1
|
Xu Y, Tung TH, Feng X, Xiang H, Wang Y, Wu H. The effect of magnesium sulfate on emergence agitation in surgical adult patients undergoing general anesthesia: A systematic review and meta-analysis of randomized controlled trials. J Clin Anesth 2024; 96:111499. [PMID: 38749290 DOI: 10.1016/j.jclinane.2024.111499] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/27/2024] [Revised: 03/31/2024] [Accepted: 05/08/2024] [Indexed: 06/16/2024]
Abstract
STUDY OBJECTIVE Investigating the effect of magnesium sulfate (MS) on emergence agitation (EA) in adult surgical patients following general anesthesia (GA). DESIGN Systematic literature review and meta-analysis (PROSPERO number: CRD42023461988). SETTING Review of published literature. PATIENTS Adults undergoing GA. INTERVENTIONS Intravenous administration of MS. MEASUREMENTS We searched PubMed/MEDLINE, EMBASE, the Cochrane Library, Scopus, and Web of Science for publications until September 14, 2023. The primary outcome was the incidence of EA, while the secondary outcomes included the impact of MS on postoperative agitation score (PAS), emergence variables and adverse events. Relative risk (RR) with 95% confidence interval (CI) measured dichotomous outcome, while standardized mean difference (SMD) or mean difference (MD) with 95% CI measured continuous outcomes. MAIN RESULTS Meta-analysis of five randomized controlled trials (RCTs) indicated that MS was associated with a lower incidence of EA at various time points (0 min: RR = 0.62, 95% CI [0.41, 0.95]; p = 0.183, I2 = 43.6%; 5 min: RR = 0.29, 95% CI [0.16, 0.52]; p = 0.211, I2 = 36%; 10 min: RR = 0.14, 95% CI [0.06, 0.32]; p = 0.449, I2 = 0%; 15 min: RR = 0.11, 95% CI [0.02, 0.55]; p = 0.265, I2 = 19.5%; 30 min: RR = 0.05, 95% CI [0.00, 0.91]; the postoperative period: RR = 0.21, 95% CI [0.09, 0.49]; p = 0.724, I2 = 0%;). Additionally, MS was associated with a reduced PAS at various time points except for 0 min. However, no significant differences were observed in extubation time, the length of stay in the post-anesthesia care unit, postoperative nausea and vomiting or total complications. CONCLUSIONS Limited available evidence suggests that MS was associated with a lower incidence of EA. Nevertheless, further high-quality studies are warranted to strengthen and validate the effect of MS in preventing EA in adult surgical patients.
Collapse
Affiliation(s)
- Ying Xu
- Evidence-based Medicine Centre, Taizhou Hospital of Zhejiang Province Affiliated to Wenzhou Medical University, Linhai 317000, Zhejiang Province, China; Institute for Hospital Management, Tsinghua University, Beijing 100084, China
| | - Tao-Hsin Tung
- Evidence-based Medicine Centre, Taizhou Hospital of Zhejiang Province Affiliated to Wenzhou Medical University, Linhai 317000, Zhejiang Province, China
| | - Xiaoru Feng
- Institute for Hospital Management, Tsinghua University, Beijing 100084, China; School of Medicine, Tsinghua University, Beijing 100084, China
| | - Haifei Xiang
- Department of Anesthesiology, Taizhou Hospital of Zhejiang Province affiliated to Wenzhou Medical University, Linhai 317000, Zhejiang Province, China
| | - Yu Wang
- Department of Anesthesiology, Taizhou Hospital of Zhejiang Province affiliated to Wenzhou Medical University, Linhai 317000, Zhejiang Province, China
| | - Hao Wu
- Department of Anesthesiology, Taizhou Hospital of Zhejiang Province affiliated to Wenzhou Medical University, Linhai 317000, Zhejiang Province, China.
| |
Collapse
|
2
|
Chisling S, Jette E, Engelhardt T, Ingelmo P, Poulin-Harnois C, Garbin M, Wasserman S, Bertolizio G. Does heart rate variability using the Newborn Infant Parasympathetic Evaluation index identify postsurgical pain levels and emergence delirium in toddlers? A prospective observational study. Can J Anaesth 2024; 71:1117-1125. [PMID: 38720113 DOI: 10.1007/s12630-024-02764-8] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/15/2023] [Revised: 02/29/2024] [Accepted: 03/02/2024] [Indexed: 07/26/2024] Open
Abstract
PURPOSE Children recovering from anesthesia commonly experience early postoperative negative behaviour, caused by pain and emergence delirium. Differentiating the two is challenging in young children. Perioperative pain influences the heart rate variability-derived Newborn Infant Parasympathetic Evaluation (NIPE) index and may also affect emergence delirium. We sought to investigate whether the perioperative NIPE index can discriminate between mild, moderate, or severe pain levels and can detect emergence delirium. METHODS This prospective observational study enrolled children aged three years or younger undergoing elective adenotonsillectomy, tonsillectomy, or adenoidectomy. The NIPE index, the Faces, Legs, Activity, Cry, Consolability (FLACC) score, and the Pediatric Anesthesia Emergence Delirium (PAED) score were recorded in the postanesthesia care unit (PACU). The primary aim was to investigate the relationship between the postoperative NIPE index and postoperative pain severity. The secondary aims were to evaluate the association between the NIPE index and emergence delirium (PAED ≥ 10) and its delirium-specific (ED-I) and pain-specific (ED-II) components. RESULTS Sixty-nine children were recruited. In the PACU, the mean (standard deviation [SD]) NIPE values in children experiencing moderate and severe pain were 50 (12) and 49 (14), respectively. These values were significantly lower than the mean (SD) value of 64 (13) observed in children with mild pain (mean difference moderate vs no/mild pain, -14; 95% confidence interval [CI], -17 to -11; P < 0.001, and mean difference severe vs no/mild pain, -17; 95% CI, -20 to -14; P < 0.001, respectively). The NIPE index was significantly lower in children experiencing pain-specific ED-II (mean [SD] NIPE instantaneous [NIPEi] for ED-II 49 [10] vs no ED-II 55 [13]; mean difference, -6; 95% CI, -11 to -2; P = 0.009). The NIPE index was unable to detect emergence delirium (mean [SD] NIPEi for ED, 54 [15] vs no ED, 51 [10]; mean difference, 3; 95% CI, -2 to 8; P = 0.23) or the delirium-specific component ED-I (mean [SD] NIPEi for ED-I, 55 [15] vs no ED-I, 51 [11]; mean difference, 4; 95% CI, 0 to 8; P = 0.06). CONCLUSION The NIPE index can identify moderate and severe postoperative pain after adenotonsillectomy but not emergence delirium in children aged three years and younger. This discrimination can be valuable in the early postoperative phase when the differentiation between pain and emergence delirium is difficult. STUDY REGISTRATION ClinicalTrials.gov ( NCT04909060 ); first submitted 26 May 2021.
Collapse
Affiliation(s)
- Sara Chisling
- Department of Anesthesia, Faculty of Medicine and Health Sciences, McGill University, Montreal, QC, Canada
| | - Evan Jette
- Department of Anesthesia, Faculty of Medicine and Health Sciences, McGill University, Montreal, QC, Canada
| | - Thomas Engelhardt
- Department of Anesthesia, Faculty of Medicine and Health Sciences, McGill University, Montreal, QC, Canada
| | - Pablo Ingelmo
- Department of Anesthesia, Faculty of Medicine and Health Sciences, McGill University, Montreal, QC, Canada
| | - Christelle Poulin-Harnois
- Department of Anesthesia, Faculty of Medicine and Health Sciences, McGill University, Montreal, QC, Canada
| | - Marta Garbin
- Department of Clinical Sciences, Université de Montréal, St-Hyacinthe, QC, Canada
| | - Samuel Wasserman
- Research Institute, McGill University Health Center, Montreal, QC, Canada
| | - Gianluca Bertolizio
- Department of Anesthesia, Faculty of Medicine and Health Sciences, McGill University, Montreal, QC, Canada
- Department of Anesthesia, Montreal Children's Hospital, 1001 Decarie Blvd, Montreal, QC, H4A 3J1, Canada
| |
Collapse
|
3
|
Bromfalk Å, Hultin M, Walldén J, Myrberg T, Engström Å. Perioperative Staff's Experiences of Premedication for Children. J Perianesth Nurs 2024:S1089-9472(24)00183-7. [PMID: 39066773 DOI: 10.1016/j.jopan.2024.05.005] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/24/2023] [Revised: 05/07/2024] [Accepted: 05/14/2024] [Indexed: 07/30/2024]
Abstract
PURPOSE Providing perioperative care for children who express anxiety or react with negative anxiety-associated consequences can be a challenge. The use of premedication is established as an important intervention for young children before surgery, yet research into care providers' experiences of premedication is limited. The aim of this study was to explore perioperative staff's experiences of premedication for preschool-age children. DESIGN A descriptive inductive qualitative study was performed based on focus group discussions. METHODS A purposive sample of a team from the operating department with experience in anesthetizing and caring for children in the perioperative period was interviewed in small focus groups: five preoperative and postoperative care nurses, five nurse anesthetists, and five anesthesiologists. The transcribed text was categorized using qualitative content analysis. FINDINGS The content analysis revealed three themes: a matter of time, do not wake the sleeping bear, and on responsive tiptoes. CONCLUSIONS Care providers must adapt their work to the child's emotional state of mind and needs, allowing time for the child to trust and accept the premedication and for the premedication to reach its peak effect. Premedication provides light sleep preoperatively, which requires careful treatment of the child to avoid emotional reactions, and the postoperative path is most peaceful when the premedication supports a long duration of sedation. Our findings highlight the need for safety precautions and a permissive and flexible organization with the goal of achieving a smooth and safe journey for the child in the perioperative path.
Collapse
Affiliation(s)
- Åsa Bromfalk
- Department of Surgical and Perioperative Sciences, Anaesthesiology and Intensive Care Medicine, Umeå University, Umeå, Sweden.
| | - Magnus Hultin
- Department of Surgical and Perioperative Sciences, Anaesthesiology and Intensive Care Medicine, Umeå University, Umeå, Sweden
| | - Jakob Walldén
- Department of Surgical and Perioperative Sciences, Anaesthesiology and Intensive Care Medicine (Sundsvall), Umeå University, Umeå, Sweden
| | - Tomi Myrberg
- Department of Surgical and Perioperative Sciences, Anaesthesiology and Intensive Care Medicine (Sunderbyn), Umeå University, Umeå, Sweden
| | - Åsa Engström
- Department of Health, Education and Technology, Division of Nursing and Medical Technology, Luleå University of Technology, Luleå, Sweden
| |
Collapse
|
4
|
Ng KT, Lim WE, Teoh WY, Zainal Abidin MFB. The effect of nalbuphine on prevention of emergence delirium in children: a systematic review with meta-analysis. BRAZILIAN JOURNAL OF ANESTHESIOLOGY (ELSEVIER) 2024; 74:844543. [PMID: 39048077 DOI: 10.1016/j.bjane.2024.844543] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Received: 12/27/2023] [Revised: 07/09/2024] [Accepted: 07/11/2024] [Indexed: 07/27/2024]
Abstract
BACKGROUND Emergence delirium remains a major postoperative concern for children undergoing surgery. Nalbuphine is a synthetic mixed agonist-antagonist opioid, which is believed to reduce the incidence of emergence delirium in children. The primary objective was to examine the effect of nalbuphine on emergence delirium in children undergoing surgery. METHODS Databases of MEDLINE, EMBASE, and CENTRAL were searched from their starting dates until April 2023. Randomized Clinical Trials (RCT) and observational studies comparing nalbuphine and control in children undergoing surgery were included. RESULTS Eight studies (n = 1466 patients) were eligible for inclusion of data analysis. Compared to the control, our pooled data showed that the nalbuphine group was associated with lower incidence of emergence delirium (RR = 0.38, 95% CI [0.30, 0.47], p < 0.001) and reduced postoperative pain scores (MD = -0.98, 95% CI [-1.92, -0.04], p = 0.04). CONCLUSIONS This review showed the administration of nalbuphine is associated with significant decrease in the incidence of emergence delirium and postoperative pain scores among children undergoing surgery. However, due to limited sample size, high degree of heterogeneity and low level of evidence, future adequately powered trials are warranted to explore the efficacy of nalbuphine on emergence delirium among the pediatric population.
Collapse
Affiliation(s)
- Ka Ting Ng
- University of Malaya, Department of Anesthesiology, Kuala Lumpur, Malaysia.
| | - Wei En Lim
- University of Glasgow, Department of Anesthesiology, Glasgow, United Kingdom
| | - Wan Yi Teoh
- University of Liverpool, Department of Medicine, Liverpool, United Kingdom
| | | |
Collapse
|
5
|
Li Y, Li Q, Zhao G, Zhang H, Zhong H, Zeng Y. Nalbuphine in Pediatric Emergence Agitation Following Cochlear Implantation: A Randomized Trial. Drug Des Devel Ther 2024; 18:2837-2845. [PMID: 39006192 PMCID: PMC11244056 DOI: 10.2147/dddt.s451089] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/21/2023] [Accepted: 04/30/2024] [Indexed: 07/16/2024] Open
Abstract
Background To investigate the effects of nalbuphine on emergency agitation (EA), which affects up to 80% of the children following otolaryngology procedures, in children undergoing cochlear implantation. Methods A prospective double-blinded randomized controlled clinical trial was conducted between November 2020 and October 2022. Eligible children, aged 6 months to 3 years old, were randomly assigned to either 0.1 mg/kg, 0.15 mg/kg, 0.2 mg/kg nalbuphine or 0.9% saline groups. EA was defined by the Pediatric Anesthesia Emergence Delirium (PAED) score ≥10. Extubation time, post-anesthesia care unit (PACU) length of stay, severe EA (PAED ≥ 15), peak PAED score, the Faces, Legs, Activity, Cry, and Consolability (FLACC) scale, Ramsay sedation score, and adverse events were also recorded. Results A total of 104 children were enrolled, with 26 children in each group. Nalbuphine significantly reduced the EA occurrence from 73.1% in the saline group to 38.5%, 30.8%, and 26.9% in the 0.1 mg/kg, 0.15 mg/kg, and 0.2 mg/kg nalbuphine groups, respectively (P < 0.001), without affecting the extubation time and PACU length of stay. More children (34.6%) in the 0.9% saline group experienced severe EA. Higher dose nalbuphine (0.15 mg/kg, 0.2 mg/kg) showed lower peak PAED score, better analgesia and sedation effect compared with 0.1 mg/kg nalbuphine and saline groups. However, 0.2mg/kg nalbuphine caused undesired over-sedation in two (7.7%) children. No other adverse events were reported. Conclusion Young children undergoing cochlear implantation surgery were at a high risk of EA and postoperative pain, while 0.2 mg/kg nalbuphine might be an ideal candidate for EA and pain prevention when used under close monitoring. Trial Registration ChiCTR2000040407.
Collapse
Affiliation(s)
- Yan Li
- Department of Anesthesia and Perioperative Medicine, Xijing Hospital, the Fourth Military Medical University, Xi’an, 710000, People’s Republic of China
| | - Qi Li
- Department of Anesthesia and Perioperative Medicine, Xijing Hospital, the Fourth Military Medical University, Xi’an, 710000, People’s Republic of China
| | - Guangchao Zhao
- Department of Anesthesia and Perioperative Medicine, Xijing Hospital, the Fourth Military Medical University, Xi’an, 710000, People’s Republic of China
| | - Haopeng Zhang
- Department of Anesthesia and Perioperative Medicine, Xijing Hospital, the Fourth Military Medical University, Xi’an, 710000, People’s Republic of China
| | - Haixing Zhong
- Department of Anesthesia and Perioperative Medicine, Xijing Hospital, the Fourth Military Medical University, Xi’an, 710000, People’s Republic of China
| | - Yi Zeng
- Department of Anesthesia and Perioperative Medicine, Xijing Hospital, the Fourth Military Medical University, Xi’an, 710000, People’s Republic of China
| |
Collapse
|
6
|
Shi X, Su L, Sun Y, Ma C, Wang Z. Non-pharmacological interventions for preventing emergence delirium in children under general anesthesia: A scoping review. J Pediatr Nurs 2024; 77:e38-e53. [PMID: 38523049 DOI: 10.1016/j.pedn.2024.03.014] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/14/2023] [Revised: 03/06/2024] [Accepted: 03/06/2024] [Indexed: 03/26/2024]
Abstract
PROBLEM The phenomenon of emergence delirium in pediatric patients undergoing general anesthesia has garnered increasing attention in the academic community. While formal non-pharmaceutical interventions have demonstrated efficacy in mitigating this phenomenon, the diversity of intervention types and their varying degrees of effectiveness necessitate further discussion. A scoping review was conducted to identify and explicate the categorization, content elements, and outcomes measures of non-pharmacological interventions utilized to forestall the onset of emergence delirium in children undergoing general anesthesia. ELIGIBILITY CRITERIA This review was conducted in accordance with the Arksey and O'Malley's methodology framework and PRISMA-ScR. It encompassed experimental and quasi-experimental studies that involved any non-pharmacological interventions during the perioperative period to prevent emergence delirium in children aged 0 to 18 years undergoing general anesthesia for elective surgery. SAMPLE Thirty-two articles met the inclusion criteria, of which 29 were randomized controlled trials. The total sample size of the population was 4633. RESULTS The scoping review revealed 10 non-pharmacological interventions, that included distraction intervention, visual preconditioning, virtual reality, parental participation, maternal voice, light drinking, acupuncture, auditory stimulation, monochromic light and breathing training. Emergence delirium, preoperative anxiety, and postoperative pain were the primary outcomes, and four assessment instruments were employed to measure the extent and incidence of emergence delirium. CONCLUSION Numerous non-pharmacological interventions have been employed to prevent emergence delirium. Nevertheless, the effectiveness of some interventions is not yet evident. IMPLICATIONS The utilization of visual preconditioning and distraction interventions appears to be an emerging area of interest.
Collapse
Affiliation(s)
- Xiaoxia Shi
- Pediatric Intensive Care Unit, Henan Provincial People's Hospital, Zhengzhou, China; Henan Provincial Key Medicine Laboratory of Nursing, Henan Evidence-based Nursing Centre: A JBI Affiliated Group, The University of Adelaide, Zhengzhou, China
| | - Lili Su
- Henan Provincial Key Medicine Laboratory of Nursing, Henan Evidence-based Nursing Centre: A JBI Affiliated Group, The University of Adelaide, Zhengzhou, China; International Medical Centre, Henan Provincial People's Hospital, Zhengzhou, China
| | - Yue Sun
- School of Nursing, Peking University, Beijing, China; Peking University Health Science Centre for Evidence-Based Nursing, Beijing, China
| | - Caixia Ma
- Pediatric Intensive Care Unit, Henan Provincial People's Hospital, Zhengzhou, China; Henan Provincial Key Medicine Laboratory of Nursing, Henan Evidence-based Nursing Centre: A JBI Affiliated Group, The University of Adelaide, Zhengzhou, China
| | - Zhiwen Wang
- School of Nursing, Peking University, Beijing, China; Peking University Health Science Centre for Evidence-Based Nursing, Beijing, China.
| |
Collapse
|
7
|
Huh J, Koo JM, Kim M, Choi H, Park HJ, Rim GM, Hwang W. Effect of Preoperative Clear Liquid Consumption on Postoperative Recovery in Pediatric Patients Undergoing Minimally Invasive Repair of Pectus Excavatum: A Prospective Randomized Controlled Study. J Clin Med 2024; 13:3593. [PMID: 38930122 PMCID: PMC11204463 DOI: 10.3390/jcm13123593] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/20/2024] [Revised: 06/16/2024] [Accepted: 06/17/2024] [Indexed: 06/28/2024] Open
Abstract
Background/Objectives: Preoperative fasting guidelines traditionally aim to reduce pulmonary aspiration risk. However, concerns over the adverse effects of prolonged fasting have led to exploring alternatives. This study aimed to investigate the impact of preoperative clear liquid intake on postoperative outcomes in children undergoing minimally invasive repair of pectus excavatum (MIRPE). Methods: A prospective randomized controlled study was conducted on children aged 3-6 years scheduled for elective MIRPE. Patients were randomized into either a routine overnight fasting group (NPO) or a clear liquid group. The incidence and severity of emergence delirium (ED) were assessed using Pediatric Anesthesia Emergence Delirium (PAED) and Watcha scales at recovery room. Postoperative pain scores and opioid requirements were evaluated at intervals of 1-6 h, 6-12 h, and 12-24 h after surgery. Results: Fasting time was 178.6 ± 149.5 min and 608.9 ± 148.4 min in the clear liquid group compared and NPO group, respectively. The incidence of ED, measured by PAED and Watcha scales, was lower in the clear liquid group (PAED score ≥ 12: 55.6% vs. 85.2%, p = 0.037; Watcha score ≥ 3: 51.9% vs. 85.2%, p = 0.019). The highest PAED score recorded in the recovery room was significantly lower in the clear liquid group (11.4 ± 2.8 vs. 14.6 ± 2.8, p < 0.001). Clear liquid group showed significantly lower pain scores at 1-6, 6-12, and 12-24 h postoperatively. Additionally, clear liquid group had lower opioid requirement at 1-6 and 6-12 h postoperatively. Conclusions: Preoperative clear liquid consumption was associated with a lower incidence of ED in pediatric patients undergoing MIRPE.
Collapse
Affiliation(s)
- Jaewon Huh
- Department of Anesthesiology and Pain Medicine, Seoul St. Mary’s Hospital, College of Medicine, The Catholic University of Korea, Seoul 06591, Republic of Korea; (J.H.); (J.-M.K.); (M.K.); (H.C.)
| | - Jung-Min Koo
- Department of Anesthesiology and Pain Medicine, Seoul St. Mary’s Hospital, College of Medicine, The Catholic University of Korea, Seoul 06591, Republic of Korea; (J.H.); (J.-M.K.); (M.K.); (H.C.)
| | - Minju Kim
- Department of Anesthesiology and Pain Medicine, Seoul St. Mary’s Hospital, College of Medicine, The Catholic University of Korea, Seoul 06591, Republic of Korea; (J.H.); (J.-M.K.); (M.K.); (H.C.)
| | - Hoon Choi
- Department of Anesthesiology and Pain Medicine, Seoul St. Mary’s Hospital, College of Medicine, The Catholic University of Korea, Seoul 06591, Republic of Korea; (J.H.); (J.-M.K.); (M.K.); (H.C.)
| | - Hyung-Joo Park
- Department of Thoracic and Cardiovascular Surgery, Nanoori Hospitals, Seoul 06048, Republic of Korea;
| | - Gong-Min Rim
- Department of Thoracic and Cardiovascular Surgery, St. Vincent’s Hospital, College of Medicine, The Catholic University of Korea, Suwon 16247, Republic of Korea;
| | - Wonjung Hwang
- Department of Anesthesiology and Pain Medicine, Seoul St. Mary’s Hospital, College of Medicine, The Catholic University of Korea, Seoul 06591, Republic of Korea; (J.H.); (J.-M.K.); (M.K.); (H.C.)
| |
Collapse
|
8
|
Henry E, Chen-Lim ML. Does Postanesthesia Forced-Air Warming Affect Emergence Delirium in Pediatric Patients Receiving Daily Anesthesia? J Perianesth Nurs 2024:S1089-9472(24)00041-8. [PMID: 38852105 DOI: 10.1016/j.jopan.2024.01.021] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/15/2023] [Revised: 01/13/2024] [Accepted: 01/24/2024] [Indexed: 06/10/2024]
Abstract
PURPOSE To determine if postanesthesia forced-air warming as a nonpharmacologic intervention for emergence delirium (ED)/emergence agitation (EA) decreased the incidence and severity of ED in children aged 18 months to 6 years old. DESIGN Prospective nonrandomized controlled trial. METHODS Participants included children aged 18 months to 6 years old receiving general anesthesia within a radiation oncology setting. Status of ED/EA was based on the participants' Pediatric Anesthesia Emergence Delirium (PAED) scale score (two consecutive scores greater than 10 out of 20) or inconsolable agitation behaviors post computed tomography simulation (day 0). Interrater reliability was conducted among the center's perianesthesia care nurses. Participants who scored positive for ED/EA received a forced-air warming blanket for the remainder of treatment with data collection 1 to 14 days postanesthesia. Non-ED/EA participants were followed for 14 days and provided forced-air warming if ED/EA occurred. Data consisted of daily PAED scores and self- or parent-report on the anxiety scale. If the participants received forced-air warming, nurses' clinical observations and parent satisfaction surveys were collected 3 times during the 14-day study period. FINDINGS A total of 59 participants completed the study (mean age 3.43 years; 60% male; 63% non-Hispanic White); 16 were identified with ED or EA (mean age 3.56 years; 50% male; 69% non-Hispanic White) with an incidence rate of 28%. For the 16 participants with ED/EA, the primary diagnosis consisted of solid tumors and an American Society of Anesthesia Classification III to IV. Prior to the forced-air warming intervention, all 16 participants exhibited inconsolable ED/EA behaviors, including 8 who had PAED scores greater than 10. ED/EA behaviors expressed included inconsolability, confusion, thrashing, and combativeness. Within the 14-day period, 3 participants received forced-air warming on day 1, while the other 13 received an average of 4.23 days of treatment (range 1 to 11 days; mode 1 day; median 4 days). Comparison of PAED scores pre (mean 4.4) and post (mean 1.8) indicated that the use of forced-air warming was statistically significant (P = .001). ED/EA behaviors and PAED scores after the forced-air warming period decreased in all but one participant. Some agitation behaviors were not captured within the PAED score. CONCLUSIONS Forced-air warming impacted PAED scores and agitation behaviors for studied participants, offering a safe, nonpharmacological nursing intervention that may be an effective tool for helping to manage this baffling condition.
Collapse
Affiliation(s)
- Elizabeth Henry
- Children's Hospital of Philadelphia, Philadelphia, PA; Hospital of the University of Pennsylvania, Perelman Center for Advanced Medicine, Philadelphia, PA.
| | - Mei Lin Chen-Lim
- Children's Hospital of Philadelphia, Philadelphia, PA; Thomas Jefferson University, College of Nursing, Philadelphia, PA; Center for Pediatric Nursing Research & Evidence-Based Practice, Children's Hospital of Philadelphia, Philadelphia, PA
| |
Collapse
|
9
|
Baek J, Kim YM. The Impact of Parental Presence on Emergence Delirium in Pediatric Patients After General Anesthesia: A Systematic Review and Meta-analysis. J Perianesth Nurs 2024; 39:475-483. [PMID: 38219079 DOI: 10.1016/j.jopan.2023.10.002] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/02/2023] [Revised: 09/20/2023] [Accepted: 10/01/2023] [Indexed: 01/15/2024]
Abstract
PURPOSE This study reviewed existing literature on parental presence in cases of pediatric patients after general anesthesia and explored its effect on emergence delirium (ED) in the postanesthesia care unit (PACU). DESIGN Systematic review and meta-analysis. METHODS After protocol registration, we searched the PubMed, EMBASE, CINHAL, Web of Science, SCOPUS, and CENTRAL databases. Two authors independently searched and selected the relevant studies, assessed their risk of bias, and abstracted the data. The primary outcome was ED, and the additional outcome was pain. We provided the narrative synthesis and meta-analysis results. FINDINGS Of the 296 articles retrieved, 6 were included in the narrative synthesis, and 5 were used for the meta-analysis. Four studies were randomized controlled trials, and two studies were nonrandomized controlled trials. There were 348 pediatric patients in the parental presence group and 314 pediatric patients in the usual care group. Parental presence effectively reduced the ED score (mean difference, -0.58; 95% confidence interval [CI], -0.84 to -0.31; P < .001). The ED incidence rate (log odds ratio, -0.58; 95% CI, -1.24 to 0.09; P = .090) and pain score (standardized mean difference, -0.24; 95% CI, -0.57 to 0.10; P = .163) were lower in the parental presence group than in the usual care group. However, the differences were not statistically significant. CONCLUSIONS The presence of parents in the PACU can reduce ED in pediatric patients. Therefore, parental presence may be a useful intervention in the PACU.
Collapse
Affiliation(s)
- Jihyun Baek
- College of Nursing, Jeonbuk National University, Jeonju-si, Jeollabuk-do, Republic of Korea; Research Institute of Nursing Science, Jeonbuk National University, Jeonju-si, Jeollabuk-do, Republic of Korea; Biomedical Research Institute, Jeonbuk National University Hospital, Jeonju-si, Jeollabuk-do, Republic of Korea
| | - Young Man Kim
- College of Nursing, Jeonbuk National University, Jeonju-si, Jeollabuk-do, Republic of Korea; Research Institute of Nursing Science, Jeonbuk National University, Jeonju-si, Jeollabuk-do, Republic of Korea; Biomedical Research Institute, Jeonbuk National University Hospital, Jeonju-si, Jeollabuk-do, Republic of Korea.
| |
Collapse
|
10
|
Filipas MC, Owen L, Adami C. A retrospective observational cohort study on the postoperative respiratory complications and their risk factors in brachycephalic dogs undergoing BOAS surgery: 199 cases (2019-2021). J Small Anim Pract 2024; 65:329-337. [PMID: 38413137 DOI: 10.1111/jsap.13707] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/18/2023] [Revised: 01/11/2024] [Accepted: 01/17/2024] [Indexed: 02/29/2024]
Abstract
OBJECTIVES To observe the occurrence of postanaesthetic respiratory complications and to determine their prevalence and risk factors in dogs undergoing brachycephalic obstructive airway syndrome surgery. MATERIALS AND METHODS Data from 199 clinical records were retrospectively analysed. Univariable logistic regression followed by multivariable logistic regression was used to identify associations between the dependent variables (set as the postoperative respiratory complications observed in the study dogs) and various independent covariates. The quality of model-fit was assessed using the likelihood ratio test. P≤0.05 was considered statistically significant. RESULTS Four postoperative respiratory complications were observed: hypoxaemia (n=10/199; 5%), dyspnoea requiring tracheal re-intubation (n=13/199, 7%), dyspnoea requiring tracheostomy (n=10/199, 5%) and aspiration pneumonia (n=12/199, 6%). Univariable logistic regression showed an association between postoperative aspiration pneumonia and increasing body condition score and American Society of Anaesthesiology classification; however, when these covariates were evaluated in the multivariable model significance was not maintained. Risk factors for tracheostomy were preoperative and postoperative aspiration pneumonia (odds ratio: 9.52, 95% confidence interval: 1.56 to 57.93) and increasing brachycephalic obstructive airway syndrome grade (odds ratio: 4.65, 95% confidence interval: 0.79 to 27.50). CLINICAL SIGNIFICANCE High brachycephalic obstructive airway syndrome grade and aspiration pneumonia, either developing peri-operatively or as pre-existing condition, may represent risk factors for postoperative tracheostomy. Preoperative diagnosis of aspiration pneumonia may further increase the risk of postoperative complications.
Collapse
Affiliation(s)
- M C Filipas
- Department of Veterinary Medicine, University of Cambridge, Madingley Road, Cambridge, CB3 OES, UK
| | - L Owen
- Department of Veterinary Medicine, University of Cambridge, Madingley Road, Cambridge, CB3 OES, UK
| | - C Adami
- Department of Veterinary Medicine, University of Cambridge, Madingley Road, Cambridge, CB3 OES, UK
| |
Collapse
|
11
|
Wei B, Yu C, Xiao J, Xu H, Zheng P, Wang W. The Median Effective Dose of Dexmedetomidine for the Inhibition of Emergence Delirium in Preschool Children Undergoing Tonsillectomy and/or Adenoidectomy: A Retrospective Dose-response Trial. Dose Response 2024; 22:15593258241248919. [PMID: 38645383 PMCID: PMC11032057 DOI: 10.1177/15593258241248919] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/21/2023] [Accepted: 04/06/2024] [Indexed: 04/23/2024] Open
Abstract
The incidence of emergence delirium (ED) is higher in preschool children undergoing tonsillectomy and/or adenoidectomy. The purpose of this study was to determine the median effective dose (ED50) of dexmedetomidine (DEX) for the inhibition of ED in preschool children by using probit regression analysis. A total of 140 anesthesia records were retrieved and divided into seven groups based on the infusion rate of DEX: .2, .25, .3, .35, .4, .45, and .5 μg·kg-1·h-1. The Pediatric Anesthesia Emergence Delirium Scale (PAEDS) was used to assess ED in preschool children, and ED was defined as a PAEDS score ≥ 10. Probit regression analysis revealed that the ED50 and ED95 of DEX were .31 μg·kg-1·h-1 (95% CI: .29-.35) and .48 μg·kg-1·h-1 (95% CI: .44-.56), respectively. Probit(p) = -2.84 + 9.28 × ln (Dose), (χ2 = 1.925, P = .859). The PAEDS score was significantly increased in the ED group, and the rate of bradycardia was significantly decreased in the ED group compared with the without ED group (27.3% vs 54.1%, P = .02). DEX can effectively inhibit the ED in preschool children undergoing tonsillectomy and/or adenoidectomy, however, bradycardia was the main complication.
Collapse
Affiliation(s)
| | | | - JinBo Xiao
- Department of Anesthesiology, The Medical Center of AnQing of Anhui Medical University, AnQing, China
| | - Huang Xu
- Department of Anesthesiology, The Medical Center of AnQing of Anhui Medical University, AnQing, China
| | - Ping Zheng
- Department of Anesthesiology, The Medical Center of AnQing of Anhui Medical University, AnQing, China
| | - WeiBing Wang
- Department of Anesthesiology, The Medical Center of AnQing of Anhui Medical University, AnQing, China
| |
Collapse
|
12
|
Chakithandy S, Nazzal H, Matoug-Elwerfelli M, Narasimhan S, Uddin S, Prabhu KS, Zarif L, Mumtaz N, Sharma A, Al-Khelaifi M. Plasma neurological biomarkers as a measure of neurotoxicity in pediatric dental general anesthesia: a prospective observational feasibility study. Eur Arch Paediatr Dent 2024; 25:267-275. [PMID: 38649631 PMCID: PMC11058848 DOI: 10.1007/s40368-024-00884-9] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/16/2023] [Accepted: 03/04/2024] [Indexed: 04/25/2024]
Abstract
PURPOSE Neurotoxicity concerns have been raised over general anesthesia and sedation medication use in children. Such concerns are largely based on animal studies, historical anesthetic agents, and assessment tools, thus warranting further investigations. Blood biomarkers in detecting neuronal inflammation and apoptosis are novel methods for detecting neuronal damage. Therefore, the aim of this feasibility study was to assess the usefulness of the levels of four plasma biomarkers in dental general anesthesia (DGA) as surrogate markers of neurotoxicity in children. The secondary aim was to compare changes in motor manipulative skills pre- and post-anesthetic exposure. METHODS This single-center prospective observational study included 22 healthy children aged between 3 and 6 years old who underwent DGA. Subclinical neurotoxicity was measured with a panel of four plasma biomarkers: Caspase-3, neuron-specific enolase (NSE), neurofilament light chain, and S100B at three time points (1; at start, 2; end and 3; on recovery from DGA). The Skillings-Mack test was used to identify the difference in the biomarker levels at three time points. Motor manipulative score assessment, prior and two weeks after DGA was also performed. RESULTS A total of 22 study participants (mean age = 5 ± 1 years) were included with a median DGA duration of 106 ± 28 min. A reduction in Caspase-3 levels was recorded, with pairwise comparison over three time points, reporting a statistical significance between time point 2 vs. 1 and time point 3 vs. 1. Although fluctuations in NSE levels were recorded, no significant changes were found following pairwise comparison analysis. Among other biomarkers, no significant changes over the three periods were recorded. Furthermore, no significant changes in manipulative motor scores were reported. CONCLUSION Caspase-3 reduced significantly in the short time frames during day-care DGA; this might be due to the relatively short anesthesia duration associated with dental treatment as compared with more extensive medical-related treatments. Therefore, further studies on Caspase-3 as a potential biomarker in pediatric DGA neurotoxicity are required to further ascertain results of this study.
Collapse
Affiliation(s)
- S Chakithandy
- Pediatric Anaesthesiology Department, Sidra Medicine, Doha, Qatar
| | - H Nazzal
- Hamad Dental Centre, Hamad Medical Corporation (HMC), Doha, Qatar.
- College of Dental Medicine, QU Health, Qatar University, Doha, Qatar.
| | | | - S Narasimhan
- Hamad Dental Centre, Hamad Medical Corporation (HMC), Doha, Qatar
| | - S Uddin
- Translational Research Institute, Hamad Medical Corporation, Doha, Qatar
| | - K S Prabhu
- Translational Research Institute, Hamad Medical Corporation, Doha, Qatar
| | - L Zarif
- Translational Research Institute, Hamad Medical Corporation, Doha, Qatar
| | - N Mumtaz
- Pediatric Anaesthesiology Department, Hamad Medical Corporation, Doha, Qatar
| | - A Sharma
- Anaesthesiology Department, Weill Cornell Medicine, NewYork-Presbyterian Hospital, New York, USA
| | - M Al-Khelaifi
- Pediatric Anaesthesiology Department, Hamad Medical Corporation, Doha, Qatar
| |
Collapse
|
13
|
Earwaker M, Anderson N, Egli V. Developing nursing interventions in Paediatric Emergence Delirium: a scoping review. Contemp Nurse 2024; 60:82-95. [PMID: 38427706 DOI: 10.1080/10376178.2024.2319852] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/18/2022] [Accepted: 02/12/2024] [Indexed: 03/03/2024]
Abstract
BACKGROUND Children who experience Emergence Delirium following an anaesthetic are at an increased risk of injury, harm to the surgical site, delayed discharge from the recovery room/ post anaesthetic care unit, an increased length of stay in hospital, the requirement of additional nursing staff to care for them and may display additional emotional and behavioural upsets in the weeks following surgery. Many factors have been postulated to be associated with the development of Emergence Delirium in children. However, to date the strength and nature of these associations has not been thoroughly investigated nor discussed considering the specific implications for contemporary nursing practice. AIM The aim of this scoping review is to provide an overview of Emergence Delirium in children, and a critical synthesis of evidence informing development of nursing interventions to prevent or minimise paediatric Emergence Delirium. METHODS This scoping review was conducted guided by the PRISMA checklist. 14 peer-reviewed studies and guidelines published between 2000 and 2020 on Emergence Delirium in children and nursing practice were included in the deductive thematic analysis stage. RESULTS The results found the anxiety of the child, the post-operative phase, continuity of care and medication administration were key themes in the nursing management of Emergence Delirium. CONCLUSION There is opportunity for further research to be conducted on child Emergence Delirium in different hospital systems with further exploration of nurse-led interventions.
Collapse
Affiliation(s)
- M Earwaker
- The School of Nursing, Faculty of Medical and Health Sciences the University of Auckland, Aotearoa New Zealand
| | - N Anderson
- The School of Nursing, Faculty of Medical and Health Sciences the University of Auckland, Aotearoa New Zealand
| | - V Egli
- The School of Nursing, Faculty of Medical and Health Sciences the University of Auckland, Aotearoa New Zealand
| |
Collapse
|
14
|
Garioud ALDB, Andersen LPK, Jensen AKG, Do HQ, Jakobsen JC, Holst LB, Rasmussen LS, Afshari A. Intravenous MELAtonin for prevention of Postoperative Agitation and Emergence Delirium in children (MELA-PAED): A protocol and statistical analysis plan for a randomized clinical trial. Acta Anaesthesiol Scand 2024; 68:280-286. [PMID: 37904610 DOI: 10.1111/aas.14342] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/25/2023] [Accepted: 10/03/2023] [Indexed: 11/01/2023]
Abstract
BACKGROUND Emergence agitation and delirium in children remain a common clinical challenge in the post-anesthetic care unit. Preoperative oral melatonin has been suggested as an effective preventive drug with a favorable safety profile. The oral bioavailability of melatonin, however, is low. Therefore, the MELA-PAED trial aims to investigate the efficacy and safety of intraoperative intravenous melatonin for the prevention of emergence agitation in pediatric surgical patients. METHODS MELA-PAED is a randomized, double-blind, parallel two-arm, multi-center, superiority trial comparing intravenous melatonin with placebo. Four hundred participants aged 1-6 years will be randomized 1:1 to either the intervention or placebo. The intervention consists of intravenous melatonin 0.15 mg/kg administered approximately 30 min before the end of surgery. Participants will be monitored in the post-anesthetic care unit (PACU), and the Post Hospitalization Behavior Questionnaire for Ambulatory Surgery (PHBQ-AS) will be performed on days 1, 7, and 14 after the intervention. Serious Adverse Events (SAE) will be assessed up to 30 days after the intervention. RESULTS The primary outcome is the incidence of emergence agitation, assessed dichotomously as any Watcha score >2 during the participant's stay in the post-anesthetic care unit. Secondary outcomes are opioid consumption in the post-anesthetic care unit and adverse events. Exploratory outcomes include SAEs, postoperative pain, postoperative nausea and vomiting, and time to awakening, to first oral intake, and to discharge readiness. CONCLUSION The MELA-PAED trial investigates the efficacy of intravenous intraoperative melatonin for the prevention of emergence agitation in pediatric surgical patients. Results may provide further knowledge concerning the use of melatonin in pediatric perioperative care.
Collapse
Affiliation(s)
- Anne Louise de Barros Garioud
- Department of Anesthesiology, Juliane Marie Center, Copenhagen University Hospital-Rigshospitalet, Copenhagen, Denmark
- Department of Clinical Medicine, University of Copenhagen, Copenhagen, Denmark
| | - Lars Peter Kloster Andersen
- Department of Clinical Medicine, University of Copenhagen, Copenhagen, Denmark
- Department of Anesthesiology, Zealand University Hospital, Køge, Denmark
| | - Aksel Karl Georg Jensen
- Section of Biostatistics, Department of Public Health, University of Copenhagen, Copenhagen, Denmark
| | - Hien Quoc Do
- Department of Anesthesiology, Juliane Marie Center, Copenhagen University Hospital-Rigshospitalet, Copenhagen, Denmark
| | - Janus Christian Jakobsen
- Copenhagen Trial Unit, Centre for Clinical Intervention Research, Copenhagen, Denmark
- Department of Regional Health Research, The Faculty of Health Sciences, University of Southern Denmark, Odense, Denmark
| | - Lars Broksø Holst
- Department of Anesthesiology, Juliane Marie Center, Copenhagen University Hospital-Rigshospitalet, Copenhagen, Denmark
| | | | - Arash Afshari
- Department of Anesthesiology, Juliane Marie Center, Copenhagen University Hospital-Rigshospitalet, Copenhagen, Denmark
- Department of Clinical Medicine, University of Copenhagen, Copenhagen, Denmark
| |
Collapse
|
15
|
He H, Cui Q, Chen H, Huang X, Wang S, Yu T, Feng J, Shao Y. The Effect of Intranasal Dexmedetomidine on Emergence Delirium Prevention in Pediatric Ambulatory Dental Rehabilitation Under General Anesthesia: A Randomized Clinical Trial. Drug Des Devel Ther 2023; 17:3563-3570. [PMID: 38054181 PMCID: PMC10695126 DOI: 10.2147/dddt.s427291] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/26/2023] [Accepted: 10/29/2023] [Indexed: 12/07/2023] Open
Abstract
Purpose Sevoflurane is the preferred anesthetic agent for induction and maintenance of ambulatory surgery due to its property of fast onset and recovery. However, it has been recognized as one of the major contributors of emergence delirium. The aim of this study was to evaluate the preventive effect of intranasal dexmedetomidine on the occurrence of emergence delirium in pediatric patients under general anesthesia with sevoflurane. Patients and Methods Ninety pediatric patients undergoing dental rehabilitation under sevoflurane anesthesia were enrolled in this study. The patients were divided into three groups (n=30 each in the 2 μg/kg dexmedetomidine, 1 μg/kg dexmedetomidine, and control with saline groups). The same volume (0.02mL/kg) of the mixed solution was dropped into the nasal cavity of the children 30 minutes before surgery. We used the Pediatric Anesthesia Emergence Delirium Scale (PAED) to assess the level and incidence of delirium in the post-anesthesia care unit. Results Compared with the control group, prophylactic use of different dosages of intranasal dexmedetomidine significantly reduces the incidence of ED and severe ED in PACU (P<0.001). Intranasal administration of 2 μg/kg dexmedetomidine was associated with a better acceptance of mask induction and a better tolerance of separation with parents. Conclusion Both 2 μg/kg and 1 μg/kg intranasal dexmedetomidine can achieve ED preventive effects in PACU in dental rehabilitation under general anesthesia. A dosage of 2 μg/kg is more effective in preventing severe ED and providing better mask acceptance.
Collapse
Affiliation(s)
- Huan He
- Department of Anesthesiology, Shanghai Stomatological Hospital & School of Stomatology, Fudan University, Shanghai, 200002, People’s Republic of China
| | - Qichun Cui
- Department of Anesthesiology, Shanghai Stomatological Hospital & School of Stomatology, Fudan University, Shanghai, 200002, People’s Republic of China
| | - Hengheng Chen
- Department of Preventive Dentistry, Shanghai Stomatological Hospital & School of Stomatology, Fudan University, Shanghai, 200002, People's Republic of China
| | - Xiao Huang
- Department of Pediatric Dentistry, Shanghai Stomatological Hospital & School of Stomatology, Fudan University, Shanghai, 200002, People’s Republic of China
| | - Shuai Wang
- Department of Pediatric Dentistry, Shanghai Stomatological Hospital & School of Stomatology, Fudan University, Shanghai, 200002, People’s Republic of China
| | - Tian Yu
- Department of Preventive Dentistry, Shanghai Stomatological Hospital & School of Stomatology, Fudan University, Shanghai, 200002, People's Republic of China
| | - Jinqiu Feng
- Department of Pediatric Dentistry, Shanghai Stomatological Hospital & School of Stomatology, Fudan University, Shanghai, 200002, People’s Republic of China
| | - Yun Shao
- Department of Anesthesiology, Shanghai Stomatological Hospital & School of Stomatology, Fudan University, Shanghai, 200002, People’s Republic of China
| |
Collapse
|
16
|
Yu H, Sun X, Li P, Deng X. Prevalence and risk factors of emergence agitation among pediatric patients undergo ophthalmic and ENT Surgery: a cross-sectional study. BMC Pediatr 2023; 23:598. [PMID: 37996779 PMCID: PMC10668514 DOI: 10.1186/s12887-023-04434-y] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/10/2022] [Accepted: 11/19/2023] [Indexed: 11/25/2023] Open
Abstract
BACKGROUND Some studies reported that pediatric patients undergoing otorhinolaryngology (ENT) and ophthalmic surgeries have higher incidences of emergence agitation (EA). Children with EA tend to carry the risk of self-harm, have longer periods of recovery and delayed hospital discharge. Consequently, EA needs to be monitored and risk factors ought to be emphasized to implement preventative measures. The objective of this study was to describe EA and to identify risk factors after pediatric ophthalmic or ENT surgery. METHODS Between September 2021 and December 2021, a cross-sectional study was conducted in 100 children aged of 0-12 years who underwent ophthalmic or ENT surgery. The Watcha scale was used to observe and record EA, which was defined at levels of 3 or 4 at any time in the post-anesthesia care unit (PACU). The pain intensity was graded with the Face, Legs, Activity, Cry, Consolability (FLACC) Scale after surgery. Patient and surgery-related characteristics, the behavioral criteria of EA, the pharmacologic and non-pharmacologic interventions and recovery outcomes were objectively recorded. A binary logistic regression model was constructed to identify the associated factors of EA. RESULTS From the 100 analyzed children, 58 were males and 42 were females, and 44 patients received ophthalmic surgery and 56 ENT surgery. The median age was 6 (IQR 4-7) years. The overall incidence of EA among pediatrics was 30% (34.5% for ENT and 24.4% for ophthalmic surgery). High preoperative modified Yale Preoperative Anxiety scale (m-YPAS) grade (OR = 1.19, 95%CI 1.06-1.33, P = 0.003) and high postoperative FLACC score (OR = 3.36, 95%CI 1.88-6.02, P < 0.001) were risk factors for EA. CONCLUSIONS This study identified that preoperative anxiety and postoperative pain are associated with EA in children after ophthalmic or ENT surgery. Preoperative anxiety assessment and management, and administration of adjunct analgesic treatments should be considered in the routine care.
Collapse
Affiliation(s)
- Hong Yu
- Department of Anesthesiology, West China Hospital, Sichuan University, No.37 Guoxue Alley, Chengdu, 610041, China
| | - Xiaohui Sun
- Department of Anesthesiology, West China School of Nursing, West China Hospital, Sichuan University, Chengdu, 610041, China
| | - Ping Li
- Department of Anesthesiology, Wu'an First People's Hospital, Handan, 056300, China
| | - Xiaoqian Deng
- Department of Anesthesiology, West China Hospital, Sichuan University, No.37 Guoxue Alley, Chengdu, 610041, China.
| |
Collapse
|
17
|
López Segura M, Busto-Aguirreurreta N. Postoperative agitation or delirium in paediatric patients. What we know and how to avoid it. REVISTA ESPANOLA DE ANESTESIOLOGIA Y REANIMACION 2023; 70:467-472. [PMID: 37678453 DOI: 10.1016/j.redare.2023.09.006] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Received: 06/13/2022] [Accepted: 09/10/2022] [Indexed: 09/09/2023]
Abstract
Emergence delirium or postoperative agitation is the name given to the state of altered consciousness that occurs after surgery and especially affects pediatric patients. Its incidence is not negligible, reaching 80% of cases in certain studies. It is frequently confused with other clinical entities, for which reason a scale has been validated to facilitate its diagnosis. Risk factors include age under 5 years, the presence of pain after surgery and especially intense preoperative anxiety. Pediatric emergence delirium presents as an adverse event after surgery and influences patient safety by significantly increasing patient comorbidity. It is essential to recognize the entity, as well as its risk factors, in order to apply effective preventive measures to reduce its incidence and intensity when it occurs.
Collapse
Affiliation(s)
- M López Segura
- Servicio de Anestesiología, Reanimación y Terapéutica del Dolor, Hospital Universitari i Politècnic La Fe, Valencia, Spain.
| | - N Busto-Aguirreurreta
- Servicio de Anestesiología, Reanimación y Terapéutica del Dolor, Complejo Hospitalario de Navarra, Pamplona, Spain
| |
Collapse
|
18
|
Kim DH, Park JB, Kim SW, Stybayeva G, Hwang SH. Effect of Infraorbital and/or Infratrochlear Nerve Blocks on Postoperative Care in Patients with Septorhinoplasty: A Meta-Analysis. MEDICINA (KAUNAS, LITHUANIA) 2023; 59:1659. [PMID: 37763778 PMCID: PMC10535682 DOI: 10.3390/medicina59091659] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 08/24/2023] [Revised: 09/07/2023] [Accepted: 09/13/2023] [Indexed: 09/29/2023]
Abstract
Background and Objectives: Through a comprehensive meta-analysis of the pertinent literature, this study evaluated the utility and efficacy of perioperative infraorbital and/or infratrochlear nerve blocks in reducing postoperative pain and related morbidities in patients undergoing septorhinoplasty. Materials and Methods: We reviewed studies retrieved from the PubMed, SCOPUS, Embase, Web of Science, and Cochrane databases up to August 2023. The analysis included a selection of seven articles that compared a treatment group receiving perioperative infraorbital and/or infratrochlear nerve blocks with a control group that either received a placebo or no treatment. The evaluated outcomes covered parameters such as postoperative pain, the amount and frequency of analgesic medication administration, the incidence of postoperative nausea and vomiting, as well as the manifestation of emergence agitation. Results: The treatment group displayed a significant reduction in postoperative pain (mean difference = -1.7236 [-2.6825; -0.7646], I2 = 98.8%), as well as a significant decrease in both the amount (standardized mean difference = -2.4629 [-3.8042; -1.1216], I2 = 93.0%) and frequency (odds ratio = 0.3584 [0.1383; 0.9287], I2 = 59.7%) of analgesic medication use compared to the control. The incidence of emergence agitation (odds ratio = 0.2040 [0.0907; 0.4590], I2 = 0.0%) was notably lower in the treatment group. The incidence of postoperative nausea and vomiting (odds ratio = 0.5393 [0.1309; 2.2218], I2 = 60.4%) showed a trend towards reduction, although it was not statistically significant. While no adverse effects reaching statistical significance were reported in the analyzed studies, hematoma (proportional rate = 0.2133 [0.0905; 0.4250], I2 = 76.9%) and edema (proportional rate = 0.1935 [0.1048; 0.3296], I2 = 57.2%) after blocks appeared at rates of approximately 20%. Conclusions: Infraorbital and/or infratrochlear nerve blocks for septorhinoplasty effectively reduce postoperative pain and emergence agitation without notable adverse outcomes.
Collapse
Affiliation(s)
- Do Hyun Kim
- Department of Otolaryngology-Head and Neck Surgery, Seoul St. Mary’s Hospital, College of Medicine, The Catholic University of Korea, Seoul 06591, Republic of Korea; (D.H.K.); (S.W.K.)
| | - Jun-Beom Park
- Department of Periodontics, College of Medicine, The Catholic University of Korea, Seoul 06591, Republic of Korea;
| | - Sung Won Kim
- Department of Otolaryngology-Head and Neck Surgery, Seoul St. Mary’s Hospital, College of Medicine, The Catholic University of Korea, Seoul 06591, Republic of Korea; (D.H.K.); (S.W.K.)
| | - Gulnaz Stybayeva
- Department of Physiology and Biomedical Engineering, Mayo Clinic, Rochester, MN 55905, USA;
| | - Se Hwan Hwang
- Department of Otolaryngology-Head and Neck Surgery, Bucheon St. Mary’s Hospital, College of Medicine, The Catholic University of Korea, Seoul 06591, Republic of Korea
| |
Collapse
|
19
|
Xu H, Shen Z, Gu Y, Hu Y, Jiang J, Li X, Zhao Y, Zhu M, Li J. Nasal splinting and mouth breathing training reduce emergence delirium after endoscopic sinus surgery: a randomized controlled trial. BMC Anesthesiol 2023; 23:302. [PMID: 37679665 PMCID: PMC10483790 DOI: 10.1186/s12871-023-02262-2] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/17/2023] [Accepted: 08/28/2023] [Indexed: 09/09/2023] Open
Abstract
BACKGROUND Emergence delirium (ED) is generally occurred after anesthesia associated with increased risks of long-term adverse outcomes. Therefore, this study aimed to evaluate the efficacy of preconditioning with nasal splint and mouth-breathing training on prevention of ED after general anesthesia. METHODS This randomized controlled trial enrolled 200 adult patients undergoing ESS. Patients were randomized to receive either nasal splinting and mouth breathing training (n = 100) or standard care (n = 100) before surgery. The primary outcome was the occurrence of ED within 30 min of extubation, assessed using the Riker Sedation-Agitation Scale. Logistic regression identified risk factors for ED. RESULTS Totally 200 patients were randomized and 182 aged from 18 to 82 years with 59.9% of males were included in the final analysis (90 in C-group and 92 in P-group). ED occurred in 16.3% of the intervention group vs. 35.6% of controls (P = 0.004). Male sex, smoking and function endoscopic sinus surgery (FESS) were independent risk factors for ED. CONCLUSIONS Preoperative nasal splinting and mouth breathing training significantly reduced the incidence of emergence delirium in patients undergoing endoscopic sinus surgery. TRIAL REGISTRATION ChiCTR1900024925 ( https://www.chictr.org.cn/index.aspx ) registered on 3/8/2019.
Collapse
Affiliation(s)
- Hongjiao Xu
- Department of Anesthesiology, Shanghai General Hospital of Nanjing Medical University, 100 Haining Road, Hongkou District, Shanghai, 200080, China
| | - Zhenyuan Shen
- Department of Medical Affairs, Gumei Community Health Service Center, Shanghai Medical College Fudan University, Shanghai, China
| | - Yuyu Gu
- Department of Anesthesiology, Shanghai Jiaotong University First People's Hospital (Shanghai General Hospital), Shanghai, China
| | - Yaodan Hu
- Department of Anesthesiology, Shanghai Jiaotong University First People's Hospital (Shanghai General Hospital), Shanghai, China
| | - Jihong Jiang
- Department of Anesthesiology, Shanghai Jiaotong University First People's Hospital (Shanghai General Hospital), Shanghai, China
| | - Xiang Li
- Department of Anesthesiology, Shanghai Jiaotong University First People's Hospital (Shanghai General Hospital), Shanghai, China
| | - Yanfang Zhao
- Department of Health Statistics, Second Military Medical University, Shanghai, China
| | - Minmin Zhu
- Department of Anesthesiology, Shanghai Jiaotong University First People's Hospital (Shanghai General Hospital), Shanghai, China.
| | - Jinbao Li
- Department of Anesthesiology, Shanghai General Hospital of Nanjing Medical University, 100 Haining Road, Hongkou District, Shanghai, 200080, China.
| |
Collapse
|
20
|
Liu T, Luo F. The Topics and Publication Trends in Emergence Deliri-Um: A Bibliometric Analysis from 2002 to 2022. J Pain Res 2023; 16:2729-2745. [PMID: 37577158 PMCID: PMC10417658 DOI: 10.2147/jpr.s419677] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/02/2023] [Accepted: 07/22/2023] [Indexed: 08/15/2023] Open
Abstract
Background Emergence delirium is an early postoperative behavior change in pediatric patients, posing risks to patient safety and leading to prolonged hospital stays and increased medical costs. As a result, the research on emergence delirium has grown substantially. This study aims to identify the most influential literature, trends, and topics in emergence delirium research, as well as to quantify the fundamental data of academic publications on this topic. Methods We searched for articles on emergence delirium in the Science Citation Index Expanded databases, covering the period from 2002 to 2022. Bibliographic information, including countries, institutions, journals, authorships, references, and keywords, was collected for further analysis. Results A total of 739 articles on emergence delirium published between 2002 and 2022 were collected. China emerged as the most prolific publisher in this field, accounting for over 30% of all articles (226 publications), followed by the United States (n = 143) and South Korea (n = 92). The top three productive journals were Pediatric anesthesia (n=78, IF=2.129), Anesthesia and Analgesia (n=28, IF=6.627), and BMC Anesthesiology (n=28, IF=2.583). Yonsei University was the most active institution, with 22 publications related to emergence delirium. Among authors, Kin, Hee-Soo (n = 9) published the most articles in this field, followed by Yao, Yusheng (n = 7), Lee, Ji-Hyun (n = 7). The prominent topics in emergence delirium research during the past two decades were "children", "emergence delirium" and "propofol". Conclusion Through bibliometric analysis, this study provides a comprehensive overview of the trends and developments in the field of emergence delirium over the past two decades. The results demonstrate a significant growth in emergence delirium research worldwide, with China leading in the number of publications. Despite the wealth of literature on strategies for preventing and managing emergence delirium in clinical settings, further basic research is needed to elucidate the underlying mechanisms of emergence delirium.
Collapse
Affiliation(s)
- Ting Liu
- Department of Anesthesiology, Tongji Hospital, Tongji Medical College, Huazhong University of Science and Technology, Wuhan, People’s Republic of China
| | - Fang Luo
- Department of Anesthesiology, Tongji Hospital, Tongji Medical College, Huazhong University of Science and Technology, Wuhan, People’s Republic of China
| |
Collapse
|
21
|
Zhou D, Yang XD, Wu HY, Xiong GL, Wang LK. Determination of the ED90 of Dexmedetomidine Infusion to Prevent Emergence Agitation in Children Undergoing Dental Rehabilitation With Sevoflurane Anesthesia: A Biased-Coin Up-and-Down Sequential Allocation Trial. Anesth Analg 2023:00000539-990000000-00613. [PMID: 37478025 DOI: 10.1213/ane.0000000000006626] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 07/23/2023]
Abstract
BACKGROUND Emergence agitation (EA) is an adverse complication during early recovery from sevoflurane anesthesia. Continuous intravenous infusion of dexmedetomidine (DEX) is commonly used for EA prevention. However, a wide dose range is used for preventing EA, and the optimal dose remains unknown. This study was aimed at determining the optimal dose (the 90% effective dose [ED90]) of DEX for continuous intraoperative infusion for EA prevention in children. METHODS We enrolled children aged 3 to 7 years who underwent dental treatment under sevoflurane anesthesia. DEX was continuously infused from the time of the establishment of the intravenous access until 5 minutes before the end of surgery. The initial DEX dose was 0.5 µg/kg/h, and subsequent dose adjustments were determined based on the response of the previous patient by using an up-down sequential allocation with a biased-coin design. The primary outcome was the ED90 for continuous DEX infusion based on the success or failure of the EA-preventing dose. RESULTS Forty-five patients were enrolled in the study. The DEX dose ranged from 0.50 to 0.90 µg/kg/h. The estimated ED90 (95% confidence interval [CI]) for preventing EA was 0.74 µg/kg/h (0.67-1.05 µg/kg/h). The duration of surgery (mean ± standard deviation [SD]) was 113 ± 30 minutes. The times (mean ± SD) for extubation, time to emergence, and recovery time were 5 ± 2 minutes, 27 ± 9 minutes, and 39 ± 7 minutes, respectively. CONCLUSIONS The ED90 for continuous intraoperative DEX infusion for EA prevention in pediatric patients receiving dental treatment under sevoflurane anesthesia was 0.74 µg/kg/h (95% CI, 0.67-1.05 µg/kg/h).
Collapse
Affiliation(s)
- Dan Zhou
- From the Department of Anesthesiology, Peking University School and Hospital of Stomatology, Beijing, China
| | | | | | | | | |
Collapse
|
22
|
Mihara T, Nakajima D, Hijikata T, Tomita M, Goto T. Effectiveness of acupuncture therapy for the prevention of emergence agitation in children: A systematic review and meta-analysis with trial sequential analysis. PLoS One 2023; 18:e0286790. [PMID: 37279209 DOI: 10.1371/journal.pone.0286790] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/18/2022] [Accepted: 05/19/2023] [Indexed: 06/08/2023] Open
Abstract
This study aimed to evaluate the effectiveness of acupuncture therapy in preventing emergence agitation (EA) in children. A systematic review and meta-analysis were conducted across multiple locations according to the articles searched. Seven databases, including trial registration sites, were searched. A total of six trials were included involving 489 patients; of them, 244 received acupuncture therapy. Randomized clinical trials (RCTs) evaluating the incidence of EA compared with placebo/sham or standard care in children were included. The primary outcome was the incidence of EA, as evaluated using a specific assessment tool. Data about the incidence rate of EA, heterogeneity, quality of trials and evidence, and adverse events were collected. Additionally, data about patient demographic characteristics, type of anesthesia, duration and onset of acupuncture therapy, EA and pain score, time taken for extubation, and post-anesthesia care unit length of stay were collected. The results indicated that the overall incidence of EA in the acupuncture therapy group and the control group was 23.4% and 39.5%, respectively, with no significant difference (risk ratio, 0.62; 95% confidence interval, 0.26-1.48; I2 = 63%). Subgroup analysis showed a significant difference in the overall incidence of EA in the acupuncture therapy and control groups according to surgery type (high-risk vs. low-risk surgery), suggesting that acupuncture therapy may be effective in reducing EA for patients undergoing high-risk surgery. The quality of evidence was downgraded to "very low" due to the study designs, inconsistency, and possible publication bias. In conclusion, this meta-analysis shows that the currently available RCTs are insufficient to determine the effectiveness of acupuncture therapy in preventing EA in children undergoing general anesthesia.
Collapse
Affiliation(s)
- Takahiro Mihara
- Department of Health Data Science, Yokohama City University Graduate School of Data Science, Yokohama, Japan
- Department of Anesthesiology, Yokohama City University, School of Medicine, Yokohama, Japan
| | - Daisuke Nakajima
- Department of Health Data Science, Yokohama City University Graduate School of Data Science, Yokohama, Japan
- Department of Anesthesiology, Yokohama City University Medical Center, Yokohama, Japan
| | - Toshiyuki Hijikata
- Department of Health Data Science, Yokohama City University Graduate School of Data Science, Yokohama, Japan
| | - Makoto Tomita
- Department of Health Data Science, Yokohama City University Graduate School of Data Science, Yokohama, Japan
| | - Takahisa Goto
- Department of Anesthesiology, Yokohama City University Medical Center, Yokohama, Japan
| |
Collapse
|
23
|
Hanna Mossad Samaan M, Mohamed Ahmed Sarhan T, Abd El Azim Ammar R, Hanafy Mahmoud T, Mohamed Ahmed El Shafie A. A study of menstrual cycle effects on pain perception, haemodynamic response to laryngoscopy, and postoperative outcome in gynaecological laparoscopy. EGYPTIAN JOURNAL OF ANAESTHESIA 2022. [DOI: 10.1080/11101849.2022.2147472] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/23/2022] Open
Affiliation(s)
- Mariam Hanna Mossad Samaan
- Assistant Lecturer in Anaesthesia and Surgical Intensive Care, Alexandria Faculty of Medicine, Alexandria, Egypt
| | - Tarek Mohamed Ahmed Sarhan
- Assistant Lecturer in Anaesthesia and Surgical Intensive Care, Alexandria Faculty of Medicine, Alexandria, Egypt
| | - Ramadan Abd El Azim Ammar
- Assistant Lecturer in Anaesthesia and Surgical Intensive Care, Alexandria Faculty of Medicine, Alexandria, Egypt
| | - Tamer Hanafy Mahmoud
- Professor of Obstetrics and Gynaecology, Alexandria Faculty of Medicine, Alexandria, Egypt
| | | |
Collapse
|
24
|
Soliman O, Nabil F, Osman HM. Listening to recorded mother’s voice versus intravenous dexmedetomidine to minimize postoperative emergence delirium in children after hypospadias repair surgeries: A prospective randomized trial. EGYPTIAN JOURNAL OF ANAESTHESIA 2022. [DOI: 10.1080/11101849.2022.2141018] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/05/2022] Open
Affiliation(s)
- Omar Soliman
- Department of Anesthesia and Intensive Care, Faculty of Medicine, Assiut University, Asyut, Egypt
| | - Fatma Nabil
- Department of Anesthesia and Intensive Care, Faculty of Medicine, Assiut University, Asyut, Egypt
| | - Hany M. Osman
- Department of Anesthesia and Intensive Care, Faculty of Medicine, Assiut University, Asyut, Egypt
| |
Collapse
|
25
|
Relationship between Fasting Times and Emergence Delirium in Children Undergoing Magnetic Resonance Imaging under Sedation. MEDICINA (KAUNAS, LITHUANIA) 2022; 58:medicina58121861. [PMID: 36557062 PMCID: PMC9786080 DOI: 10.3390/medicina58121861] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Subscribe] [Scholar Register] [Received: 11/02/2022] [Revised: 12/09/2022] [Accepted: 12/15/2022] [Indexed: 12/24/2022]
Abstract
Background and Objectives: This study aimed to determine whether there is a relationship between preoperative fasting time, fasting blood glucose (FBG), and postoperative emergence delirium (ED) in pediatric patients undergoing MRI under sedation. Materials and Methods: 110 pediatric patients were included in the study. Preoperative fasting (solid-fluid) time and FBG were recorded. The development of ED in the patients who underwent MRI under sedation was evaluated with the pediatric anesthesia emergence delirium (PAED) value for 30 min every 5 min in the recovery room. PAED score of ≥10 was grouped as having ED, and a PAED score of <10 as without ED at any time. The PAED scores were compared with other variables, ASA, age, weight, MRI examination time, and FBG level and fasting times. The risk factors affecting the occurrence of ED were examined. Results: Mean age was 3.94 ± 1.53 years, mean FBG was 106.97 ± 12.53 mg/dL, fasting time was 10.75 ± 2.61 h, solid food fasting time was 11.92 ± 2.33 h, and thirst time was 10.74 ± 2.58 h. FBG was never associated with PAED measurement at any time (p > 0.05). There was a weak positive correlation between the fasting time and the 0th, 5th, and 10th minute PAED score (r = 0.225; p = 0.018, r = 0.195; p = 0.041, r = 0.195; p = 0.041). There was a weak positive correlation between the solid food fasting time and the PAED score at the 0th, 5th, 10th, 15th, and 20th minutes (r = 0.382; p < 0.001, r = 0.357; p < 0.001, r = 0.345; p < 0.001, r = 0.360; p < 0.001, r = 0.240; p < 0.001). There was a weak positive correlation between thirst time and the PAED score at the 0th, 5th, and 10th minutes (r = 0.222; p = 0.020. r = 0.192; p = 0.045, r = 0.199; p = 0.037). The incidence of ED at any time was 34.5%. Conclusions: Prolonged fasting time, solid food fasting time and thirst time are risk factors for developing postoperative ED in children undergoing MRI under sedation.
Collapse
|
26
|
Improving Identification of Pediatric Emergence Delirium in the Post Anesthesia Care Unit: A Quality Improvement Opportunity. J Perianesth Nurs 2022; 37:770-773. [PMID: 35691830 DOI: 10.1016/j.jopan.2021.12.004] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/09/2020] [Revised: 12/02/2021] [Accepted: 12/26/2021] [Indexed: 11/22/2022]
Abstract
OBJECTIVE This article offers a recommendation on how the Pediatric Assessment Emergence Delirium Scale (PAEDS) could be implemented in the post anesthesia care unit (PACU) to improve the assessment and treatment of pediatric emergence delirium (PED). BACKGROUND PED is an anticipated complication in the PACU characterized by mental confusion, irritability, disorientation, inconsolable crying, and prolonged postanesthetic recovery time. Although it is a short-lived phenomenon, it increases the risk for traumatic injuries and may lead to a decrease in overall parent satisfaction with their child's surgical experience. METHOD Implementation of the PAEDS in the PACU has the potential to improve the care and safety of the surgical pediatric patient population and could be a catalyst for PED process improvements. This tool has been used in various studies and has demonstrated the validity and reliability in the assessment of emergence delirium. CONCLUSIONS Clinical use of the PAEDS is not standard of practice, but considering the adverse effects of PED on patients, parents, and medical staff, a PAEDS protocol could be beneficial to the PACU.
Collapse
|
27
|
Liu M, Zhang H, Liu Y, Li Z, Wang Z, Wang X. The Ameliorating Role of A Playful Situational Game Intervention in School-Aged Children Undergoing Ophthalmic Surgeries: A Randomized Controlled Trial. Curr Eye Res 2022; 47:1646-1651. [PMID: 36170042 DOI: 10.1080/02713683.2022.2130360] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/27/2023]
Abstract
PURPOSE The objective of the study was to investigate if a playful situational game (PSG) intervention, as a perioperative procedure, could effectively alleviate stress and anxiety and improve postoperative outcomes for children to receive ophthalmic surgeries. METHODS This trial enrolled 153 children, among which 116 met inclusion criteria and were randomized to control (n = 58, who did not participate in PSG) or PSG group (n = 58, who participated PSG). In the PSG group, children were arranged in renovated wards and allocated to play situational games specifically designed to improve surgery readiness. Satisfaction of the care from parents, posthospitalization behavioral change incidences, Yale Preoperative Anxiety Scale (YPAS) scores, induction compliance checklist (ICC) scores, and pediatric anesthesia emergence delirium (PAED) scores were documented as postoperative assessments. RESULTS The PSG group demonstrated significantly higher satisfaction of the care from the parents (p = 0.004), and posthospitalization behavioral change incidences were markedly rarer in the PSG group (p = 0.015). The YPAS scores of the PSG group showed a slower increase compared to the control group before and after surgery (p < 0.001). ICC and PAED scores were also lower in the PSG group (p < 0.01). CONCLUSION Our data could support that PSG is an effective intervention in alleviating the anxiety of children undergoing ophthalmic surgery and PSG can increase the satisfaction rate among patients and decrease behavioral change incidences. The adoption of PSG in children could potentially been promoted in the clinical setting.
Collapse
Affiliation(s)
- Mingyuan Liu
- Department of Anesthesiology, Cangzhou Central Hospital, Cangzhou, PR China
| | - Huiqin Zhang
- Department of Ophthalmology, Cangzhou Central Hospital, Cangzhou, PR China
| | - Yu Liu
- Department of Ophthalmology, Cangzhou Central Hospital, Cangzhou, PR China
| | - Zhaoxia Li
- Department of Ophthalmology, Cangzhou Central Hospital, Cangzhou, PR China
| | - Zhixue Wang
- Department of Ophthalmology, Cangzhou Central Hospital, Cangzhou, PR China
| | - Xi Wang
- Department of Respiration, Cangzhou Central Hospital, Cangzhou, PR China
| |
Collapse
|
28
|
Chima AM, Mahmoud MA, Narayanasamy S. What Is the Role of Dexmedetomidine in Modern Anesthesia and Critical Care? Adv Anesth 2022; 40:111-130. [PMID: 36333042 DOI: 10.1016/j.aan.2022.06.003] [Citation(s) in RCA: 7] [Impact Index Per Article: 3.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/23/2022]
Abstract
Dexmedetomidine's unique sedative properties have led to its widespread use. Dexmedetomidine has a beneficial pharmacologic profile including analgesic sparing effects, anxiolysis, sympatholysis, organ-protective effects against ischemic and hypoxic injury, and sedation which parallels natural sleep. An understanding of predictable side effects, effects of age-related physiologic changes, and pharmacokinetic and pharmacodynamic effects of dexmedetomidine is crucial to maximize its safe administration in adults and children. This review focuses on the growing body of literature examining advances in applications of dexmedetomidine in children and adults.
Collapse
Affiliation(s)
- Adaora M Chima
- Department of Anesthesiology, Cincinnati Children's Hospital Medical Center, MLC 2001, 3333 Burnet Avenue, Cincinnati, OH 45229, USA; University of Cincinnati, College of Medicine, Cincinnati, OH, USA.
| | - Mohamed A Mahmoud
- Department of Anesthesiology, Cincinnati Children's Hospital Medical Center, MLC 2001, 3333 Burnet Avenue, Cincinnati, OH 45229, USA; University of Cincinnati, College of Medicine, Cincinnati, OH, USA
| | - Suryakumar Narayanasamy
- Department of Anesthesiology, Cincinnati Children's Hospital Medical Center, MLC 2001, 3333 Burnet Avenue, Cincinnati, OH 45229, USA; University of Cincinnati, College of Medicine, Cincinnati, OH, USA
| |
Collapse
|
29
|
Xiao Y, Jin X, Zhang Y, Huang T, Zhou L, Gao J. Efficacy of propofol for the prevention of emergence agitation after sevoflurane anaesthesia in children: A meta-analysis. Front Surg 2022; 9:1031010. [PMID: 36263091 PMCID: PMC9574203 DOI: 10.3389/fsurg.2022.1031010] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/29/2022] [Accepted: 09/14/2022] [Indexed: 11/07/2022] Open
Abstract
Background Emergence agitation (EA) is a common postoperative behavioral disorder, predominantly in pediatric patients, after sevoflurane general anesthesia. This study was aimed at assessing propofol's efficacy and clinical conditions established for preventing EA in children under sevoflurane anesthesia. Methods Randomized controlled trials (RCTs) that comparatively investigated propofol and control treatment in terms of efficacy and safety on administration at the end of surgery and examinations to prevent EA in children under sevoflurane anesthesia were searched. The sources accessed included PubMed, Embase, Cochrane Central Register of Controlled Trials, and ClinicalTrials.gov. Furthermore, manual searches were performed to identify studies; the last review was conducted on March 21, 2022. When the risk of bias assessment of trials was performed with the Cochrane Risk of Bias Tool, we calculated risk ratios (RRs) with 95% confidence intervals (CIs) for EA incidence and mean differences (MDs) with 95% CI for continuous data. Results We included 12 RCTs with 1103 children. EA incidence (RR: 0.51, 95% CI: 0.39 to 0.67) and Pediatric Anesthesia Emergence Delirium scores (MD: −3.14, 95% CI: −4.37 to −1.92) were lower in the propofol group. Subgroup analyses showed lower EA incidences with 3 mg/kg propofol (RR: 0.22, 95% CI: 0.13 to 0.38) without extension of the PACU time (MD: 4.97, 95% CI: −0.84 to 10.78) in the laryngeal mask airway (LMA; RR: 0.52, 95% CI: 0.36 to 0.77) and spontaneous breathing (RR: 0.36, 95% CI: 0.21 to 0.62) groups. Discussion We confirmed that a prophylactic dose of propofol prevented EA and decreased its severity in children under sevoflurane anesthesia. Furthermore, several conditions such as 3 mg/kg propofol, LMA, and spontaneous breathing, potentially contributed to EA prevention.
Systematic Review Registration https://www.crd.york.ac.uk/prospero/display_record.php?RecordID=274692, identifier: PROSPERO (No. CRD42021274692).
Collapse
Affiliation(s)
- Yinggang Xiao
- Medical College of Yangzhou University, Yangzhou, China,Department of Anesthesiology, Institute of Anesthesia, Emergency and Critical Care, Yangzhou University Affiliated Northern Jiangsu People's Hospital, Yangzhou, China
| | - Xuening Jin
- Medical College of Yangzhou University, Yangzhou, China
| | - Yang Zhang
- Department of Anesthesiology, Institute of Anesthesia, Emergency and Critical Care, Yangzhou University Affiliated Northern Jiangsu People's Hospital, Yangzhou, China
| | - Tianfeng Huang
- Department of Anesthesiology, Institute of Anesthesia, Emergency and Critical Care, Yangzhou University Affiliated Northern Jiangsu People's Hospital, Yangzhou, China
| | - Luojing Zhou
- Department of Anesthesiology, Institute of Anesthesia, Emergency and Critical Care, Yangzhou University Affiliated Northern Jiangsu People's Hospital, Yangzhou, China
| | - Ju Gao
- Department of Anesthesiology, Institute of Anesthesia, Emergency and Critical Care, Yangzhou University Affiliated Northern Jiangsu People's Hospital, Yangzhou, China,Correspondence: Ju Gao
| |
Collapse
|
30
|
Prevalence of Emergence Delirium in Children Undergoing Tonsillectomy and Adenoidectomy. Anesthesiol Res Pract 2022; 2022:1465999. [PMID: 36212781 PMCID: PMC9534659 DOI: 10.1155/2022/1465999] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/17/2022] [Revised: 09/07/2022] [Accepted: 09/08/2022] [Indexed: 11/29/2022] Open
Abstract
Objective Emergence delirium (ED) is associated with behavioral disturbances and psychomotor agitation, increased risk of selfinjury, delayed discharge, and parental dissatisfaction with quality of care. Otolaryngology procedures are associated with an increased risk of ED. The aims of this study were to determine the prevalence of ED in children who had tonsillectomy and adenoidectomy (T&A), assess the characteristics of children who had ED, and ascertain the recovery times of patients with ED. Methods Charts of patients who had tonsillectomy and adenoidectomy between Jan 1, 2018 and March 26, 2020 at a tertiary children's hospital were reviewed. Data collection included demographics, body mass index, indication for T&A, Pediatric Anesthesia Emergence Delirium (PAED) score, American Society of Anesthesiologists (ASA) physical status classification, total anesthesia time, postanesthesia care phase I time, and postanesthesia care phase II time. Results Of the 4974 patients who underwent T&A, ED occurred in 1.3% of patients. Toddlers (2.9%) and male children (1.6%) had a significantly higher prevalence of ED. Prevalence of ED was similar amongst patients with recurrent tonsillitis, patients with obstructive sleep disordered breathing, and patients with both obstructive sleep apnea (OSA) and recurrent tonsillitis. The prevalence of ED was not different amongst ASA I, ASA II, and ASA III. Males with ED had longer total anesthesia times (41 v. 34 minutes, p=0.02) and ASA I patients with ED had longer phase I times (p=0.04) in the postanesthesia care unit (PACU). There was no significant difference in total anesthesia time, phase I time, or phase II time when compared across the subgroups of gender, age, indication for T&A, severity of obstructive sleep apnea (OSA), and ASA score. Conclusions Males, toddlers, and preschool-age children were more likely to have ED. Males with ED had longer total anesthesia times. ED was associated with longer phase I times in ASA I patients.
Collapse
|
31
|
Li Y, Li J, Shi Y, Zhou X, Feng W, Han L, Ma D, Jiang H, Yuan Y. Urinary Aromatic Amino Acid Metabolites Associated With Postoperative Emergence Agitation in Paediatric Patients After General Anaesthesia: Urine Metabolomics Study. Front Pharmacol 2022; 13:932776. [PMID: 35928271 PMCID: PMC9343964 DOI: 10.3389/fphar.2022.932776] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/30/2022] [Accepted: 06/22/2022] [Indexed: 11/29/2022] Open
Abstract
Background: Emergence agitation (EA) is very common in paediatric patients during recovery from general anaesthesia, but underlying mechanisms remain unknown. This prospective study was designed to profile preoperative urine metabolites and identify potential biomarkers that can predict the occurrence of EA. Methods: A total of 224 patients were screened for recruitment; of those, preoperative morning urine samples from 33 paediatric patients with EA and 33 non-EA gender- and age-matched patients after being given sevoflurane general anaesthesia were analysed by ultra-high-performance liquid chromatography (UHPLC) coupled with a Q Exactive Plus mass spectrometer. Univariate analysis and orthogonal projection to latent structures squares-discriminant analysis (OPLS-DA) were used to analyse these metabolites. The least absolute shrinkage and selection operator (LASSO) regression was used to identify predictive variables. The predictive model was evaluated through the receiver operating characteristic (ROC) analysis and then further assessed with 10-fold cross-validation. Results: Seventy-seven patients completed the study, of which 33 (42.9%) patients developed EA. EA and non-EA patients had many differences in preoperative urine metabolic profiling. Sixteen metabolites including nine aromatic amino acid metabolites, acylcarnitines, pyridoxamine, porphobilinogen, 7-methylxanthine, and 5′-methylthioadenosine were found associated with an increased risk of EA, and they all exhibited higher levels in the EA group than in the non-EA group. The main metabolic pathways involved in these metabolic changes included phenylalanine, tyrosine and tryptophan metabolisms. Among these potential biomarkers, L-tyrosine had the best predictive value with an odds ratio (OR) (95% CI) of 5.27 (2.20–12.63) and the AUC value of 0.81 (0.70–0.91) and was robust with internal 10-fold cross-validation. Conclusion: Urinary aromatic amino acid metabolites are closely associated with EA in paediatric patients, and further validation with larger cohorts and mechanistic studies is needed. Clinical Trial Registration:clinicaltrials.gov, identifier NCT04807998
Collapse
Affiliation(s)
- Yueyue Li
- Department of Pharmacy, Shanghai Ninth People’s Hospital, Shanghai JiaoTong University School of Medicine, Shanghai, China
| | - Jingjie Li
- Department of Anaesthesiology, Shanghai Ninth People’s Hospital, Shanghai Jiao Tong University School of Medicine, Shanghai, China
| | - Yuhuan Shi
- Department of Pharmacy, Shanghai Ninth People’s Hospital, Shanghai JiaoTong University School of Medicine, Shanghai, China
| | - Xuhui Zhou
- Department of Anaesthesiology, Shanghai Ninth People’s Hospital, Shanghai Jiao Tong University School of Medicine, Shanghai, China
| | - Wanqing Feng
- Department of Anaesthesiology, Shanghai Ninth People’s Hospital, Shanghai Jiao Tong University School of Medicine, Shanghai, China
| | - Lu Han
- Department of Pharmacy, Shanghai Ninth People’s Hospital, Shanghai JiaoTong University School of Medicine, Shanghai, China
| | - Daqing Ma
- Division of Anaesthetics, Pain Medicine and Intensive Care, Department of Surgery and Cancer, Faculty of Medicine, Imperial College London, Chelsea and Westminster Hospital, London, United Kingdom
| | - Hong Jiang
- Department of Anaesthesiology, Shanghai Ninth People’s Hospital, Shanghai Jiao Tong University School of Medicine, Shanghai, China
- *Correspondence: Hong Jiang, ; Yongfang Yuan,
| | - Yongfang Yuan
- Department of Pharmacy, Shanghai Ninth People’s Hospital, Shanghai JiaoTong University School of Medicine, Shanghai, China
- *Correspondence: Hong Jiang, ; Yongfang Yuan,
| |
Collapse
|
32
|
Neumann C, Babasiz T, Straßberger-Nerschbach N, Schindler E, Reuter C, Weinhold L, Wittmann M, Hilbert T, Klaschik S. Comparison of the Newborn Infant Parasympathetic Evaluation (NIPE™) index to changes in heart rate to detect intraoperative nociceptive stimuli in healthy and critically ill children below 2 years: An observational study. Paediatr Anaesth 2022; 32:815-824. [PMID: 35332622 DOI: 10.1111/pan.14446] [Citation(s) in RCA: 5] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/16/2021] [Revised: 02/24/2022] [Accepted: 03/08/2022] [Indexed: 11/30/2022]
Abstract
BACKGROUND The validity of current tools for intraoperative objective assessment of nociception/antinociception balance during anesthesia in young and very young surgery children is unknown. AIM Primary aim of the study was to test the hypothesis that the Newborn Infant Parasympathetic Evaluation (NIPE) index performs better in indicating nociception in anesthetized children below 2 years than changes in heart rate. Secondary aims were to evaluate associations between intraoperative changes in NIPE index values and postoperative pain and emergence delirium. METHODS Fifty-one children aged <2 years who underwent surgery were included in this prospective observational study. Patients were assigned to either group 1 (healthy children, n = 31) or group 2 (critically ill, ventilated premature infants and neonates, n = 20). The NIPE index and heart rate in response to three defined nociceptive stimuli were continuously recorded. Two different scales, Kindliche Unbehagens- und Schmerzskala (KUS) and Pediatric Anesthesia Emergence Delirium (PAED) as well as a Pain Questionnaire were used to assess postoperative pain levels and emergence delirium. RESULTS In total, 110 nociceptive events were evaluated. The analysis revealed a statistically significant association between a decrease in the NIPE index and all nociceptive stimuli, with a sensitivity of 92% and a specificity of 96%. The mean percentage decrease ranged from approx. 15%-30% and was highly statistically significant in both groups and for each of the nociceptive events except for venous puncture (p = .004). In contrast, no consistent change in heart rate was demonstrated. The KUS and PAED scale scores were significantly associated with the duration of anesthesia (p = .04), but not with intraoperative NIPE depression. CONCLUSION The NIPE index was reliable for assessing intraoperative nociception in children aged <2 years and was more reproducible for detecting specific nociceptive stimuli during general anesthesia than heart rate. An effect on postoperative outcome is still elusive.
Collapse
Affiliation(s)
- Claudia Neumann
- Department of Anesthesiology and Intensive Care Medicine, University Hospital Bonn, Bonn, Germany
| | - Tamara Babasiz
- Department of Anesthesiology and Intensive Care Medicine, University Hospital Bonn, Bonn, Germany
| | | | - Ehrenfried Schindler
- Department of Anesthesiology and Intensive Care Medicine, University Hospital Bonn, Bonn, Germany
| | - Christian Reuter
- Department of Anesthesiology and Intensive Care Medicine, University Hospital Bonn, Bonn, Germany
| | - Leonie Weinhold
- Department of Medical Biometry, Informatics and Epidemiology, University Hospital Bonn, Bonn, Germany
| | - Maria Wittmann
- Department of Anesthesiology and Intensive Care Medicine, University Hospital Bonn, Bonn, Germany
| | - Tobias Hilbert
- Department of Anesthesiology and Intensive Care Medicine, University Hospital Bonn, Bonn, Germany
| | - Sven Klaschik
- Department of Anesthesiology and Intensive Care Medicine, University Hospital Bonn, Bonn, Germany
| |
Collapse
|
33
|
She D, Wang ZY, Wu F, Zhang YQ, Ao Q. Meta-analysis of visual pretreatment for the prevention of emergence delirium in children undergoing ophthalmic surgery. J Comp Eff Res 2022; 11:679-688. [PMID: 35531783 DOI: 10.2217/cer-2022-0037] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/21/2022] Open
Abstract
Objective: To evaluate the role of visual pretreatment in preventing emergence delirium in children receiving ophthalmic surgery. Methods: Four randomized controlled trials were identified in four databases, and a meta-analysis was conducted using RevMan 5.3. Results: The meta-analysis demonstrated a significantly lower incidence of postoperative emergence delirium (risk ratio: 0.39; 95% CI: 0.31-0.49) and propofol rescue (risk ratio: 0.29; 95% CI: 0.13-0.65) but comparable modified Yale Preoperative Anxiety Scale score (mean difference: -3.66; 95% CI: -9.96 to 2.65) and incidence of adverse events in the visual pretreatment group. Conclusion: Visual pretreatment is effective in preventing postoperative emergence delirium in children undergoing ophthalmic surgery without significant adverse effects and can also decrease the incidence of propofol rescue.
Collapse
Affiliation(s)
- Dong She
- Department of Emergency, Third Affiliated Hospital of Chongqing Medical University, Chongqing, 401120, China
| | - Zi-Yu Wang
- Department of Ophthalmology, Third Affiliated Hospital of Chongqing Medical University, Chongqing, 401120, China
| | - Fei Wu
- Department of Emergency, Third Affiliated Hospital of Chongqing Medical University, Chongqing, 401120, China
| | - Yin-Qin Zhang
- Department of Ophthalmology, Third Affiliated Hospital of Chongqing Medical University, Chongqing, 401120, China
| | - Qin Ao
- Department of Emergency, Third Affiliated Hospital of Chongqing Medical University, Chongqing, 401120, China
| |
Collapse
|
34
|
Ismail TI, Mahrous RSS. Parental active participation during induction of general anesthesia to decrease children anxiety and pain. EGYPTIAN JOURNAL OF ANAESTHESIA 2022. [DOI: 10.1080/11101849.2022.2069335] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/18/2022] Open
Affiliation(s)
- Tarek I Ismail
- Department of Anaesthesia and Surgical Intensive Care, Helwan University, Cairo, Egypt
| | - Rabab S. S. Mahrous
- Department of Anaesthesia and Surgical Intensive Care, Alexandria University
| |
Collapse
|
35
|
Nakajima D, Mihara T, Hijikata T, Tomita M, Goto T. Effectiveness of acupuncture therapy for preventing emergence agitation in children: A protocol for systematic review and meta-analysis with trial sequential analysis. PLoS One 2022; 17:e0264197. [PMID: 35349573 PMCID: PMC8963563 DOI: 10.1371/journal.pone.0264197] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/10/2021] [Accepted: 01/31/2022] [Indexed: 11/23/2022] Open
Abstract
Pain, autonomic distress, and emergence agitation occur commonly in children undergoing general anesthesia. While acupuncture therapy has been reported to effectively reduce such pain and autonomic distress in children, its effect in preventing emergence agitation remains unclear. Therefore, we will conduct a systematic review and meta-analysis with trial sequential analysis to evaluate the effect of acupuncture therapy in preventing emergence agitation in children undergoing general anesthesia. Methods and analysis This protocol was prepared according to the 2015 Preferred Reporting Items for Systematic Reviews and Meta-Analyses (PRISMA) for Protocols guidelines. We will conduct a search for randomized controlled trials that evaluated the effect of acupuncture therapy in preventing emergence agitation. The following databases will be searched for relevant articles: MEDLINE, CENTRAL, Embase, and Web of Science; four pre-registration sites will be accessed from inception to April 1, 2021. No language restrictions will be applied. Two authors will independently scan and select eligible studies, extract the data, and assess the risk of bias. The incidence of emergence agitation will be combined as a risk ratio with a 95% confidence interval using a random-effect model. The I2 statistics will be used to assess heterogeneity. We will evaluate the quality of the clinical trials using the Cochrane methodology and assess the quality of evidence using the Grading of Recommendation Assessment, Development, and Evaluation approach. If appropriate, a trial sequential analysis will be performed. Expected outcomes This meta-analysis will be the first to evaluate the effect of acupuncture therapy in preventing emergence agitation in children. The findings from this meta-analysis have the potential to reveal pivotal factors that affect the clinical effect of acupuncture therapy, thereby supporting the optimization of acupuncture therapy for emergence agitation. Protocol registration University Hospital Medical Information Network Clinical Trials Registry (UMIN000040775).
Collapse
Affiliation(s)
- Daisuke Nakajima
- Department of Health Data Science, Yokohama City University Graduate School of Data Science, Yokohama, Japan
| | - Takahiro Mihara
- Department of Health Data Science, Yokohama City University Graduate School of Data Science, Yokohama, Japan
- * E-mail:
| | - Toshiyuki Hijikata
- Department of Health Data Science, Yokohama City University Graduate School of Data Science, Yokohama, Japan
| | - Makoto Tomita
- Department of Health Data Science, Yokohama City University Graduate School of Data Science, Yokohama, Japan
| | - Takahisa Goto
- Department of Anesthesiology, Yokohama City University, School of Medicine, Yokohama, Japan
| |
Collapse
|
36
|
Russell PSS, Mammen PM, Shankar SR, Viswanathan SA, Rebekah G, Russell S, Earnest R, Chikkala SM. Pediatric Anesthesia Emergence Delirium Scale: A diagnostic meta-analysis. World J Clin Pediatr 2022; 11:196-205. [PMID: 35433300 PMCID: PMC8985492 DOI: 10.5409/wjcp.v11.i2.196] [Citation(s) in RCA: 2] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/19/2021] [Revised: 05/27/2021] [Accepted: 02/10/2022] [Indexed: 02/06/2023] Open
Abstract
BACKGROUND Emergence delirium (EmD) is a troublesome motoric, emotional, and cognitive disturbance associated with morbidity. It is often misdiagnosed despite being present in a substantial proportion of children and adolescents during emergence from anesthesia.
AIM To evaluate the summary diagnostic accuracy of Pediatric Anesthesia Emergence Delirium Scale (PAEDS) for EmD among children and adolescents.
METHODS Two researchers electronically and hand searched the published literature from May 2004 to February 2021 that evaluated the diagnostic accuracy of PAEDS for EmD among children and adolescents, using appropriate terms. Two independent researchers extracted the diagnostic parameters and appraised the study quality with QUADAS-2. Overall, the diagnostic accuracy of the measures was calculated with the summary receiver operating characteristic curve (SROC), the summary sensitivity and specificity, and diagnostic odds ratio (DOR) for EmD. Various diagnostic cut-off points were evaluated for their diagnostic accuracy. Heterogeneity was analyzed by meta-regression.
RESULTS Nine diagnostic accuracy studies of EmD that conformed to our selection criteria and PRISMA guidelines were included in the final analysis. There was no publication bias. The area under the SROC was 0.97 (95% confidence interval [CI]: 95%-98%). Summary sensitivity and specificity were 0.91 (95%CI: 0.81-0.96; I2 = 92.93%) and 0.94 (95%CI: 0.89-0.97; I2 = 87.44%), respectively. The summary DOR was 148.33 (95%CI: 48.32-455.32). The effect size for the subgroup analysis of PAEDS cut-off scores of < 10, ≥ 10, and ≥ 12 was 3.73, 2.19, and 2.93, respectively; they were not statistically significantly different. The setting of the study and reference standard were statistically significantly related to the sensitivity of PAEDS but not specificity.
CONCLUSION The PAEDS is an accurate diagnostic measure for the diagnosis of EmD among children and adolescents. Further studies should document its clinical utility.
Collapse
Affiliation(s)
| | - Priya Mary Mammen
- Child and Adolescent Psychiatry Unit, Christian Medical College, Vellore 632 002, Tamil Nadu, India
| | - Satya Raj Shankar
- Child and Adolescent Psychiatry Unit, Christian Medical College, Vellore 632 002, Tamil Nadu, India
| | | | - Grace Rebekah
- Department of Biostatistics, Christian Medical College, Vellore 632 002, Tamil Nadu, India
| | - Sushila Russell
- Child and Adolescent Psychiatry Unit, Christian Medical College, Vellore 632 002, Tamil Nadu, India
| | - Richa Earnest
- Child and Adolescent Psychiatry Unit, Christian Medical College, Vellore 632 002, Tamil Nadu, India
| | - Swetha Madhuri Chikkala
- Child and Adolescent Psychiatry Unit, Christian Medical College, Vellore 632 002, Tamil Nadu, India
| |
Collapse
|
37
|
Shen QH, Xu-Shen, Lai L, Chen YJ, Liu K, Sun LJ. The effect of magnesium sulfate on emergence agitation in children undergoing general anesthesia: A systematic review and meta-analysis. J Clin Anesth 2022; 78:110669. [PMID: 35151145 DOI: 10.1016/j.jclinane.2022.110669] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/02/2021] [Revised: 01/25/2022] [Accepted: 01/27/2022] [Indexed: 11/26/2022]
Abstract
STUDY OBJECTIVE Emergence agitation (EA) is a common complication in pediatric patients after general anesthesia. The effectiveness of magnesium sulfate in decreasing the incidence of EA in children remains controversial. Therefore, a systematic review and meta-analysis was performed to assess the efficacy of magnesium sulfate in preventing EA in pediatric patients following general anesthesia. DESIGN Systematic review and meta-analysis. SETTING PubMed, Embase, Web of Science, and Cochrane Library were searched to identify eligible randomized controlled trials from their respective database inception dates to June 30, 2021. PATIENTS Pediatric patients (< 18 years old) undergoing general anesthesia. INTERVENTIONS Intravenous administration of magnesium sulfate. MEASUREMENTS The primary outcome of the meta-analysis was EA incidence. The risk of bias of the included studies was evaluated using the revised Cochrane risk of bias tool for randomized trials (RoB 2.0). Grading of Recommendations, Assessment, Development, and Evaluation was applied to assess the level of certainty. MAIN RESULTS Eight studies with 635 participants were identified. The forest plot revealed no significant difference in the incidence of EA between patients treated with magnesium sulfate and the control group (risk ratio = 0.69, 95% confidence interval [0.44, 1.07]; P = 0.10, I2 = 74%, moderate level of certainty). Additionally, magnesium sulfate did not reduce postoperative pediatric anesthesia emergence delirium scores but prolonged the emergence time. No significant differences were observed in postoperative complications (nausea, vomiting, laryngospasm, breath-holding, coughing, oxygen desaturation, and cardiac arrhythmias). CONCLUSIONS Administration of magnesium sulfate during general anesthesia did not affect the occurrence of EA in pediatric patients. However, magnesium sulfate can prolong the emergence time without adverse effects. PROSPERO registration number: CRD42021252924.
Collapse
Affiliation(s)
- Qi-Hong Shen
- Department of Anesthesiology, Affiliated Hospital of Jiaxing University, Jiaxing, Zhejiang, China
| | - Xu-Shen
- Department of Anesthesiology, Affiliated Hospital of Jiaxing University, Jiaxing, Zhejiang, China.
| | - Lan Lai
- Department of Anesthesiology, Affiliated Hospital of Jiaxing University, Jiaxing, Zhejiang, China
| | - Yan-Jun Chen
- Department of Anesthesiology, Affiliated Hospital of Jiaxing University, Jiaxing, Zhejiang, China
| | - Ke Liu
- Department of Anesthesiology, Affiliated Hospital of Jiaxing University, Jiaxing, Zhejiang, China
| | - Lian-Juan Sun
- Department of Anesthesiology, Zhejiang University School of Medicine First Affiliated Hospital, China
| |
Collapse
|
38
|
Haley J, Engstrand SL, Cole A, Schenkel S, Hinsley K, Brawn B, Esch J, Ibla J, DeGrazia M. Safety and feasibility of the paediatric post-cardiac catheterisation Wrap: a pilot study. Cardiol Young 2022; 33:1-10. [PMID: 35105395 DOI: 10.1017/s1047951122000178] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/07/2022]
Abstract
OBJECTIVE The paediatric post-cardiac catheterisation Wrap (Wrap), an innovative medical safety device, swaddles young paediatric patients in a supine position aiding in immobilisation post-cardiac catheterisation. This pilot study investigated the feasibility and safety of using the Wrap on young paediatric patients during their bed rest period following cardiac catheterisation with femoral access. SETTING Boston Children's Hospital Cardiac Catheterization Lab. PARTICIPANTS 20 patients, ages 1-5 years and weighing 3-25 kg. METHODS Investigator-developed tools used to collect data included the Demographic and Outcome Measures Data Tool, the Parent/Caregiver Satisfaction, and Provider Ease of Use tools. They measured:1.The feasibility of using the Wrap2.Wrap ease of use from the nurse providers' perspective3.Parent satisfaction related to the Wrap4.Frequency of Wrap non-bleeding-related adverse events5.Frequency of rebleeding at femoral groin access sites. RESULTS The Wrap was feasible and safe; increased nurse provider satisfaction by allowing visualisation of the groin access sites while minimising the need for hands-on care; and increased parent satisfaction by allowing parents to hold and provide comfort while their child was on bed rest. IMPLICATIONS FOR RESEARCH The Wrap is a safe alternative to the current practice of swaddling with a bath blanket. Further studies are warranted to assess the Wrap's effectiveness in reducing the incidence of rebleeding events in the post-cardiac catheterisation period and explore clinical use outside of the Cardiac Catheterization Lab.
Collapse
Affiliation(s)
- Jennifer Haley
- Cardiac Catheterization Lab, Boston Children's Hospital, Boston, MA, USA
| | - Shannon L Engstrand
- Cardiovascular and Critical Care, Boston Children's Hospital, Boston, MA, USA
| | - Alexandra Cole
- Cardiovascular and Critical Care, Boston Children's Hospital, Boston, MA, USA
| | - Sara Schenkel
- Division of Pediatric Global Health, Massachusetts General Hospital, Boston, MA, USA
| | - Karen Hinsley
- Cardiac Catheterization Lab, Boston Children's Hospital, Boston, MA, USA
| | - Brenda Brawn
- Cardiac Catheterization Lab, Boston Children's Hospital, Boston, MA, USA
| | - Jesse Esch
- Cardiac Catheterization Lab, Boston Children's Hospital, Boston, MA, USA
| | - Juan Ibla
- Cardiac Catheterization Lab, Boston Children's Hospital, Boston, MA, USA
| | - Michele DeGrazia
- Cardiovascular and Critical Care, Boston Children's Hospital, Boston, MA, USA
| |
Collapse
|
39
|
Coşkun AS. Comparing the effects of propofol and ketamine on the emergence agitation of male children undergoing circumcision. ANNALS OF PEDIATRIC SURGERY 2022. [DOI: 10.1186/s43159-021-00136-1] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/10/2022] Open
Abstract
Abstract
Background
Separation from the family, prolonged hunger, inability to perceive the surgical procedure performed, and feeling pain are among the main reasons for agitation in young children. In operations like circumcision, in which all bodily integrity is disrupted and children cannot make sense of it and feel punished, this agitation increases. The aim of the present study was to compare the effects of propofol and ketamine on the emergence agitation (EA) in children undergoing circumcision.
Result
When the patients were taken to post-anesthesia care unit (PACU), no statistically significant difference was observed between propofol and ketamine groups in the Aono’s four-point scale at minute 0 (p = 0.073). In the 5th minute, it was higher in the ketamine group compared to the propofol group (p < 0.001). With Aono’s four-point scale, EA diagnosis is made in areas with 3 and 4 points. The average Aono’s four-point scale in the ketamine group at the 5th minute was 3.08 ± 1.02. Since the Modified Steward score was ≥ 6, the time taken was longer in the ketamine group compared to the propofol group (p < 0.001).
Conclusion
EA does not only occur in inhalational anesthetics, it is also seen with ketamine. In view of the fact that ketamine can cause EA in children, it should not be used alone in anesthesia. Propofol provides a safe anesthesia. Instead of inhalational anesthesia, where the type of surgery is suitable, anesthesia with propofol infusion should be applied. Further research is required to investigate EA.
Collapse
|
40
|
Sadeghi A, Sajad Razavi S, Eghbali A, Alireza Mahdavi S, Kimia F, Panah A. The Comparison of the Efficacy of Early versus Late Administration of Dexmedetomidine on Postoperative Emergence Agitation in Children Undergoing Oral Surgeries: A Randomized Clinical Trial. IRANIAN JOURNAL OF MEDICAL SCIENCES 2022; 47:25-32. [PMID: 35017774 PMCID: PMC8743374 DOI: 10.30476/ijms.2020.84509.1471] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 01/11/2020] [Revised: 08/09/2020] [Accepted: 10/11/2020] [Indexed: 11/16/2022]
Abstract
BACKGROUND Emergence Agitation (EA) is a dissociated state of consciousness characterized by irritability, uncompromising stance, and inconsolability. The etiology of EA is not completely understood. Dexmedetomidine is a highly selective α2-adrenoreceptor agonist with sedative and analgesic properties, which has been used to reduce the incidence of EA. We aimed to assess the efficacy of early versus late administration of dexmedetomidine on EA in children undergoing oral surgery. METHODS A randomized, parallel, double-blind clinical trial was conducted at Mofid Children's Hospital affiliated to Shahid Beheshti University of Medical Sciences (Tehran, Iran) from November 2016 to March 2017. A total of 81 children, who underwent adenotonsillectomy or cleft palate repair surgery were enrolled in the study. Based on simple randomization, the children were assigned to two groups, namely early (group A, n=41) and late (group B, n=40) administration of dexmedetomidine. Intra-operative and postoperative hemodynamic variables, extubation time, post-anesthesia care unit (PACU) length of stay, and the scores on Ramsay sedation scale and FLACC pain scale were measured and compared. The data were analyzed using SPSS software (version 20.0), and P<0.05 were considered statistically significant. RESULTS The mean FLACC score was lower in the late group than in the early group (2.0±1.5 vs. 4.2±1.6, P<0.001). The mean Ramsay sedation score was higher in the late group than in the early group (3.5±1.4 vs. 1.8±0.8, P<0.001). CONCLUSION Late administration of dexmedetomidine 1 µg/kg reduced the incidence of EA and PACU length of stay and improved postoperative pain management. TRIAL REGISTRATION NUMBER IRCT 2016122031497N1.
Collapse
Affiliation(s)
- Afsaneh Sadeghi
- Anesthesia Research Center, Shahid Beheshti University of Medical Sciences, Tehran, Iran
| | - Seyed Sajad Razavi
- Anesthesia Research Center, Shahid Beheshti University of Medical Sciences, Tehran, Iran
| | - Ahmad Eghbali
- Anesthesia Research Center, Shahid Beheshti University of Medical Sciences, Tehran, Iran
| | - Seyed Alireza Mahdavi
- Anesthesia Research Center, Shahid Beheshti University of Medical Sciences, Tehran, Iran
| | - Fereshteh Kimia
- Anesthesia Research Center, Shahid Beheshti University of Medical Sciences, Tehran, Iran
| | - Ashkan Panah
- Anesthesiology and Critical Care Research Center, Shiraz University of Medical Sciences, Shiraz, Iran
| |
Collapse
|
41
|
Zhao N, Zeng J, Fan L, Zhang C, Wu Y, Wang X, Gao F, Yu C. The Effect of Alfentanil on Emergence Delirium Following General Anesthesia in Children: A Randomized Clinical Trial. Paediatr Drugs 2022; 24:413-421. [PMID: 35698001 PMCID: PMC9191756 DOI: 10.1007/s40272-022-00510-5] [Citation(s) in RCA: 5] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Accepted: 04/13/2022] [Indexed: 11/29/2022]
Abstract
BACKGROUND Emergence delirium can occur after general anesthesia in children. An intravenous infusion of alfentanil may reduce the incidence or severity of emergence delirium after sevoflurane anesthesia. OBJECTIVE The study aimed to investigate the effects of alfentanil intravenous infusion on emergence delirium and other perioperative complications. METHOD This was a single-center, randomized, placebo-controlled, double-blind clinical trial. A total of 172 children undergoing ambulatory dental treatment were randomized into three groups. Alfentanil group Alf2 received 0.2 μg/kg/min of alfentanil for continuous infusion, alfentanil group Alf4 received 0.4 μg/kg/min alfentanil, and the saline group (group Sal) received a continuous infusion of normal saline, with the same volume as the two other groups, as a placebo. The incidence of emergence delirium (assessed by the Paediatric Anaesthesia Emergence Delirium [PAED] scale), hemodynamic parameters, and recovery characteristics were recorded during the recovery period. The Aono scale was also used to assess for emergence delirium. A WeChat applet was designed to facilitate a caregiver teleconsultation and to provide feedback on postoperative nausea and vomiting and any other complications after discharge. RESULTS The incidence of emergence delirium in group Alf2 (22.9%) and group Alf4 (21.1%) was significantly lower than that observed in the Sal group (48.3%). The PAED scores in group Alf2 (6.4 ± 3.5) and group Alf4 (5.8 ± 3.8) were significantly lower than those for group Sal (9.6 ± 5.1) (p < 0.01). Ten children in the Alf4 group needed manual ventilatory assistance to maintain end-tidal carbon dioxide (ETCO2) < 55 mm; children in group Alf2 did not. There was no significant difference between the discharge time of groups Alf2 and Sal (31.2 ± 4.64 vs 30.5 ± 2.82 min; 0.659 [95% confidence interval {CI} -1.052 to 2.369], p = 0.643); the time to discharge of group Alf4 (35.16 ± 3.97 min) was significantly longer than that of groups Alf2 and Sal (p < 0.01). The incidence of nausea and vomiting was similar in the three groups. No other clinically relevant adverse events were observed. CONCLUSIONS Intravenous infusion of 0.2 μg/kg/min and 0.4 μg/kg/min alfentanil decreased the incidence of emergence delirium in the post-anesthesia care unit. The 0.2 μg/kg/min dose of alfentanil resulted in less respiratory depression and discharge delay than the 0.4 μg/kg/min alfentanil dose. TRIAL REGISTRATION Chinese Clinical Trial Registry (ChiCTR2100043320).
Collapse
Affiliation(s)
- Nan Zhao
- Department of Anesthesiology, Stomatological Hospital of Chongqing Medical University, 426 Songshi North Road, Yubei District, Chongqing, China ,Chongqing Key Laboratory of Oral Diseases and Biomedical Sciences, Chongqing, China ,Chongqing Municipal Key Laboratory of Oral Biomedical Engineering of Higher Education, Chongqing, China
| | - Jie Zeng
- Department of Anesthesiology, Stomatological Hospital of Chongqing Medical University, 426 Songshi North Road, Yubei District, Chongqing, China ,Chongqing Key Laboratory of Oral Diseases and Biomedical Sciences, Chongqing, China ,Chongqing Municipal Key Laboratory of Oral Biomedical Engineering of Higher Education, Chongqing, China
| | - Lin Fan
- Department of Anesthesiology, Stomatological Hospital of Chongqing Medical University, 426 Songshi North Road, Yubei District, Chongqing, China ,Chongqing Key Laboratory of Oral Diseases and Biomedical Sciences, Chongqing, China ,Chongqing Municipal Key Laboratory of Oral Biomedical Engineering of Higher Education, Chongqing, China
| | - Chao Zhang
- Department of Anesthesiology, Stomatological Hospital of Chongqing Medical University, 426 Songshi North Road, Yubei District, Chongqing, China ,Chongqing Key Laboratory of Oral Diseases and Biomedical Sciences, Chongqing, China ,Chongqing Municipal Key Laboratory of Oral Biomedical Engineering of Higher Education, Chongqing, China
| | - YuJia Wu
- Department of Anesthesiology, Stomatological Hospital of Chongqing Medical University, 426 Songshi North Road, Yubei District, Chongqing, China ,Chongqing Key Laboratory of Oral Diseases and Biomedical Sciences, Chongqing, China ,Chongqing Municipal Key Laboratory of Oral Biomedical Engineering of Higher Education, Chongqing, China
| | - Xin Wang
- Department of Anesthesiology, Stomatological Hospital of Chongqing Medical University, 426 Songshi North Road, Yubei District, Chongqing, China ,Chongqing Key Laboratory of Oral Diseases and Biomedical Sciences, Chongqing, China ,Chongqing Municipal Key Laboratory of Oral Biomedical Engineering of Higher Education, Chongqing, China
| | - Feng Gao
- Department of Anesthesiology, Stomatological Hospital of Chongqing Medical University, 426 Songshi North Road, Yubei District, Chongqing, China ,Chongqing Key Laboratory of Oral Diseases and Biomedical Sciences, Chongqing, China ,Chongqing Municipal Key Laboratory of Oral Biomedical Engineering of Higher Education, Chongqing, China
| | - Cong Yu
- Department of Anesthesiology, Stomatological Hospital of Chongqing Medical University, 426 Songshi North Road, Yubei District, Chongqing, China. .,Chongqing Key Laboratory of Oral Diseases and Biomedical Sciences, Chongqing, China. .,Chongqing Municipal Key Laboratory of Oral Biomedical Engineering of Higher Education, Chongqing, China.
| |
Collapse
|
42
|
Eull D, Zachrison B, Nickel A. Feasibility trial of weighted blankets as an intervention for emergence delirium in postoperative pediatric patients. J Pediatr Nurs 2022; 62:30-35. [PMID: 34871946 DOI: 10.1016/j.pedn.2021.11.022] [Citation(s) in RCA: 5] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/28/2020] [Revised: 11/12/2021] [Accepted: 11/20/2021] [Indexed: 12/01/2022]
Abstract
BACKGROUND Emergence delirium (ED) is a significant problem in the post anesthesia care unit (PACU), resulting in dislodgement of medical devices, patient and staff injury, prolonged recovery, and parent dissatisfaction. Parental requests for the use of weighted blankets in the hospital setting have increased. However, while weighted blankets have shown potential as treatment for anxiety in adults and children, no studies have demonstrated their safe use with children in the hospital setting. PURPOSE To explore the safety of weighted blanket use with children in the PACU as an intervention for ED, a feasibility study was conducted. DESIGN AND METHODOLOGY A convenience sample of 93 participants, aged three to 10 years were recruited. Watcha scores, vital signs, length of wear time, and reason for blanket removal were recorded for all patients. RESULTS Eighty-five patients completed the study. Four participants experienced vital signs outside the defined safety parameters, with only one experiencing an adverse event (1.2%). This was consistent with the historic adverse event rate of 1% for the study site. Staff did not report issues with the use or cleaning of the blankets. Of interest, there was significant correlation between ED and suspected pain. CONCLUSION The study demonstrated weighted blanket use is safe and feasible with children in the hospital setting, Additional studies are needed to determine the effectiveness of weighted blankets as an intervention for ED and the impact pain may have on the severity and prevalence of ED.
Collapse
Affiliation(s)
- Donna Eull
- Children's MN, 2525 Chicago Avenue South, 32-5T, Minneapolis, MN 55404, United States of America.
| | - Brenda Zachrison
- Prairie Care, 212 Medical Building 111 Hundertmark Rd 205N, Chaska, MN 55318, United states of America
| | - Amanda Nickel
- Children's MN, 2525 Chicago Avenue South, 32-5T, Minneapolis, MN 55404, United States of America.
| |
Collapse
|
43
|
Do W, Kim HS, Kim SH, Kang H, Lee D, Baik J, Lee HJ, Hong JM. Sleep quality and emergence delirium in children undergoing strabismus surgery: a comparison between preschool- and school-age patients. BMC Anesthesiol 2021; 21:290. [PMID: 34809579 PMCID: PMC8607612 DOI: 10.1186/s12871-021-01507-2] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/28/2021] [Accepted: 11/08/2021] [Indexed: 11/12/2022] Open
Abstract
Background Emergence delirium (ED) is common in pediatric patients undergoing general anesthesia with sevoflurane. Preoperative sleep quality is associated with the risk factors for ED. However, research on the relationship between sleep quality and ED is limited. We aimed to investigate the relationship between ED and preoperative sleep quality in pediatric patients undergoing strabismus surgery. Methods This clinical trial included pediatric patients aged 4–12 years who underwent elective strabismus surgery. The patients and their parents were questioned about the patients’ preoperative sleep quality using the Pittsburgh Sleep Quality Index (PSQI) questionnaire. For anesthesia induction, thiopental (5 mg/kg) and rocuronium (0.6 mg/kg) were used, and anesthesia was maintained with sevoflurane (minimum alveolar concentration, 1–1.5). After administration of a reversal drug, extubation was performed, and the patients were transferred to a post-anesthesia recovery unit. At 10 min after extubation, the degree of ED was measured using the pediatric anesthesia emergence delirium (PAED) and Watcha scale scores. Results Of the 62 enrolled patients, three pediatric patients were excluded. The overall incidence of ED was 22%. A total of 59 patients were divided into the two groups. The ED group and the non-ED group comprised 13 and 46 patients. Age, height and weight were significantly lower in the ED group than in the non-ED group. Preoperative PSQI and Watcha scale score were significantly higher in the ED group than in the non-ED group. Multivariate analysis showed that age (adjusted OR [95% CI]: 0.490 [0.290–0.828], p = 0.008) and preoperative PSQI score (adjusted OR [95% CI]: 2.149[1.224–3.771], p = 0.008) was associated with ED. In sub-group analysis, PAED scale and Watcha scale scores showed a moderate correlation with preoperative sleep quality in preschool-age patients. Conclusion In conclusion, the incidence of ED tended to be higher in younger age and poorer preoperative sleep quality in pediatric patients. In particular, the poorer sleep quality score was associated with higher incidence of ED in the preschool-age. Large-scale clinical studies and long-term follow-up studies on ED and sleep quality are required. Trial registration This study was registered with Clinicaltrials.gov (NCT03332407) at November 5th 2017. Supplementary Information The online version contains supplementary material available at 10.1186/s12871-021-01507-2.
Collapse
Affiliation(s)
- Wangseok Do
- Biomedical Research Institute, Pusan National University Hospital, Busan, 49241, Republic of Korea
| | - Hyo-Sung Kim
- Biomedical Research Institute, Pusan National University Hospital, Busan, 49241, Republic of Korea
| | - Seung Ha Kim
- Biomedical Research Institute, Pusan National University Hospital, Busan, 49241, Republic of Korea
| | - Hyunjong Kang
- Biomedical Research Institute, Pusan National University Hospital, Busan, 49241, Republic of Korea
| | - Dowon Lee
- Biomedical Research Institute, Pusan National University Hospital, Busan, 49241, Republic of Korea.,Department of Anesthesia and Pain Medicine, School of Medicine, Pusan National University, 1-10, Ami-dong, Seo-gu, Busan, 49241, Republic of Korea
| | - Jiseok Baik
- Biomedical Research Institute, Pusan National University Hospital, Busan, 49241, Republic of Korea.,Department of Anesthesia and Pain Medicine, School of Medicine, Pusan National University, 1-10, Ami-dong, Seo-gu, Busan, 49241, Republic of Korea
| | - Hyeon Jeong Lee
- Biomedical Research Institute, Pusan National University Hospital, Busan, 49241, Republic of Korea.,Department of Anesthesia and Pain Medicine, School of Medicine, Pusan National University, 1-10, Ami-dong, Seo-gu, Busan, 49241, Republic of Korea
| | - Jeong-Min Hong
- Biomedical Research Institute, Pusan National University Hospital, Busan, 49241, Republic of Korea. .,Department of Anesthesia and Pain Medicine, School of Medicine, Pusan National University, 1-10, Ami-dong, Seo-gu, Busan, 49241, Republic of Korea.
| |
Collapse
|
44
|
Wang C, Wang W, Wang S, He R, Yang H, Jia Y, Chen L. Effect of Recorded Maternal Voice on Emergence Delirium in Children Under General Anesthesia: A Randomized Controlled Trial. J Nerv Ment Dis 2021; 209:814-819. [PMID: 34537805 DOI: 10.1097/nmd.0000000000001433] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/27/2022]
Abstract
ABSTRACT To determine the effect of recorded maternal voice on emergence delirium (ED) in children under general anesthesia, a three-group randomized trial was conducted. A total of 102 children were randomly assigned to mother recording group (n = 34), stranger recording group (n = 34), and control group (n = 34). All subjects were assessed for ED with the Pediatric Anesthesia Emergence Delirium Scale; pain with the Face, Legs, Activity, Cry, and Consolability Scale; and various recovery durations and hemodynamic parameters at six time points. One-way analysis of variance showed that the ED score was significantly lower in the mother recording group (F = 18.520, p = 0.000), and statistical significance was observed in the duration of eye opening (p = 0.001) and tracheal extubation (p = 0.002). Generalized estimating equations observed interaction effects on heart rate and blood pressure (both p = 0.000). Mothers' voice might help reduce ED in children under general anesthesia.
Collapse
Affiliation(s)
| | - Wei Wang
- Department of PACU, The First Bethune Hospital of Jilin University
| | | | | | | | - Yong Jia
- School of Nursing, Jilin University
| | | |
Collapse
|
45
|
Karasu D, Karaca U, Ozgunay SE, Yilmaz C, Yetik F, Ozkaya G. The frequency of emergence delirium in children undergoing outpatient anaesthesia for magnetic resonance imaging. Int J Clin Pract 2021; 75:e14763. [PMID: 34455665 DOI: 10.1111/ijcp.14763] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/29/2021] [Revised: 08/26/2021] [Accepted: 08/27/2021] [Indexed: 12/21/2022] Open
Abstract
AIM The aim of this study was to investigate the effect on the occurrence of emergence delirium of propofol and ketofol with intranasal dexmedetomidine and midazolam applied as premedication to paediatric patients during magnetic resonance imaging (MRI). METHODS The study included children aged 2-10 years who received sedation for MRI, separated into four groups. Group MP (midazolam-propofol) received intranasal midazolam (0.2 mg/kg) for premedication and intravenous (IV) propofol (1 mg/kg) as the anaesthetic agent. Group MK (midazolam-ketofol) received intranasal midazolam (0.2 mg/kg) for premedication and IV ketofol (1 mg/kg) as the anaesthetic agent. Group DP (dexmedetomidine-propofol) received intranasal dexmedetomidine (1 mcg/kg) for premedication and IV propofol (1 mg/kg) as the anaesthetic agent. Group DK (dexmedetomidine-ketofol) received intranasal dexmedetomidine (1 mcg/kg) for premedication and IV ketofol (1 mg/kg) as the anaesthetic agent. The Paediatric Anaesthesia Emergence Delirium (PAED) scale was used to evaluate delirium. A PAED score ≥ 10 was accepted as delirium. RESULTS Statistical analysis was made of 140 paediatric patients. Delirium developed in 1.42% of all the patients, and in 5.7% of Group MP. The mean Aldrete and PAED scores were lower and the length of stay in the recovery room was shorter in Group DP than in the other groups. The need for additional anaesthetic was highest in Group DP at 94.3% and lowest in Group DK at 14.3%. The groups administered ketofol were observed to have a lower requirement for additional anaesthetic. CONCLUSION Delirium was seen at a very low rate only in the Group MP and it is difficult to say the best combination in terms of delirium frequency. However, intranasal dexmedetomidine and IV ketofol seem to be better and safer than the other groups in terms of the need for additional doses and the number of side effects. The addition of ketamine to propofol reduces the need for additional doses with a synergistic effect.
Collapse
Affiliation(s)
- Derya Karasu
- Department of Anaesthesiology and Reanimation, Bursa Yuksek Ihtisas Training and Research Hospital, University of Health Sciences Turkey, Bursa, Turkey
| | - Umran Karaca
- Department of Anaesthesiology and Reanimation, Bursa Yuksek Ihtisas Training and Research Hospital, University of Health Sciences Turkey, Bursa, Turkey
| | - Seyda Efsun Ozgunay
- Department of Anaesthesiology and Reanimation, Bursa Yuksek Ihtisas Training and Research Hospital, University of Health Sciences Turkey, Bursa, Turkey
| | - Canan Yilmaz
- Department of Anaesthesiology and Reanimation, Bursa Yuksek Ihtisas Training and Research Hospital, University of Health Sciences Turkey, Bursa, Turkey
| | - Ferit Yetik
- Department of Anaesthesiology and Reanimation, Bursa Gemlik State Hospital, Bursa, Turkey
| | - Guven Ozkaya
- Department of Biostatistics, Uludag University, Bursa, Turkey
| |
Collapse
|
46
|
Jarosinski SK, Simon BT, Baetge CL, Parry S, Araos J. The Effects of Prophylactic Dexmedetomidine Administration on General Anesthesia Recovery Quality in Healthy Dogs Anesthetized With Sevoflurane and a Fentanyl Constant Rate Infusion Undergoing Elective Orthopedic Procedures. Front Vet Sci 2021; 8:722038. [PMID: 34651033 PMCID: PMC8505894 DOI: 10.3389/fvets.2021.722038] [Citation(s) in RCA: 7] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/08/2021] [Accepted: 08/30/2021] [Indexed: 12/28/2022] Open
Abstract
To determine the effects of a dexmedetomidine slow bolus, administered prior to extubation, on recovery from sevoflurane-anesthesia and a fentanyl continuous rate infusion (CRI) in dogs undergoing orthopedic surgical procedures. Sixty-two client-owned, healthy dogs weighing 27.4 ± 11 kg undergoing elective orthopedic procedures were premedicated with: 0.1 mg/kg hydromorphone intramuscular, 0.05 mg/kg hydromorphone intravenously (IV) or 5 mcg/kg fentanyl IV. Following premedication, dogs were induced with propofol, administered locoregional anesthesia and maintained with sevoflurane and a fentanyl CRI (5-10 mcg/kg/hr). Dogs were randomly assigned to one of two treatment groups: 0.5 mcg/kg dexmedetomidine (DEX) or 0.5 ml/kg saline (SAL). Following surgery, patients were discontinued from the fentanyl CRI and administered DEX or SAL IV over 10 min. Following treatment, dogs were discontinued from sevoflurane and allowed to recover without interference. Recoveries were video recorded for 5 min following extubation and assessed by two blinded anesthesiologists using a visual analog scale (VAS; 0-10 cm) and a numerical rating scale (NRS; 1-10). Mean arterial pressure (MAP), heart rate (HR), pulse oximetry (SpO2), temperature, respiratory rate (RR), and end-tidal sevoflurane (EtSevo) and carbon dioxide (EtCO2) concentrations were recorded at specific time-points from induction to 5 min post-bolus administration and analyzed using linear mixed models. Fentanyl, propofol, and hydromorphone dose and the time to extubation were compared using an unpaired t-test. Differences in recovery scores between groups were evaluated with a Mann-Whitney test. Data reported as mean ± SD or median [interquartile range] when appropriate. A p < 0.05 was significant. There were no significant differences between groups in fentanyl, propofol, and hydromorphone dose, duration of anesthesia, intraoperative MAP, HR, RR, SpO2, temperature, EtCO2, EtSevo or anesthetic protocol. MAP was higher in DEX compared to SAL at 10 (104 ± 27 and 83 ± 23, respectively) and 15 (108 ± 28 and 86 ± 22, respectively) min after treatment. DEX had significantly lower VAS [0.88 (1.13)] and NRS [2.0 (1.5)] scores when compared to SAL [VAS = 1.56 (2.59); NRS = 2.5 (3.5)]. Time to extubation (min) was longer for DEX (19.7 ± 11) when compared to SAL (13.4 ± 10). Prophylactic dexmedetomidine improves recovery quality during the extubation period, but prolongs its duration, in sevoflurane-anesthetized healthy dogs administered fentanyl.
Collapse
Affiliation(s)
- Sarah K Jarosinski
- Department of Small Animal Clinical Sciences, College of Veterinary Medicine and Biomedical Sciences, Texas A&M University, College Station, TX, United States
| | - Bradley T Simon
- Department of Small Animal Clinical Sciences, College of Veterinary Medicine and Biomedical Sciences, Texas A&M University, College Station, TX, United States
| | - Courtney L Baetge
- Department of Small Animal Clinical Sciences, College of Veterinary Medicine and Biomedical Sciences, Texas A&M University, College Station, TX, United States
| | - Stephen Parry
- Cornell Statistical Consulting Unit, Cornell University, Ithaca, NY, United States
| | - Joaquin Araos
- Department of Clinical Sciences, Cornell University College of Veterinary Medicine, Ithaca, NY, United States
| |
Collapse
|
47
|
Cho CK, Chang M, Lee SJ, Cho SA, Sung TY. Effects of chlorpheniramine on emergence agitation after general anesthesia for ureteroscopic stone surgery: a retrospective cohort study. Anesth Pain Med (Seoul) 2021; 17:157-164. [PMID: 34784458 PMCID: PMC9091677 DOI: 10.17085/apm.21066] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/22/2021] [Accepted: 08/04/2021] [Indexed: 11/21/2022] Open
Abstract
Background The presence of a urinary catheter, postoperative pain, and postoperative nausea and vomiting are risk factors for emergence agitation (EA). Antimuscarinic agents are primary agents used in the prevention and treatment of urinary catheter-related bladder discomfort. Chlorpheniramine has antimuscarinic, antinociceptive, and antiemetic effects. This retrospective study investigated the role of chlorpheniramine in EA prevention following ureteroscopic stone surgery. Methods Of 110 adult patients who underwent ureteroscopic stone surgery under general anesthesia between January and December 2019, the medical records of 93 patients were analyzed retrospectively. The patients were divided into control (n = 52) and chlorpheniramine (n = 41) groups according to the receipt of intravenous chlorpheniramine before the induction of anesthesia. The incidence and severity of EA were compared between the groups as primary and secondary endpoints, respectively. The effects of chlorpheniramine on the requirement for inhalation anesthetic (desflurane) during surgery, changes in mean blood pressure and heart rate during emergence, and adverse events were also compared. Results The incidence (21.2% in the control group, 24.4% in the chlorpheniramine group) and severity of EA did not differ between groups. The intraoperative requirement for desflurane, changes in mean blood pressure and heart rate during emergence, and adverse events were also similar between groups. Conclusions Chlorpheniramine was not associated with a decrease in EA incidence or severity in patients who underwent ureteroscopic stone surgery.
Collapse
Affiliation(s)
- Choon-Kyu Cho
- Department of Anesthesiology and Pain Medicine, Konyang University Hospital, Konyang University College of Medicine, Daejeon, Korea
| | - Minhye Chang
- Department of Anesthesiology and Pain Medicine, Konyang University Hospital, Konyang University College of Medicine, Daejeon, Korea
| | - Seok-Jin Lee
- Department of Anesthesiology and Pain Medicine, Konyang University Hospital, Konyang University College of Medicine, Daejeon, Korea
| | - Sung-Ae Cho
- Department of Anesthesiology and Pain Medicine, Konyang University Hospital, Konyang University College of Medicine, Daejeon, Korea
| | - Tae-Yun Sung
- Department of Anesthesiology and Pain Medicine, Konyang University Hospital, Konyang University College of Medicine, Daejeon, Korea
| |
Collapse
|
48
|
Kim J, Byun SH, Kim JW, Kim JY, Kim YJ, Choi N, Lee BS, Yu S, Kim E. Behavioral changes after hospital discharge in preschool children experiencing emergence delirium after general anesthesia: A prospective observational study. Paediatr Anaesth 2021; 31:1056-1064. [PMID: 34309126 DOI: 10.1111/pan.14259] [Citation(s) in RCA: 12] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/30/2020] [Revised: 05/10/2021] [Accepted: 06/10/2021] [Indexed: 01/15/2023]
Abstract
BACKGROUND Emergence delirium is well known as early postoperative behavioral change after general anesthesia. However, it is unclear whether children with emergence delirium have negative behavioral changes after hospital discharge. AIM This observational study investigated the association between emergence delirium and posthospital behavioral changes. METHODS One-hundred preschoolers aged 2-7 years undergoing elective surgery were enrolled in 2 tertiary university hospitals. Preoperative anxiety level was assessed using modified Yale preoperative anxiety scale. Emergence delirium was defined via pediatric anesthesia emergence delirium score ≥12 at any time in the recovery room. We divided the delirium score into a delirium-specific score (the sum of the first 3 items: eye contact, purposeful movement, and awareness of surrounding) and a pain-related score (the sum of the last 2 items: restlessness and inconsolability). High delirium scores represent severe emergence delirium. Posthospital behavioral changes were assessed by a change in Child Behavior Checklist 1.5-5 scores before and 1 week after surgery. The primary outcome was the total behavior checklist scores 1 week after surgery. Multiple linear regression was performed to identify risk factors for posthospital behavioral changes. RESULTS Children with emergence delirium (n = 58) had higher postoperative behavior checklist scores than children without emergence delirium (n = 42) [mean (SD), 22.8 (17.5) vs. 14.0 (12.1); mean difference (95% CI), 8.8 (1.5-16.2)]. Increases in preoperative anxiety level [regression coefficient (b) (95% CI) =0.241 (0.126-0.356)] and peak delirium-specific score [b = 0.789 (0.137-1.442)] were associated with an increase in behavior checklist score 1 week after surgery, while pain-related score, type of surgery, premedication, and age were not. CONCLUSION Children with emergence delirium developed more severe behavior changes 1 week after surgery than those without emergence delirium. High preoperative anxiety level and emergence delirium scores were associated with posthospital behavioral changes.
Collapse
Affiliation(s)
- Jonghae Kim
- Department of Anesthesiology and Pain Medicine, Daegu Catholic University Medical Center, School of Medicine, Daegu Catholic University, Daegu, Korea
| | - Sung Hye Byun
- Department of Anesthesiology and Pain Medicine, School of Medicine, Kyungpook National University Chilgok Hospital, Kyungpook National University, Daegu, Korea
| | - Jun Won Kim
- Department of Psychiatry, School of Medicine, Catholic University of Daegu, Daegu, Korea
| | - Ji-Yoon Kim
- Department of Anesthesiology and Pain Medicine, Hanyang University Medical Center, Seoul, Korea
| | - Yun Jin Kim
- Biostatistical Consulting and Research Lab, Medical Research Collaborating Center, Hanyang University, Seoul, Korea
| | - Nayeon Choi
- Biostatistical Consulting and Research Lab, Medical Research Collaborating Center, Hanyang University, Seoul, Korea
| | - Bong Soo Lee
- Department of Anesthesiology and Pain Medicine, Hanyang University Medical Center, Seoul, Korea
| | - Seungcheol Yu
- Department of Anesthesiology and Pain Medicine, Hanyang University Medical Center, Seoul, Korea
| | - Eugene Kim
- Department of Anesthesiology and Pain Medicine, Hanyang University Medical Center, College of Medicine, Hanyang University, Seoul, Korea
| |
Collapse
|
49
|
Wang W, Zhou H, Sun A, Xiao J, Dong J, Xu H. Determination of the Median Effective Dose of Dexmedetomidine for the Prevention of Emergence Agitation in Geriatric Patients Undergoing Major Open Surgery With General Anesthesia: A Prospective, Double-Blinded, Dose-Response Trial. Dose Response 2021; 19:15593258211037153. [PMID: 34471401 PMCID: PMC8404654 DOI: 10.1177/15593258211037153] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/04/2021] [Revised: 07/04/2021] [Accepted: 07/09/2021] [Indexed: 12/03/2022] Open
Abstract
Dexmedetomidine can effectively decrease the incidences of emergence agitation (EA) in adult patients, but there are major side effects related to increased dose of dexmedetomidine. The purpose of this study was to determine the median effective dose of dexmedetomidine in the prevention of EA among geriatric patients undergoing major open surgery with general anesthesia. A total of 50 geriatric patients were enrolled in this study. Dexmedetomidine 0.5 μg·kg−1·h−1 continuous intravenous infusion was administered to the first patient. The next dose was increased or decreased by .05 depending on the response of the previous patient, according to the Dixon up-and-down method. An “effective” or “ineffective” response was determined based on the Riker sedation-agitation score (RSAS), we defined “effective” as RSAS<5, and “ineffective” as RSAS≥5. The ED50 of dexmedetomidine in prevention of EA was .30 μg·kg−1·h−1 (95% CI, .27–.33) and the predicted ED95 was .42 μg·kg−1·h−1 (95% CI, .38–.51). The incidence of bradycardia was significantly increased in the group without EA compared to the group with EA (57.1% vs 13.6%, P = .002). The ED50 of dexmedetomidine in prevention of EA was .30 μg·kg−1·h−1 (95% CI, .27–.33) and the predicted ED95 was .42 μg·kg−1·h−1 (95% CI, .38–.51). Bradycardia was the main complication.
Collapse
Affiliation(s)
- WeiBing Wang
- Department of Anesthesiology, The Affiliated AnQing Municipal Hospitals of Anhui Medical University, AnQing, China
| | - Hui Zhou
- Department of Anesthesiology, The Affiliated AnQing Municipal Hospitals of Anhui Medical University, AnQing, China
| | - AiJiao Sun
- Department of Anesthesiology, The Affiliated AnQing Municipal Hospitals of Anhui Medical University, AnQing, China
| | - JinBo Xiao
- Department of Anesthesiology, The Affiliated AnQing Municipal Hospitals of Anhui Medical University, AnQing, China
| | - JingChong Dong
- Department of Anesthesiology, The Affiliated AnQing Municipal Hospitals of Anhui Medical University, AnQing, China
| | - Huang Xu
- Department of Anesthesiology, The Affiliated AnQing Municipal Hospitals of Anhui Medical University, AnQing, China
| |
Collapse
|
50
|
Haile S, Girma T, Akalu L. Effectiveness of propofol on incidence and severity of emergence agitation on pediatric patients undergo ENT and ophthalmic surgery: Prospective cohort study design. Ann Med Surg (Lond) 2021; 69:102765. [PMID: 34484732 PMCID: PMC8403542 DOI: 10.1016/j.amsu.2021.102765] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/03/2021] [Revised: 08/20/2021] [Accepted: 08/22/2021] [Indexed: 11/26/2022] Open
Abstract
INTRODUCTION Emergence agitation is a common problem that can occur after administration of general anesthesia and during recovery time especially in pediatric patients, which can result in life-threatening events if not managed adequately and timely. Usage of modern inhalational anesthetic agents like sevoflurane, isoflurane, and also halothane is a common cause for emergence agitation. Currently, the use of propofol is gaining acceptance largely on decreasing emergence agitation in addition to prevention of postoperative nausea and vomiting. The objective of this study was to assess the effectiveness of prophylaxis administration of propofol on incidence & severity of emergence agitation on pediatric patients undergo ENT & ophthalmic surgery under general anesthesia. METHODS AND MATERIAL An institutional-based prospective cohort study was conducted on 90 patients. Patients who take 1 mg/kg of propofol were grouped into exposed while if propofol were not given grouped to non-exposed. Data were collected through intraoperative observation & by using WATCH & PAED score the patients were observed at 5, 15 & 30 min in the recovery room. Incidence of emergence agitation was analyzed by chi-square test & Mann Whitney U test was applied for the severity of emergence agitation. A P-value less than 0.05 was declared as statistically significant. RESULT From a total of 90 study participants 64% of the non-exposed group & 31% of the exposed group were developed emergence agitation which was statistically significant with p = 0.002. The severity of agitation was also higher in the non-exposed group than the exposed group at 5, 15 & 30 min with p = 0.009, 0.013, and 0.011 respectively. CONCLUSION Administering 1 mg/kg propofol before the end of surgery in pediatrics ENT & ophthalmic procedure under general anesthesia is effective in reducing incidence & severity of emergence agitation. Based on our findings we recommend using 1 mg/kg propofol at the end of surgery to reduce the occurrence of emergency agitation.
Collapse
Affiliation(s)
- Samrawit Haile
- Department of Anesthesia, Saint Paulos Medical College, Addis Ababa, Ethiopia
| | - Timsel Girma
- Department of Anesthesiology, College of Health Science and Medicine, Dilla University, Dilla, Ethiopia
| | - Leulayehu Akalu
- Departement of Anesthesia, Saint Paulos Millenium Medical College, Addis Ababa, Ethiopia
| |
Collapse
|