Effect of Pregabalin Premedication on Emergence Agitation in Children after Sevoflurane Anesthesia: A Randomized Controlled Study

Perioperative Indications for Gabapentinoids in Pediatrics: A Narrative Review

In recent years, there has been increased interest in using gabapentinoids (gabapentin and pregabalin) as part of multimodal medication plans or enhanced recovery after surgery protocols to mitigate several perioperative clinical challenges. Outcomes explored in the context of using gabapentinoids perioperatively in children are variable and include acute complications of pain, anxiety, nausea and vomiting, and emergence agitation, as well as the long-term postoperative outcome of chronic postsurgical pain. This narrative review describes the current literature regarding perioperative use of gabapentinoids in pediatric patients and aims to describe the role of gabapentinoids in the perioperative setting for each specific indication.

Efficacy of Dexmedetomidine Anesthesia plus Dorsal Penile Nerve Block in Pediatric Circumcision

Objective

To assess the efficacy of dexmedetomidine anesthesia plus dorsal penile nerve block in pediatric circumcision.

Methods

In this retrospective study, 80 children receiving circumcision in our hospital from February 2020 to February 2021 were recruited and assigned via different anesthesia methods at a ratio of 1 : 1 to receive dorsal penile nerve block plus dexmedetomidine anesthesia (combined anesthesia group) or only sevoflurane for total inhalational anesthesia (total anesthesia group). Traditional Chinese medicine (TCM) care was introduced to both groups of patients. Outcome measures included vital signs, operative indices, anesthesia effect, adverse reactions, parent satisfaction, and nursing satisfaction.

Results

There were no significant differences in the heart rate, oxygen saturation, and mean arterial pressure between the two groups of children before anesthesia, after anesthesia, and during the awakening period (P > 0.05). Patients receiving combined anesthesia showed a shorter time lapse before the disappearance of eyelash reflex, longer time lapse before postoperative analgesic use, faster awakening, and shorter operation time and hospital stay versus those receiving total inhalational anesthesia alone (P > 0.05). The combined anesthesia resulted in a lower Induction Compliance Checklist (ICC) score, McGill score, and Richmond Agitation-Sedation Scale (RASS) score and a higher Ramsay score versus total anesthesia (P > 0.05). Patients receiving combined anesthesia showed a significantly lower incidence of adverse events (5.00% (2/40)) versus total inhalational anesthesia (62.50% (25/40)) (X² = 29.574, P > 0.05). The combined anesthesia group had a higher parent satisfaction (92.50% (37/40)) versus the total anesthesia group (75.00% (30/40)) (X² = 4.501, P > 0.05). A total of 80 questionnaires were distributed, with a 100% return rate and a 100% validity rate, and all 80 questionnaires scored 90 points or above. The families of children in both groups were satisfied with the quality of TCM care.

Conclusion

The efficacy of dorsal penile nerve block plus dexmedetomidine anesthesia in pediatric circumcision is better than total inhalational anesthesia with sevoflurane.

Emergence agitation after the cleft lip or palate surgery in pediatric patients: a prospective study

OBJECTIVE

The pediatric patients after the cleft lip or palate surgery have high incidences of postoperative complications. Emergence agitation is a common complication. It is also a mild complication compared with lingual swelling and other airway-related complications, which are more often expected in children. However, it can cover signs of hypoxic episodes that appear immediately after surgery, because enough monitoring of an agitated child is not possible. The study aimed to discuss the occurrence of EA after cleft lip or palate surgery in pediatric patients, and further to provide a basis for later interventions.

METHODS

This prospective study included 214 patients aged 3 months to 6 years old at a tertiary stomatological teaching hospital. We calculated the EA scores for every patient when they entered PACU, were in PACU, and left from PACU, and the score ranges from 1 to 5 point. The patients occurred agitation if they scored from 3 to 5 on the 5-point scale, and the patients needed medication and care if they had a score of 4 or 5.

RESULT

The results showed that the EA scores of 69.63% (n = 149) among patients were 3 or higher when they entered PACU, 40.65% (n = 87) were 3 or higher when they were in PACU, and 21.03% (n = 45) were 3 or higher when they left from PACU. Whether they are children with cleft lip, cleft palate, or horizontal cleft, the EA scores had a significant difference among different timings when entering PACU, in PACU, and leaving PACU (P = 0.000). Further comparison showed that the EA score of patients was the highest when entering PACU, and the lowest when leaving PACU. A significant difference in the EA scores was found among the patients with cleft lip, cleft palate, and horizontal cleft when they were in PACU (P = 0.024), further comparison showed that the EA score of the patients with cleft lip was lower than patients with cleft palate or horizontal cleft. While there were no statistical differences in the EA scores among the patients with cleft lip, cleft palate, and horizontal cleft when they entered PACU and left from PACU (P > 0.05).

CONCLUSION

Children had a high incidence of EA after cleft lip or cleft palate or horizontal cleft surgery, especially when they entered PACU. Children after cleft palate and horizontal cleft surgery had higher incidences of EA than cleft lip surgery when they were in PACU.

Gabapentin in Improvement of Procedural Sedation and Analgesia in Oncologic Pediatric Patients: A Clinical Trial

Background

Preoperative anxiety and distress can produce significant psychological impacts on children undergoing oncologic care or investigation. Adjuvant therapy is used for pain management in children; however, pre-analgesia options are restricted because they can cause undesirable outcomes.

Objectives

Our study aimed to investigate the use of gabapentin in procedural sedation as adjuvant therapy in children undergoing oncologic treatment.

Methods

We performed a double-blinded, randomized, clinical trial at Albert Sabin Infant’s Hospital in Fortaleza, Brazil. Children aged 1 - 6 years who had myelogram or lumbar puncture (associated or not with intrathecal chemotherapy) received placebo or gabapentin syrups (15 mg/kg and 30 mg/kg) one to two hours before the procedure. Preoperative anxiety was evaluated by the Yale preoperative anxiety scale modified (m-YPAS scale). The pediatric anesthesia emergence delirium (PAED) and children and infants postoperative pain scale (CHIPP) scales were used for emergence delirium and pain intensity measurement, respectively.

Results

We evaluated 135 patients. We observed that the gabapentin groups presented lower m-YPAS scores than the placebo group at separation and induction times. Postoperatively, the gabapentin groups had lower PAED and CHIPP scores than the placebo group; however, only had PAED scores clinical relevance. No significant differences were found between the gabapentin groups. Furthermore, children with less than three prior similar procedures were more likely to benefit from gabapentin. Postoperative vomiting was prevented by 30 mg/kg gabapentin.

Conclusions

Although gabapentin has little preoperative effects, it ameliorates anxiety before induction, improves anesthetic induction, and reduces the occurrence of emergence delirium and postoperative vomiting up to eight hours after the procedure. Thus, we indicate gabapentin as adjuvant therapy for procedural sedation.

Effects of Bilateral Infraorbital and Infratrochlear Nerve Block on Emergence Agitation after Septorhinoplasty: A Randomized Controlled Trial

Emergence agitation is common after septorhinoplasty, and postoperative pain is the main risk factor for this condition. Infraorbital and infratrochlear nerve block have been reported to facilitate pain management in patients after nasal procedures. The effect of peripheral nerve block on the incidence of emergence agitation has not been evaluated. Sixty-six patients that were scheduled for septorhinoplasty were assigned to receive bilateral infraorbital and infratrochlear nerve block with either 8 mL of 0.5% ropivacaine (Block group) or isotonic saline (Sham Block group). The incidence of emergence agitation was evaluated using the Riker sedation-agitation scale. Analgesic consumption, hemodynamic parameters, postoperative pain scores, adverse events, and patient satisfaction with analgesia were evaluated. The incidence of emergence agitation was lower in the Block group than in the Sham Block group (6 (20.0%) versus 20 (62.5%), p = 0.002). The mean intraoperative remifentanil consumption was lower in the Block group than in the Sham Block group (0.074 ± 0.014 μg/kg/min. versus 0.093 ± 0.019 μg/kg/min., respectively, p < 0.0001), as was the proportion of patients that needed postoperative tramadol administration and median postoperative pain score at 0–2 h after surgery (9 (30.0%) versus 21 (65.6%), p = 0.011; 3.0 (2.0–4.0) versus 4.0 (3.0–4.0), p < 0.0001, respectively). Hemodynamic parameters and the incidence of adverse events were similar between the two groups. The median patient satisfaction score with respect to analgesia was higher in the Block group than in the Sham Block group (3.5 (3.0–4.0) versus 3.0 (3.0–4.0), respectively, p = 0.034). The preoperative bilateral infraorbital and infratrochlear nerve block decreased the incidence of emergence agitation after septorhinoplasty.