Rapid emergence does not explain agitation following sevoflurane anaesthesia in infants and children: a comparison with propofol

Cohen, Ira Todd; Finkel, Julia C.; Hannallah, Raafat S.; Hummer, Kelly A.; Patel, Kantilal M.

doi:10.1046/j.1460-9592.2003.00948.x

Cited by 151 publications

(106 citation statements)

References 25 publications

(33 reference statements)

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“…Thus, we strongly recommend that pain should be anticipated and treated preventively, as early as during surgery itself, and that the proper postoperative analgesia be used after major operations, such as thoracic and abdominal surgeries. 2,15 The incidence of agitation in males was greater than in females. This may be due to the lower pain tolerance in males following surgery, as previous studies have reported that men report more pain and consume more patient-controlled analgesia than women.…”

Section: Discussionmentioning

confidence: 98%

Emergence agitation in adults: risk factors in 2,000 patients

Chai

Sun

et al. 2010

Can J Anesth/J Can Anesth

207

247

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Purpose The study was designed to determine the incidence of postoperative agitation following general anesthesia in 2,000 adult patients and to examine the associated risk factors. Methods The study enrolled 2,000 adults who were scheduled for surgery under general anesthesia in a single institution during December 2007 to December 2008. The following risk factors were examined: age, gender, ASA physical status, type of surgery, anesthesia technique (inhalational or intravenous), administration of neostigmine or doxapram, adequate postoperative analgesia, pain, presence of a tracheal tube, and presence of a urinary catheter. Results Agitation occurred in 426 patients (21.3%). It was more common in males (28.1%) than in females (16.1%) (P = 0.017) and more prevalent after inhalational (27.8%) than total intravenous (7.5%) anesthesia (P = 0.001). Agitation was more common after oral cavity and otolaryngological surgery than after other types of surgery. Multivariate analysis showed that use of doxapram (odds ratio [OR] = 9.2; 95% confidence interval [CI] = 6.2 -15.4; P = 0.002) and pain (OR = 8.2; 95% CI = 4.5 -16.9; P \ 0.001) were the most important risk factors associated with emergence agitation. Other causes were the presence of a tracheal tube and/or a urinary catheter. Adequate postoperative analgesia was associated with less agitation (OR = 0.4; 95% CI = 0.1 -0.4; P = 0.006). Conclusion Doxapram administration, pain, and presence of a tracheal tube and/or a urinary catheter appear to be the most important causes of postoperative agitation. To avoid this complication, it is suggested, whenever possible, to use intravenous anesthesia, to remove endotracheal tubes and urinary catheters as early as possible, and to provide adequate postoperative analgesia. RésuméObjectif Cette e´tude a e´te´conçue afin de de´terminer l'incidence d'agitation postope´ratoire apre`s une anesthe´sie ge´ne´rale chez 2000 patients adultes et d'examiner les facteurs de risque associe´s. Méthode L'e´tude a recrute´2000 adultes devant subir une chirurgie sous anesthe´sie ge´ne´rale dans une seule institution entre de´cembre 2007 et de´cembre 2008. Les facteurs de risque suivants ont e´te´examine´s: l'aˆge, le sexe, le statut physique ASA, le type de chirurgie, la technique anesthe´sique (par inhalation ou intraveineuse), l'administration de ne´ostigmine ou de doxapram, une analge´sie postope´ratoire adapte´e, la douleur, la pre´sence d'une sonde endotrache´ale et la pre´sence d'un cathe´ter urinaire. Résultats Au total, 426 patients ont montre´des signes d'agitation (21,3 %). Elle e´tait plus courante chez les hommes (28,1 %) que chez les femmes (16,1 %) (P = 0,017) et plus pre´valente apre`s une anesthe´sie par inhalation (27,8 %) qu'apre`s une anesthe´sie re´alise´e exclusivement par intraveineuse (7,5 %) (P = 0,001). L'agitation e´tait plus fre´quente apre`s une chirurgie otorhinolaryngologique ou de la cavite´orale qu'apre`s d'autres types de chirurgie. Une analyse multivarie´e a montre´que l'utilisation de doxapram (rappo...

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Section: Discussionmentioning

confidence: 98%

Emergence agitation in adults: risk factors in 2,000 patients

Chai

Sun

et al. 2010

Can J Anesth/J Can Anesth

207

247

View full text Add to dashboard Cite

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“…The only inhalational agent not associated with emergence delirium is halothane [7] and this is no longer available in the UK. Although both sevoflurane and propofol allow for rapid emergence from general anaesthesia, a comparison of sevoflurane and propofol found that only sevoflurane was associated with a high incidence of emergence delirium in infants and young children, so rapid emergence itself does not explain this phenomenon [8].…”

Section: Editorialmentioning

confidence: 99%

Emergence delirium in children

Wong

Bailey

2015

Anaesthesia

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“…Ancak, sevofluran ve propofol anestezisinin karşılaştı-rıldığı bir başka çalışmada, propofol anestezisi alan çocuklarda, derlenme daha hızlı olmasına karşın, postoperatif ajitasyon insidansı sevofluran grubunda belirgin olarak daha yüksek bulunmuştur. (17,18) Mayer ve ark. 'nın (19) sevofluran indüksiyonu sonrasında anestezi idamesinde desfluran ve sevofluranı karşılaştırdığı bir çalışmada da, desfluran alan grupta derlenmenin daha hızlı olduğu, postoperatif ajitasyonunun ise sevofluran grubunda anlamlı olarak yüksek olduğu gösterilmiştir.…”

Section: Gereç Ve Yöntemunclassified

The Effect of Gabapentin Premedication on the Emergence Delirium in Pediatric Patients Undergoing Circumcision Under Sevoflurane Anesthesia

Dönmez¹,

Salman²,

Sülemanji³

et al. 2012

J Turk Anaesth Int Care

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ÖZETAmaç: Gabapentin anksiyolitik ve analjezik etkileri nedeniyle kullanılan antiepileptik bir ajandır. Gabapentinin perioperatif dönemde kullanımı son yıllarda çalışılmıştır.Biz bu çalışmada gabapentinin sevofluran anestezisi altında sünnet yapılan çocuklarda postoperatif analjezik tüketi-mine ve derlenme ajitasyonu üzerine etkisini incelemeyi amaçladık.Gereç ve Yöntem: Yaşları 3'ten büyük 25 ASA I-II grubu sünnet yapılacak çocuk, bu prospektif randomize çalışmaya dahil edildi. Gabapentin grubuna(grup G,n=12) 15 mg kg -1 gabapentin 10 mL salin içinde operasyondan ½ sa önce verildi. Kontrol grubuna (grup K, n=13) ise 10 mL salin verildi. Sevofluran tek anestetik ajan olarak kullanıldı. Cerrahiden önce tüm çocuklara penil blok uygulandı. Vital parametreler, preoperatif anksiyete skorları, göz açma süresi, Modifiye Aldrete skorları ve derlenme ajitasyon skorları kaydedildi. Postoperatif 24. saatte toplam analjezik tüketim, aile memnuniyeti ve yan etkiler sorgulandı.Bulgular: Demografik veriler, preoperatif anksiyete skorları, vital parametreler, Modifiye Aldrete skorları, operasyon süresi, göz açma süresi, postoperatif ağrı skorları, 24 saatlik toplam analjezik tüketim, aile memnuniyeti skoru gruplar arasında benzerdi. Postoperatif 10. dk. derlenme skoru gabapentin grubunda anlamlı olarak düşüktü.Sonuç: Kısıtlı sayıda hasta üzerinde yapılan bu çalışmada, preoperatif oral gabapentinin postoperatif ağrı ve total analjezik tüketimi üzerine etkisi gösterilememiştir. Postoperatif 10. dk. derlenme skoru anlamlı olarak düşüktür.Anahtar kelimeler: Gabapentin, deliryum, pediatri SUMMARY The Effect of Gabapentin Premedication on the Emergence Delirium in Pediatric Patients Undergoing Circumcision Under Sevoflurane AnesthesiaObjective: Gabapentin, an anticonvulsant drug, has been used for its analgesic and anxiolytic properties. The use of gabapentin in the perioperative setting has been studied in recent studies involving adults. In this study, we aimed to investigate the effect of gabapentine on the postoperative analgesic consumption and emergence delirium of pediatric patients undergoing circumcision under sevoflurane anesthesia.Material and Methods: Twenty-five ASA I-II children >3 years of age undergoing circumcision under sevoflurane anesthesia were included in this prospective randomized study. Gabapentin 15 mg kg -1 dissolved in 10 mL saline was given to group G (n=12) children orally 30 min. prior to surgery. Control group (n=13) received 10 mL of saline. Sevoflurane is used as sole anesthetic agent. Penile block was performed to all patients before surgery. Vital signs, preoperative anxiety scores, time to eye openning, Modified Aldrete scores, emergence agitation scores were recorded. All parents were contacted 24 hours after surgery to evaluate pain, total analgesic consumption at 24 hr, family satisfaction, and any side effects.Results: Demographic data, preoperative anxiety scores, vital signs, Modified Aldrete scores, operation time, time to eye opening, postoperative pain scores and total analgesic consumpti...

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Rapid emergence does not explain agitation following sevoflurane anaesthesia in infants and children: a comparison with propofol

Abstract: Although both sevoflurane and propofol allow for rapid emergence from general anaesthesia, only sevoflurane is associated with a high incidence of emergence agitation in infants and young children. Rapid emergence does not fully explain this phenomena.

Cited by 151 publications

References 25 publications

Emergence agitation in adults: risk factors in 2,000 patients

Emergence agitation in adults: risk factors in 2,000 patients

Emergence delirium in children

The Effect of Gabapentin Premedication on the Emergence Delirium in Pediatric Patients Undergoing Circumcision Under Sevoflurane Anesthesia

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