients have a lower incidence of PONV than non-African patients 18 but no such association has yet been shown in children.…”

Section: Introductionmentioning

confidence: 99%

Induction behaviour and race and its association with postoperative agitation in paediatric elective surgery

Swart

Rajah

Rodseth

2017

Southern African Journal of Anaesthesia and Analgesia

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Background: It has been suggested that preoperative agitation in children may be a risk factor for postoperative delirium and postoperative vomiting. Previous studies have suggested that adult African patients have a lower incidence of postoperative nausea and vomiting, but no such association has been shown in children. Aim: To determine the incidence of both postoperative delirium and postoperative vomiting in elective paediatric surgical patients in a South African hospital and their association with preoperative agitation and patient race. Methods: A retrospective database analysis was undertaken of patients 1-12 years of age undergoing elective surgery. The Watcha behavioural scale was used to assess pre-and postoperative agitation. A Watcha score > 2 defined significant preoperative agitation or postoperative delirium. Multivariable logistic regression evaluated ENT surgery, sex, age, volatile type, significant preoperative agitation and race as predictors of postoperative delirium. Sex, race, significant preoperative agitation, ENT surgery and vomiting prophylaxis were evaluated as predictors of postoperative vomiting. Results: Significant preoperative agitation occurred in 13.5% (125/928); postoperative delirium in 3.4% (32/928) and postoperative vomiting in 1.4% (12/856) of patients. Postoperative delirium occurred in 3.1% of African patients as compared with 10.4% of non-African patients (p = 0.007); and postoperative vomiting in 1.2% of African patients as compared with 4.4% of non-African patients (p = 0.074). The predictors of postoperative delirium were non-African race (odds ratio [OR] 3.67; 95% confidence interval [CI] 1.22-11.07; p = 0.021), significant preoperative agitation (OR 3.54; 95% CI 1.55-8.09; p = 0.003), and ENT surgery (OR 2.5; 95% CI 1.0-6.0; p = 0.040). Only non-African race predicted postoperative vomiting (OR 3.73; 95% CI 1.01-13.79; p = 0.049), which included other variables like ENT surgery, significant preoperative anxiety, PONV prophylaxis. Conclusion: Preoperative agitation, non-African race and ENT surgery were predictors of postoperative agitation. Postoperative vomiting was predicted only by non-African race, which correlates with the trend seen in adults, even though incidence difference between African and non-African patients was not statistically significant.

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“…These adverse effects can cause sympathetic hyperactivity, prolonged hospital stay, and decreased patient satisfaction. Sethi et al [11] reported that the occurrence of emergence agitation in pediatric patients was not significantly different between sevoflurane and desflurane. We hypothesized that desflurane may cause more emergence delirium if it is caused by rapid recovery, but desflurane maintenance after sevoflurane induction can provide gentle induction and rapid emergence while minimizing cardiovascular changes during induction.…”

Section: Introductionmentioning

confidence: 99%

The change of sevoflurane to desflurane after anesthesia induction induces rapid emergence without increased cardiovascular responses and emergence delirium in pediatric strabismus surgery patients

Hwang¹,

Kwon²,

Kim³

et al. 2015

Anesth Pain Med

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This is an Open Access article distributed under the terms of the Creative Commons Attribution Non-Commercial License (http://creativecommons.org/licenses/by-nc/3.0) which permits unrestricted non-commercial use, distribution, and reproduction in any medium, provided the original work is properly cited. Background:Desflurane has lower solubility and shows a more rapid induction and recovery than sevoflurane, although it often induces increased cardiovascular response, emergence delirium, and respiratory complications. The change of anesthetic agent from sevoflurane to desflurane after induction may provide a smooth induction and rapid emergence. The aim of this study was to evaluate the effect of changing sevoflurane to desflurane after induction on the cardiovascular response, emergence delirium, and recovery characteristics during pediatric strabismus surgery. Methods: For the study, 135 children scheduled for strabismus surgery were randomly divided into three groups: the S group (n = 45) and D group (n = 45) received sevoflurane or desflurane, respectively, for induction and maintenance, while the C group (n = 45) received sevoflurane for induction and desflurane for maintenance. Cardiovascular responses, pediatric anesthesia emergence delirium (PAED) scale scores, post-anesthesia care unit (PACU) length of stay, and the incidence of postoperative complications were compared between groups. Results: The blood pressure of the D group was significantly different from that of the S and C groups (P ＜ 0.05). The time to extubation and first crying were significantly longer in the S group (P ＜ 0.001). There were no significant differences in PAED score, PACU length of stay, and the incidence of postoperative complications, except for cough, among the three groups. Conclusions: The change of desflurane after sevoflurane induction in pediatric strabismus surgery provided rapid emergence compared with sevoflurane, and attenuated cardiovascular responses and lesser respiratory complications as compared to desflurane. The emergence delirium was not influenced by either inhalational anesthetic. (Anesth Pain Med 2015; 10: 128-133)

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Postoperative emergence delirium in pediatric patients undergoing cataract surgery – a comparison of desflurane and sevoflurane

Cited by 47 publications

References 24 publications

Effects of changing from sevoflurane to desflurane on the recovery profile after sevoflurane induction: a randomized controlled study

Effects of changing from sevoflurane to desflurane on the recovery profile after sevoflurane induction: a randomized controlled study

Induction behaviour and race and its association with postoperative agitation in paediatric elective surgery

The change of sevoflurane to desflurane after anesthesia induction induces rapid emergence without increased cardiovascular responses and emergence delirium in pediatric strabismus surgery patients

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