Preoperative caudal block prevents emergence agitation in children following sevoflurane anesthesia

Aouad, Marie T.; Kanazi, Ghassan E.; Siddik-Sayyid, Sahar M.; Gerges, Frederic J.; Rizk, Laudia B.; Baraka, Anis

doi:10.1111/j.1399-6576.2005.00642.x

Cited by 82 publications

(57 citation statements)

References 22 publications

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“…It is widely believed that reducing or eliminating pain decreases the incidence of emergence agitation after sevoflurane anesthesia. Several studies demonstrated that regional block, opioids, and nonsteroidal antiinflamatory drugs decrease the incidence of emergence agitation [10,11,[13][14][15]. However, emergence agitation often occurs even after adequate pain treatment or after procedures that are not associated with pain.…”

Section: Discussionmentioning

confidence: 99%

Oral melatonin, dexmedetomidine, and midazolam for prevention of postoperative agitation in children

2011

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Section: Discussionmentioning

confidence: 99%

Oral melatonin, dexmedetomidine, and midazolam for prevention of postoperative agitation in children

2011

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“…The present study aimed to exclude the influence of post-operative pain on EA and decrease the incidence of EA. Due to regional block, opioids and nonsteroidal anti-inflammatory agents have been reported to decrease the incidence of EA (35,36). However, EA still occurs, even after adequate pain treatment or procedures that are not associated with pain (37).…”

Section: Group ------------------------------------------------------mentioning

confidence: 99%

Effect of dexmedetomidine combined with sufentanil on preventing emergence agitation in children receiving sevoflurane anesthesia for cleft palate repair surgery

Luo

Cao

et al. 2017

Experimental and Therapeutic Medicine

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Abstract. The aim of the present study was to observe whether dexmedetomidine (DEX) combined with sufentanil decreased emergence agitation (EA) in children receiving sevoflurane anesthesia for cleft palate repair surgery. Children undergoing elective cleft palate repair surgery were randomly allocated into the DEX + sufentanil group (group DS; n=50) and the normal saline + fentanyl group (group SF; n=50). Patients in group DS were treated with 0.5 µg/kg DEX prior to induction of anesthesia, whereas patients in group SF received an equal volume of normal saline. Sufentanil (0.2 µg/kg) was administered to induce anesthesia, and 30 min before the end of surgery for patients in group DS. Fentanyl (2 µg/kg) was administered at the same time point for patients in group SF. Mean arterial pressure (MAP), heart rate (HR), duration of surgery and anesthesia, and the dosage of remifentanil were assessed. EA score, Pediatric Anesthesia Emergence Delirium (PAED) score and the Children and Infants Postoperative Pain Scale (CHIPPS) score were documented every 15 min in the post-anesthesia care unit (PACU). The number of cases requiring fentanyl (1 µg/kg) and the recovery profile data were analyzed. Compared with group DS (P<0.05) and the baseline (P<0.05), HR and MAP were significantly increased in group SF immediately following tracheal intubation and extubation. Mean values of maximum EA, PAED and CHIPPS scores were significantly reduced in group DS compared with group SF at 0 (P<0.01), 15 (P<0.05), and 30 min (P<0.05) after arrival at PACU. The incidence of EA in group SF was significantly increased compared with group DS (P<0.05). The dosage of remifentanil during the surgery and the number of cases requiring fentanyl (1 µg/kg) in group DS were significantly decreased compared with group SF (P<0.05). The findings of the present study suggested that DEX combined with sufentanil was able to effectively decrease the incidence of EA in children receiving sevoflurane anesthesia for cleft palate repair surgery.

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“…Pre-school aged children, preoperative anxiety, inadequate pain control, type of the surgery (especially ophthalmological and otorhinolaryngological), anesthesia method are defined as the risk factors for EA in children. [3][4][5][6][7] Sevoflurane and desflurane are the preferred inhalational anesthetic agents for the induction of anesthesia in children. However, these agents have been reported to increase the ratio of EA because of their low blood/gas partition coefficients.…”

Section: Letter To the Editormentioning

confidence: 99%

Pediatric Emergence Agitation

Honca¹,

Reanimation²

2016

Anesthesiol Open J

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Emergence Agitation (EA) is still remaining as a major problem during the early stage of recovery from general anesthesia in children. EA was first reported in 1960's and it has been considered as a mental disturbance during recovery from general anesthesia which consists of hallucinations, delusions and confusion manifested by moaning, restlessness, involuntary physical activity and thrashing about in the bed.1 The incidence of EA is variable and can reach to 80%. Pre-school aged children, preoperative anxiety, inadequate pain control, type of the surgery (especially ophthalmological and otorhinolaryngological), anesthesia method are defined as the risk factors for EA in children.3-7 Sevoflurane and desflurane are the preferred inhalational anesthetic agents for the induction of anesthesia in children. However, these agents have been reported to increase the ratio of EA because of their low blood/gas partition coefficients.8 Although emerge times from propofol and sevoflurane are similar, EA is frequently observed in sevoflurane based anesthesia. In recent studies elevation of intraserebral glucose and lacticasid concentrations were observed with Magnetic Resonance Spectroscopy (MRS) with the use of sevoflurane.9 Also epileptogenic activity of sevoflurane has been reported. 10However the exact mechanism of EA has not been understood yet.Different anesthetic agents such as opioids, midazolam, ketamine, alpha-2 agonist sedatives and nonsteroidal anti-inflammatory drugs have been used to prevent EA. Low dose ketamine added to propofol was found effective in the prevention of EA in children with a history of EA with propofol Total intravenous anaesthesia (TIVA).11 Hadi et al Found that ketodex (lowdoseketamine 0,15 mg/kg followed by dexmedetomidine 0,3 µ/kg IV) reduced the incidence and severity of EA in children undergoing adenotonsillectomy following sevoflurane based anesthesia and provided smooth extubation.12 µ-opioid agonists were found effective in decreasing the incidence of EA under sevoflurane anesthesia but postoperativenausea and vomiting were increased.13 In a study by Fang et al, the efficacy of midazolam, dexmedetomidine, ketamine, fentanyl, and propofol were compared for the prevention of sevoflurane-related EA in children with placebo. They found that all of these agents have decreased the incidence of EA but dexmedetomidine was considered the most effective agent in their study.14 In a study by Rosen et al, 42% of the anesthesiologists declared that EA was a significant problem at their institution and propofol was found the most common anesthetic agent used to prevent and to treat EA compared with the other medications. 15EA is a major problem in the postoperative period that may cause physical harm to the patient and can be disturbing to the parents and nursing staff in there covery room. There is not defined spesific treatment and optimal anesthetic technique in current practice. For this reason further studies are needed to understand the mechanism of EA and improve the treatment.

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Preoperative caudal block prevents emergence agitation in children following sevoflurane anesthesia

Abstract: Our results show that in children undergoing inguinal hernia repair, pain control with a preoperative caudal block as compared to intraoperative intravenous fentanyl significantly reduces the incidence of emergence agitation and pain scores following sevoflurane anesthesia.

Cited by 82 publications

References 22 publications

Oral melatonin, dexmedetomidine, and midazolam for prevention of postoperative agitation in children

Oral melatonin, dexmedetomidine, and midazolam for prevention of postoperative agitation in children

Effect of dexmedetomidine combined with sufentanil on preventing emergence agitation in children receiving sevoflurane anesthesia for cleft palate repair surgery

Pediatric Emergence Agitation

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