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

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.

Pengetahuan Dengan Kemampuan Komunikasi Terapeutik Perawat Pada Pasien Anak Usia Prasekolah (Knowledge and Nurses' Therapeutic Communication Skills in Pre-School Age Patient)

2020 ◽  
Vol 9 (2) ◽  
pp. 102
Author(s):  
Idayati Idayati ◽  
Diny Vellyana ◽  
Sondang Sondang
Keyword(s):  
Communication Skills ◽  
Growth And Development ◽  
Pediatric Patients ◽  
Preschool Age ◽  
P Value ◽  
Therapeutic Communication ◽  
Cross Sectional ◽  
Spearman Rank ◽  
Relationship Of ◽  
The Relationship

AbstractHaving treatment in a hospital (hospitalization) is an unpleasant and threatening experience for everyone, especially for children who are still in the process of growth and development. One way to resolve this problem is to use therapeutic communication effectively which will and will be carried out nursing actions. To communicate with children, special approaches or techniques are needed so that the relationship can run well according to the child's growth and development. One of the predisposing factors according to Lawrencen Green's theory is knowledge, when a nurse has good knowledge, her ability in therapeutic communication will be good too. The aim of study is to determine the relationship of knowledge with the therapeutic communication skills of nurses in pediatric patients. This research uses survey analytic methode with crosssectional. Sample in the study were 66 nurses in inpatient rooms of Graha Husada Hospital,technique purposive samplingfor sampling.Data analysis using the Spearman Rank (Rho) correlation test with a significance level (α = 0.05)  is obtained p value 0.025 (p <0.05). There is relationship of knowledge with therapeutic communication ability of nurses in pediatric patients treated at Graha Husada Hospital  Bandar Lampung. Nurses are expected to be able to improve services in providing nursing care to pediatric patients, especially preschool age pediatric patients. AbstrakBerobat di rumah sakit (hospitalisasi) merupakan pengalaman yang tidakmenyenangkan dan mengancam bagi setiaporang,terutama bagi anak – anak yang masih dalam proses tumbuh kembang. Salah satu cara untuk mengatasi masalah tersebut adalah dengan menggunakan komunikasi terapeutik secara efektif yang akan dilakukan tindakan keperawatan. Untuk berkomunikasi dengan anak diperlukan pendekatan atau teknik khusus agar hubungan dapat berjalan dengan baik sesuai dengan tumbuh kembang anak. Salah satu faktor predisposisi menurut teori Lawrence Green adalah pengetahuan, bila perawat memiliki pengetahuan yang baik maka kemampuannya dalam komunikasi terapeutik juga akan baik. Tujuan penelitian ini untuk mengetahui hubungan pengetahuan dengan keterampilan komunikasi terapeutik perawat pada pasien anak. Penelitian ini menggunakan metode survey analitik dengan pendekatan cross sectional. Sampel dalam penelitian ini adalah 66 perawat ruang rawat inap Rumah Sakit Graha Husada dengan teknik pengambilan sampel purposive sampling. Analisis data menggunakan uji korelasi Spearman Rank (Rho) dengan tingkat signifikansi (α = 0.05) diperoleh dari niai p 0.025 (p<0.05). Ada hubungan pengetahuan dengan kemampuan komunikasi terapeutik perawat pada pasien anak yang di rawat di RS Graha Husada Bandar almpung. Perawat diharapkan mampu meningkatkan pelayanan dalam memberikan asuhan keperawatan kepada pasien anak khususnya pasien anak usia prasekolah.

Factors Affecting Oculocardiac Reflex Incidence In Pediatric Strabismus Surgery: Retrospective Study

2021 ◽  
Author(s):  
Bengü Gülhan Aydın ◽  
Gamze Küçükosman ◽  
Özcan Pişkin ◽  
Bahar Aktaş ◽  
Rahşan Dilek Okyay ◽  
...  
Keyword(s):  
Risk Factors ◽  
Pediatric Patients ◽  
Sinus Bradycardia ◽  
Strabismus Surgery ◽  
Neuromuscular Blocker ◽  
Anesthesia Induction ◽  
Factors Affecting ◽  
Oculocardiac Reflex ◽  
Anesthetic Drugs ◽  
Duration Of Surgery

INTRODUCTION: Oculocardiac reflex (OCR) activation is common during the strabismus surgery. As a result of the OCR, sinus bradycardia, atrioventricular block, ventricular fibrillation and even asystole may occur. Pediatric patients are also more vulnerable to harmful effects of this reflex. The aim of this study was to determine the possible risk factors affecting the incidence of OCR in pediatric patients undergoing strabismus surgery. METHODS: The medical records of the pediatric patients who underwent strabismus surgery between January 2015 and September 2018 were retrospectively reviewed. Operations performed by only one surgeon. OCR was defined as a more than 20% reduction in HR induced by the extraocular muscle (EOM) manipulation. Demographic data, duration of surgery, history of any previous strabismus surgery and possible development of OCR, anesthesia management, neuromuscular blocker and anesthetic drugs used for the anesthesia induction and maintenance as well as the airway management, the number of operated eyes, and also the muscle types of the patients were all recorded. Risk factors for OCR were evaluated by logistic regression analysis. RESULTS: Out of 92 pediatric patients who were initially evaluated, six were excluded from the study because their files were missing. A total of 86 patients were included in the study. During surgery, OCR occurred in 29 (33.7%) patients. The absence of administering benzodiazepine for premedication (p=0.03) and neuromuscular blocker after induction (p=0.046) in pediatric patients are specified as independent risk factors. We found that the use of a neuromuscular blocker and benzodiazepine in premedication reduced the risk of OCR by 3.64 and 3.11 times, respectively. DISCUSSION AND CONCLUSION: The incidence of OCR may decrease with preventive measures such as neuromuscular blocker application, premedication with benzodiazepine in strabismus surgeries.

scholarly journals Emergence delirium and intranasal dexmedetomidine premedication in pediatric anesthesia: a retrospective study in plastic surgery

2019 ◽  
Author(s):  
Alessandra Di Palma ◽  
Federica Maldarelli ◽  
Antonietta Cimino ◽  
Mario Zama ◽  
Sergio Giuseppe Picardo
Keyword(s):  
Retrospective Study ◽  
Plastic Surgery ◽  
Lower Incidence ◽  
Pediatric Patients ◽  
Pediatric Anesthesia ◽  
Control Group ◽  
Emergence Delirium ◽  
Different Ages ◽  
Combined Anesthesia ◽  
And Control

Abstract Background Dexmedetomidine is widely used in the treatment of emergency delirium (ED) in pediatric patients. However, further evidence on its use in pediatric anesthesia on potential differences in the reduction of ED according to patient’s age and type of anesthesia is required. Moreover, whether dexmedetomidine influences time of discharge from the surgical area remains unclear. We evaluated whether intranasal dexmedetomidine is effective in decreasing the incidence of ED in 106 children who had anesthesia for plastic surgery undergoing general or combined anesthesia at different ages. We also assessed if this drug has an impact on time to discharge from the surgical area. Methods In total, 106 children, aged 2–10 years, were enrolled in this retrospective study. Among them, 50 have been premedicated with dexmedetomidine (dexmedetomidine group); the remaining 56 patients served as controls (control group). The incidence of ED was evaluated according to the use of dexmedetomidine premedication, age and type of anesthesia (general vs combined). The length of anesthesia and duration of staying in the surgical area were also analyzed. Results Three patients who received dexmedetomidine premedication showed ED (6%), compared with 43 patients in the control group (77%; p<0.05). This lower incidence of ED was also present when stratifying patients according to the type of anesthesia or age. No difference between the dexmedetomidine group and control group were reported in timing of discharge from surgical area.Conclusions Premedication with dexmedetomidine is associated with decreased incidence of ED without increasing timing of discharge after surgery, regardless of patients’ age or type of anesthesia. In particular, patients subjected to combined anesthesia report benefit from the use of this molecule.

scholarly journals EMERGENCE DELIRIUM IN PEDIATRIC PATIENTS UNDERGOING GENERAL ANESTHESIA

2021 ◽  
Vol 31 (4) ◽  
pp. 19-25
Author(s):  
Greta Patapavičiūtė ◽  
Laura Lukošienė ◽  
Ilona Razlevičė ◽  
Andrius Macas
Keyword(s):  
Postoperative Period ◽  
Pediatric Population ◽  
Recovery Period ◽  
Pediatric Anesthesia ◽  
Perioperative Period ◽  
Anesthesia Induction ◽  
Early Recovery ◽  
Pain Group ◽  
Emergence Delirium ◽  
Late Postoperative Period

Background: Emergence delirium (ED) is described as a transient state of cognitive disturbance and psychomotor agitation, which begins with emergence from anesthesia and continues through the early recovery period. The incidence of ED in the pediatric population remains unclear and ranges from 10 to 80%. The pathophysiology and underlying mechanisms of ED are also uncertain. This study aimed to determine the prevalence of ED, potential risk factors that may contribute to the development of ED and observe behaviour changes related to ED in the late postoperative period. Methods: A prospective observational study was carried out with children aged 1 to 12 years. The child’s behaviour before anesthesia was evaluated using the Pediatric Anesthesia Behavior (PAB) score. Medications used during the perioperative period were registered. The Watcha scale was used to evaluate if children developed ED and the Visual Analogue Scale (VAS) was used to register pain intensity during the first 15 minutes after the awakening. Parents of patients who experienced agitation were asked to assess their child’s behaviour two weeks after the anesthesia. Results: Among 136 observed patients 24 (17.6%) had ED. The duration of anesthesia among ED experienced patients was 45.42 (SD 18.35) min and it was significantly shorter than among children who didn’t develop ED – 60 (SD 29.03) min, p = 0.016. Eighteen (15.5%) patients in a mild pain group (VAS 0 to 3) experienced ED while in a moderate-25 severe pain group (VAS 4-10) there were 6 (37.5%) children who developed ED, p=0.033. However, age, the American Society of Anesthesiologists Classification (ASA) class, surgery type, behaviour before anesthesia induction and perioperative medications were not associated with ED. Conclusions: The prevalence of ED observed during our study, short duration of anesthesia and postoperative pain association with ED coincided with the results specified by other researchers. ED associated behavior changes were reported in the late postoperative period. Our other findings appeared to be not consistent with the results reported in other studies. Thus, the dilemma of ED still remains unresolved.

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

2007 ◽  
Vol 107 (5) ◽  
pp. 733-738 ◽  
Author(s):  
Marie T. Aouad ◽  
Vanda G. Yazbeck-Karam ◽  
Viviane G. Nasr ◽  
Mohamad F. El-Khatib ◽  
Ghassan E. Kanazi ◽  
...  
Keyword(s):  
Single Dose ◽  
Pediatric Anesthesia ◽  
Saline Group ◽  
Strabismus Surgery ◽  
Postanesthesia Care Unit ◽  
Double Blind Study ◽  
Healthy Children ◽  
Emergence Agitation ◽  
Double Blind ◽  
Emergence Delirium

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.

scholarly journals Comparative Effects of Total Intravenous Anesthesia with Propofol and Remifentanil Versus Inhalational Sevoflurane with Dexmedetomidine on Emergence Delirium in Children Undergoing Strabismus Surgery

2020 ◽  
Vol In Press (In Press) ◽  
Author(s):  
Mohamed E Oriby ◽  
Ayman Elrashidy
Keyword(s):  
Recovery Time ◽  
Pediatric Anesthesia ◽  
Postoperative Nausea And Vomiting ◽  
Strabismus Surgery ◽  
Total Intravenous Anesthesia ◽  
Intravenous Anesthesia ◽  
Emergence Delirium ◽  
Group I ◽  
Group Ii ◽  
Postanesthetic Care Unit

Background: Emergence delirium (ED) is common after strabismus surgery due to postoperative visual disturbance, vomiting, and pain. Total intravenous anesthesia (TIVA) has many advantages like smooth emergence from anesthesia, decreased incidence of postoperative nausea and vomiting (PONV), and postoperative analgesia. Objectives: Our study aimed to compare the incidence of ED using inhalational sevoflurane with dexmedetomidine (DEX) versus TIVA with remifentanil. Methods: Eighty-four patients aged 3 - 11 years scheduled for strabismus surgery under general anesthesia were randomly allocated into two groups. Patients in group I received sevoflurane and DEX (group I, n = 42), while group II patients received TIVA with propofol and remifentanil infusion (group II, n = 42). Mean arterial pressure (MAP), heart rate (HR), and pulse oximetry (SpO2) were monitored before induction, at induction, and every 10 minutes during the surgery. In the postanesthetic care unit (PACU), pediatric anesthesia emergence delirium (PAED), face, legs, activity, cry, and consolability (FLACC), need for rescue analgesics, recovery time, level of parents’ satisfaction, and PONV were recorded. Results: Based on the results, HR and MAP significantly decreased 10 and 20 min after induction compared to baseline in group I after infusion of DEX. The incidence of PONV was significantly lower in group II than in group I, while the recovery time was significantly shorter in group I. The incidence of emergence delirium decreased in both groups. Conclusions: The use of either total intravenous anesthesia with propofol and remifentanil or sevoflurane inhalational anesthesia with dexmedetomidine resulted in a lower incidence of emergence delirium, although dexmedetomidine resulted in hypotension, bradycardia, and PONV.

scholarly journals Oculocardiac and Oculorespiratory Reflex during Strabismus Surgery under General Anesthesia with Laryngeal Mask Airway for Maintaining Spontaneous Respiration: A Retrospective Study

2019 ◽  
Author(s):  
Sun Young Shin ◽  
Min Ju Kim ◽  
Jin Joo
Keyword(s):  
Laryngeal Mask Airway ◽  
General Anesthesia ◽  
Pediatric Patients ◽  
Strabismus Surgery ◽  
Adult Patients ◽  
Laryngeal Mask ◽  
Spontaneous Respiration ◽  
Anesthesia Induction ◽  
Depth Of Anesthesia ◽  
Specific Muscle

Abstract Background: The oculocardiac reflex (OCR) is defined as a 10–20% reduction in heart rate (HR) from the baseline value or dysrhythmia, and the oculorespiratory reflex (ORR) manifests as shallow respiratory movement and bradypnea caused by manipulation of the eye. The aim of this study was to elucidate whether the specific muscle operated on has an effect on OCR and ORR, as well as whether the depth of anesthesia influences the OCR and ORR in patients undergoing strabismus surgery with laryngeal mask airway (LMA) to maintain spontaneous respiration. Methods: The medical records of patients who underwent strabismus surgery on lateral rectus (LR) and medial rectus (MR) muscles from January 2017 to December 2017 were reviewed. For anesthesia induction, propofol was administered and the LMA was inserted. Anesthesia was maintained with sevoflurane and spontaneous respiration. Results: The incidences of OCR during LR and MR operations were not significantly different between pediatric and adult patients (29% vs 27% and 15% vs 16%, respectively, p < 0.05). The incidence of ORR, as indexed by tidal volume (TV), was higher during MR surgery than during LR surgery in pediatric patients (29.3% vs 10.1%, p < 0.05). The change in HR during muscle traction and bispectral index (BIS) showed a negative correlation in pediatric patients, but this was not statistically significant. The change in TV during muscle traction and BIS was significantly correlated, in both pediatric and adult patients (r2 = 0.034 and 0.058, respectively, p < 0.05), while the change in respiratory rate (RR) during muscle traction and BIS did not show a significant correlation in either group. Conclusions: The incidence rate of OCR did not differ between LR and MR surgeries, and the depth of anesthesia did not correlate with HR changes during muscle traction. Young age and MR surgery may be risk factors for ORR. However, MV did not decrease because of the increased RR during muscle traction. Thus, maintenance of spontaneous respiration with an LMA is safe during strabismus surgery under general anesthesia for both pediatric and adult patients.

Development and Psychometric Evaluation of the Pediatric Anesthesia Emergence Delirium Scale

2004 ◽  
Vol 100 (5) ◽  
pp. 1138-1145 ◽  
Author(s):  
Nancy Sikich ◽  
Jerrold Lerman
Keyword(s):  
Clinical Judgment ◽  
Content Validity ◽  
Rating Scale ◽  
Statistical Significance ◽  
Pediatric Anesthesia ◽  
Reliability And Validity ◽  
Psychometric Evaluation ◽  
Emergence Delirium ◽  
Scale Scores ◽  
Total Scale Score

Background Emergence delirium has been investigated in several clinical trials. However, no reliable and valid rating scale exists to measure this phenomenon in children. Therefore, the authors developed and evaluated the Pediatric Anesthesia Emergence Delirium (PAED) scale to measure emergence delirium in children. Methods A list of scale items that were statements describing the emergence behavior of children was compiled, and the items were evaluated for content validity and statistical significance. Items that satisfied these evaluations comprised the PAED scale. Each item was scored from 1 to 4 (with reverse scoring where applicable), and the scores were summed to obtain a total scale score. The degree of emergence delirium varied directly with the total score. Fifty children were enrolled to determine the reliability and validity of the PAED scale. Scale validity was evaluated using five hypotheses: The PAED scale scores correlated negatively with age and time to awakening and positively with clinical judgment scores and Post Hospital Behavior Questionnaire scores, and were greater after sevoflurane than after halothane. The sensitivity of the scale was also determined. Results Five of 27 items that satisfied the content validity and statistical analysis became the PAED scale: (1) The child makes eye contact with the caregiver, (2) the child's actions are purposeful, (3) the child is aware of his/her surroundings, (4) the child is restless, and (5) the child is inconsolable. The internal consistency of the PAED scale was 0.89, and the reliability was 0.84 (95% confidence interval, 0.76-0.90). Three hypotheses supported the validity of the scale: The scores correlated negatively with age (r = -0.31, P &lt;0.04) and time to awakening (r = -0.5, P &lt;0.001) and were greater after sevoflurane anesthesia than halothane (P &lt;0.008). The sensitivity was 0.64. Conclusions These results support the reliability and validity of the PAED scale.

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