Recovery Characteristics of Sevoflurane and Halothane in Preschool-Aged Children Undergoing Bilateral Myringotomy and Pressure Equalization Tube Insertion

Abstract

We conclude that the incidence of emergence agitation in children undergoing ultrashort anesthetic procedures is similar for sevoflurane and halothane and that ketorolac markedly diminishes emergence agitation and/or pain behavior.

The Effect of Ketamine with Remifentanil for Improving the Quality of Anaesthesia and Recovery in Paediatric Patients Undergoing Middle-Ear Ventilation Tube Insertion

“…severe) emergence agitation was also rare in the present study, only occurring in one patient (3.3%) in each group. Pain and discomfort in preverbal and preschool-aged children may, however, be indistinguishable from behaviour associated with delirium on emergence from anaesthesia, 4 and might have led to the underreporting of psychomimetic side-effects in the present study. Also, in the present study, 43.3% of patients (n = 13) receiving ketamine alone had agitation scores of 2, compared with 10.0% of patients (n = 3) receiving ketamine and remifentanil.…”

“…2 Because MEVTI frequently accompanies upper respiratory tract infection, inhalational anaesthesia increases the risk of laryngospasm; 3 in addition, sevoflurane evokes a high incidence of emergence delirium. 4 Thus, we prefer to use i.v. anaesthesia for MEVTI.…”

Agitação no despertar da anestesia em crianças: aspectos atuais

“…The occurrence of agitation has been observed to be reduced when intravenous ketorolac has been used intraoperatively in otorhinolaryngological surgical procedures of short duration where the peak of the pharmacological agent's analgesic effect was after emergence. 17 Nevertheless, even when postoperative pain is treated effectively or even absent (anesthetic procedures used for magnetic resonance imaging), postoperative agitation may still occur. Two groups of patients who underwent volatile anesthesia with sevoflurane for non-surgical procedures were studied.…”

“…26 One of the hypotheses offered to explain this increased incidence of emergence agitation when sevoflurane is used, is the low solubility of this agent in blood, when compared with halothane, promoting earlier emergence from anesthesia and emergence agitation. 4,17 However, anesthesia with propofol also favors rapid emergence, but with lower agitation incidence rates than those observed with sevoflurane. 27 Furthermore, gradually reducing the concentration of sevoflurane, resulting in more prolonged emergence, did not result in a reduction in the incidence of agitation associated with this agent.…”

Anesthetic management of pediatric adenotonsillectomy

“…Apart from the choice of anesthetic agent (sevoflurane and desflurane being the main offenders), patient and surgical factors may be involved, notably young age, intense preoperative anxiety, and painful procedures. 38,39 Although many areas of uncertainty remain, 38 various strategies have been proposed to lower the incidence of emergence agitation, such as using propofol rather than sevoflurane, 40 administering appropriate analgesia, 41 and providing premedication with clonidine. 11,42 Interestingly, premedication with midazolam does not seem to consistently reduce emergence agitation.…”