The change of sevoflurane to desflurane after anesthesia induction induces rapid emergence without increased cardiovascular responses and emergence delirium in pediatric strabismus surgery patients

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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Remifentanil Requirements during Sevoflurane Administration to Block Somatic and Cardiovascular Responses to Skin Incision in Children and Adults

Anesthesiology ◽

10.1097/00000542-200211000-00018 ◽

2002 ◽

Vol 97 (5) ◽

pp. 1142-1145 ◽

Cited By ~ 30

Author(s):

Hernán R. Muñoz ◽

Luis I. Cortínez ◽

Fernando R. Altermatt ◽

Jorge A. Dagnino

Keyword(s):

Infusion Rate ◽

Cardiovascular Responses ◽

Skin Incision ◽

Autonomic Response ◽

P Value ◽

Anesthesia Induction ◽

Remifentanil Infusion ◽

Autonomic Responses ◽

Unpaired Student ◽

Somatic Response

Background The authors found no studies comparing intraoperative requirements of opioids between children and adults, so they determined the infusion rate of remifentanil to block somatic (IR50) and autonomic response (IRBAR50) to skin incision in children and adults. Methods Forty-one adults (aged 20-60 yr) and 24 children (aged 2-10 yr) undergoing lower abdominal surgery were studied. In adults, anesthesia induction was with sevoflurane during remifentanil infusion, whereas in children remifentanil administration was started after induction with sevoflurane. After intubation, sevoflurane was administered in 100% O2 and was adjusted to an ET% of 1 MAC-awake corrected for age at least 15 min before surgery. Patients were randomized to receive remifentanil at a rate ranging from 0.05 to 0.35 microg x kg(-1) x min(-1) for at least 20 min before surgery. At the beginning of surgery, only the skin incision was performed, and the somatic and autonomic responses were observed. The somatic response was defined as positive with any gross movement of extremity, and the autonomic response was deemed positive with any increase in heart rate mean arterial pressure equal to or more than 10% of preincision values. Using logistic regression, the IR50 and IRBAR50 were determined in both groups of patients and compared with unpaired Student t test. A P value less than 0.05 was considered significant. Results The IR50 +/- SD was 0.10 +/- 0.02 microg x kg(-1) x min(-1) in adults and 0.22 +/- 0.03 microg x kg(-1) x min(-1) in children (P < 0.001). The IRBAR50 +/- SD was 0.11 +/- 0.02 microg x kg(-1) x min(-1) in adults and 0.27 +/- 0.06 microg x kg(-1) x min(-1) in children (P < 0.001). Conclusions To block somatic and autonomic responses to surgery, children require a remifentanil infusion rate at least twofold higher than adults.

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

Journal of Anesthesiology and Reanimation Specialists’ Society ◽

10.5222/jarss.2021.29484 ◽

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.

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Penehyclidine mitigates intraoperative oculocardiac reflex and postoperative nausea and vomiting in the patients with strabismus surgery: a prospective, randomized, double-blinded comparison

10.21203/rs.3.rs-69403/v1 ◽

2020 ◽

Author(s):

Jiacheng Sun ◽

Xiaofei Cao ◽

Ting Lu ◽

Nan Li ◽

Xinxu Min ◽

...

Keyword(s):

Recovery Time ◽

Postoperative Nausea And Vomiting ◽

Strabismus Surgery ◽

Anesthesia Induction ◽

Facial Flushing ◽

Severity Scoring ◽

Glandular Secretion ◽

Gender And Age ◽

Blinded Study ◽

Double Blinded

Abstract BackgroundPONV is one of the most frequent complications following anesthesia and strabismus surgery. Penehyclidine, an anticholinergic, is widely and preoperatively used for reducing glandular secretion in patients. This study investigated the effect of penehyclidine on PONV in strabismus surgery.MethodsIn this prospective, randomized, and double-blinded study, patients of strabismus surgery under general anesthesia were randomly assigned to either penehyclidine (n = 114) or normal saline (NS, n = 104) groups. Penehyclidine was administrated immediately after anesthesia induction, and patients treated with NS served as controls. PONV was investigated within 48 h after surgery. Intraoperative OCR was also recorded.ResultsCompared with NS controls, penehyclidine significantly reduced PONV incidence [30.7% vs. 54.8%, P < 0.001] and mitigated PONV severity as indicated by severity scoring (P < 0.001). When stratified by gender and age, the reduction of PONV incidence following penehyclidine treatment was found significant in all adult patients and male underaged patients. Unexpectedly, penehyclidine also significantly reduced OCR incidence [57.9% vs. 77.9%, P < 0.01] and mitigated OCR severity which indicated by requirement of atropine to rescue [77.3% vs. 90.1%, P < 0.05]. Moreover, penehyclidine did not significantly change anesthesia recovery time, facial flushing and drowsiness occurrence compared to NS controls.ConclusionsPenehyclidine administration after anesthesia induction significantly attenuated intraoperative OCR and PONV in strabismus surgery patients.Trial registrationClinicalTrials.gov (NCT04054479). Registered July 19, 2019, https://www.clinicaltrials.gov/ct2/show/NCT04054479?id=NCT04054479&draw=2&rank=1

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

Egyptian Journal of Anaesthesia ◽

10.1080/11101849.2020.1863309 ◽

2020 ◽

Vol 37 (1) ◽

pp. 21-27

Author(s):

Mona Raafat Elghamry ◽

Amira Mahfouz Elkeblawy

Keyword(s):

Single Dose ◽

Strabismus Surgery ◽

Emergence Delirium

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Magnesium Supplementation and Postoperative Recovery Quality in Children Undergoing Strabismus Surgery: A Prospective, Randomised, Controlled Study

10.21203/rs.3.rs-63561/v1 ◽

2020 ◽

Author(s):

Ji-Hyun Lee ◽

Seungeun Choi ◽

Minkyoo Lee ◽

Young-Eun Jang ◽

Eun-Hee Kim ◽

...

Keyword(s):

Postoperative Pain ◽

Strabismus Surgery ◽

Preoperative Anxiety ◽

Controlled Study ◽

Control Group ◽

Anesthesia Induction ◽

Emergence Agitation ◽

Magnesium Supplementation ◽

Respiratory Events ◽

Postanesthetic Care Unit

Abstract Background: The benefits of intraoperative magnesium supplementation have been reported. In this prospective, randomized study, the effects of magnesium supplementation during general anesthesia on emergence agitation 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 anesthesia 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 Pediatric Anesthesia Emergence Delirium (PAED) score, pain score, and respiratory events were assessed at the postanesthetic 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 agitation 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 anesthesia had no significant effects on the incidence of emergence agitation or postoperative pain in children undergoing strabismus surgery.Clinical trial registry: ClinicalTrials.gov (NCT03132701)

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EMERGENCE DELIRIUM IN PEDIATRIC PATIENTS UNDERGOING GENERAL ANESTHESIA

10.35988/sm-hs.2021.115 ◽

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.

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