Effect of single-dose dexmedetomidine on the incidence of emergence delirium after sevoflurane-based anesthesia in children undergoing strabismus surgery

Background Emergence agitation in children after sevoflurane is common. Different drugs have been used to decrease its occurrence with variable efficacy. The authors compared the incidence and severity of emergence agitation in children who received a single dose of propofol at the end of strabismus surgery versus children who received saline. Methods In this prospective, randomized, double-blind study, the authors enrolled 80 healthy children aged 2-6 yr. The children were randomly allocated to the propofol group (n = 41), which received 1 mg/kg propofol at the end of surgery, or to the saline group (n = 39), which received saline. Results The mean scores on the Pediatric Anesthesia Emergence Delirium scale were significantly lower in the propofol group compared with the saline group (8.6 +/- 3.9 vs. 11.5 +/- 4.5; P = 0.004). Also, the incidence of agitation was significantly lower in the propofol group compared with the saline group (19.5% vs. 47.2%; P = 0.01). A threshold score greater than 10 on the Pediatric Anesthesia Emergence Delirium scale was the best discriminator between presence and absence of emergence agitation. Times to removal of the laryngeal mask airway (10.6 +/- 1.5 vs. 9.4 +/- 1.9 min; P = 0.004) and emergence times (23.4 +/- 5.7 vs. 19.7 +/- 5 min; P = 0.004) were significantly longer in the propofol group. However, discharge times were similar between the two groups (propofol: 34.1 +/- 8.4 min; saline: 34.9 +/- 8.6 min). More parents in the propofol group were satisfied. Conclusions In children undergoing strabismus surgery, 1 mg/kg propofol at the end of surgery after discontinuation of sevoflurane decreases the incidence of agitation and improves parents' satisfaction without delaying discharge from the postanesthesia care unit.

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A Single Dose of Propofol at the End of Surgery for the Prevention of Emergence Agitation in Children Undergoing Strabismus Surgery during Sevoflurane Anesthesia

Yearbook of Anesthesiology and Pain Management ◽

10.1016/s1073-5437(08)70849-0 ◽

2008 ◽

Vol 2008 ◽

pp. 88

Author(s):

S. Black

Keyword(s):

Single Dose ◽

Strabismus Surgery ◽

Sevoflurane Anesthesia ◽

Emergence Agitation

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A comparison of single dose dexmedetomidine with propofol for the prevention of emergence delirium after desflurane anaesthesia in children

Anaesthesia ◽

10.1111/anae.13230 ◽

2015 ◽

Vol 71 (1) ◽

pp. 50-57 ◽

Cited By ~ 21

Author(s):

J. K. Makkar ◽

N. Bhatia ◽

I. Bala ◽

D. Dwivedi ◽

P. M. Singh

Keyword(s):

Single Dose ◽

Emergence Delirium ◽

Desflurane Anaesthesia

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Notice of Retraction: “A Randomized Clinical Trial of a Single Dose of Ramosetron for the Prevention of Vomiting After Strabismus Surgery in Children: A Dose-Ranging Study” (Arch Ophthalmol. 2005;123[1]:25-28)

Archives of Ophthalmology ◽

10.1001/archophthalmol.2012.1387 ◽

2012 ◽

Vol 130 (7) ◽

pp. 952

Author(s):

Daniel M. Albert ◽

Howard Bauchner

Keyword(s):

Clinical Trial ◽

Single Dose ◽

Randomized Clinical Trial ◽

Strabismus Surgery ◽

Dose Ranging

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Sleep quality and emergence delirium in children undergoing strabismus surgery: a comparison between preschool- and school-age patients

BMC Anesthesiology ◽

10.1186/s12871-021-01507-2 ◽

2021 ◽

Vol 21 (1) ◽

Author(s):

Wangseok Do ◽

Hyo-Sung Kim ◽

Seung Ha Kim ◽

Hyunjong Kang ◽

Dowon Lee ◽

...

Keyword(s):

Sleep Quality ◽

Pediatric Patients ◽

Group Analysis ◽

Pediatric Anesthesia ◽

Strabismus Surgery ◽

Preschool Age ◽

Anesthesia Induction ◽

Emergence Delirium ◽

Scale Scores ◽

The Relationship

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.

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A Randomized Clinical Trial of a Single Dose of Ramosetron for the Prevention of Vomiting After Strabismus Surgery in Children

Archives of Ophthalmology ◽

10.1001/archopht.123.1.25 ◽

2005 ◽

Vol 123 (1) ◽

pp. 25 ◽

Cited By ~ 9

Author(s):

Yoshitaka Fujii ◽

Hiroyoshi Tanaka ◽

Mutsuko Ito

Keyword(s):

Clinical Trial ◽

Single Dose ◽

Randomized Clinical Trial ◽

Strabismus Surgery

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Effect of magnesium supplementation on emergence delirium and postoperative pain in children undergoing strabismus surgery: a prospective randomised controlled study

BMC Anesthesiology ◽

10.1186/s12871-020-01192-7 ◽

2020 ◽

Vol 20 (1) ◽

Author(s):

Ji-Hyun Lee ◽

Seungeun Choi ◽

Minkyoo Lee ◽

Young-Eun Jang ◽

Eun-Hee Kim ◽

...

Keyword(s):

Postoperative Pain ◽

Randomized Study ◽

Strabismus Surgery ◽

Preoperative Anxiety ◽

Controlled Study ◽

Control Group ◽

Magnesium Supplementation ◽

Emergence Period ◽

Emergence Delirium ◽

Respiratory Events

Abstract Background The benefits of intraoperative magnesium supplementation have been reported. In this prospective, randomized study, the effects of magnesium supplementation during general anaesthesia on emergence delirium and postoperative pain in children were evaluated. Methods A total of 66 children aged 2 to 5 years who underwent strabismus surgery were assigned to the magnesium or to the control group. Preoperative anxiety was assessed using the modified Yale Preoperative Anxiety Scale. After anaesthesia induction, the magnesium group received an initial loading dose of 30 mg/kg magnesium sulphate over 10 min and, then, continuous infusion of 10 mg/kg per h until 10 min before the end of the surgery. The control group received an equal volume of normal saline via the same regimen. The Paediatric Anaesthesia Emergence Delirium (PAED) score, pain score, and respiratory events were assessed at the postanaesthetic care unit. Results Data obtained from 65 children were analyzed. The PAED and pain scores of the two groups did not differ significantly. There were 26 of 33 (78.8%) and 27 of 32 (84.4%) children with emergence delirium in the control and the magnesium groups, respectively (odds ratio 0.69, 95% CI 0.19–2.44; p = 0.561). The preoperative anxiety score was not significantly correlated with the PAED score. The incidence of respiratory events during the emergence period did not differ significantly between the two groups. Conclusions Magnesium supplementation during anaesthesia had no significant effects on the incidence of emergence delirium or postoperative pain in children undergoing strabismus surgery. Trial registration ClinicalTrials.gov (NCT03132701). Prospectively registered May 8, 2017.

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