scholarly journals Comparison of the effects of desflurane and sevoflurane on emergence characteristics in pediatric patients premedicated with ketamine

2021 ◽  
Keyword(s):  
Preschool Children ◽  
Separation Anxiety ◽  
Pediatric Anesthesia ◽  
Sevoflurane Anesthesia ◽  
Emergence Time ◽  
Respiratory Complications ◽  
Ambulatory Anesthesia ◽  
Waiting Room ◽  
Gag Reflex ◽  
Group D

Objectives: Desflurane may be useful for ambulatory anesthesia. However, desflurane-induced airway irritability makes its use challenging, especially in children. Ketamine can be used to reduce separation anxiety and emergence agitation (EA). However, ketamine may increase bronchial secretions. This study compared desflurane with sevoflurane anesthesia, in terms of emergence time and EA, in preschool children with intravenous (IV) ketamine premedication. Methods: Fifty-six children were scheduled for elective epiblepharon surgery. In the waiting room, ketamine (1 mg/kg) was intravenously administered to patients to reduce separation anxiety. After transport to the operating room, general anesthesia was induced with sevoflurane. The anesthetic agent was changed to desflurane in the desflurane group (group D), while sevoflurane was continued in the sevoflurane group (group S) during surgery. Emergence time (time to gag reflex and time to extubation) and EA (measured using the Pediatric Anesthesia Emergence Delirium [PAED] scale) were compared between the two groups. Respiratory complications were also recorded. Results: Time to gag reflex (611.1 ± 288.9 s vs. 275.0 ± 126.7 s, P < 0.001) and time to extubation (756.3 ± 267.2 s vs. 425.9 ± 122.9 s, P < 0.001) were significantly shorter in group D than group S. EA did not differ between the two groups. There were no severe respiratory complications. Conclusions: Emergence time was shorter for desflurane anesthesia than sevoflurane anesthesia in preschool children who received IV ketamine premedication. Desflurane anesthesia with IV 0.1 mg/kg of ketamine premedication could be used safely in pediatric ophthalmic surgery; there were no significant respiratory events.

scholarly journals Comparison of the Effects of 0.03 and 0.05 mg/kg Midazolam with Placebo on Prevention of Emergence Agitation in Children Having Strabismus Surgery

2014 ◽  
Vol 120 (6) ◽  
pp. 1354-1361 ◽  
Author(s):  
Eun Jung Cho ◽  
Seung Zhoo Yoon ◽  
Jang Eun Cho ◽  
Hye Won Lee
Keyword(s):  
Intravenous Administration ◽  
Controlled Trial ◽  
Pediatric Anesthesia ◽  
Strabismus Surgery ◽  
Secondary Outcome ◽  
Sevoflurane Anesthesia ◽  
Emergence Agitation ◽  
Emergence Time ◽  
Double Blind ◽  
To Receive

Abstract Background: Midazolam has been widely studied for preventing emergence agitation. The authors previously reported that in children with sevoflurane anesthesia, intravenous administration of midazolam (0.05 mg/kg) before the end of surgery reduced the incidence of emergence agitation but prolonged the emergence time. This study was designed to test the hypothesis that a lower midazolam dose could suppress emergence agitation with minimal disturbance of the emergence time in children with sevoflurane anesthesia. Methods: In this randomized, double-blind, placebo-controlled trial, 90 children (1 to 13 yr of age) having strabismus surgery were randomized to 1:1:1 to receive 0.03 mg/kg of midazolam, 0.05 mg/kg of midazolam, or saline just before the end of surgery. The primary outcome, the incidence of emergence agitation, was evaluated by using the pediatric anesthesia emergence delirium scale and the four-point agitation scale. The secondary outcome was time to emergence, defined as the time from sevoflurane discontinuation to the time to extubation. Results: The incidence of emergence agitation was lower in patients given 0.03 mg/kg of midazolam (5 of 30, 16.7%) and patients given 0.05 mg/kg of midazolam (5 of 30, 16.7%) compared with that in patients given saline (13/of 30, 43.3%; P = 0.036 each). The emergence time was longer in patients given 0.05 mg/kg of midazolam (17.1 ± 3.4 min, mean ± SD) compared with that in patients given 0.03 mg/kg of midazolam (14.1 ± 3.6 min; P = 0.0009) or saline (12.8 ± 4.1 min; P = 0.0003). Conclusion: Intravenous administration of 0.03 mg/kg of midazolam just before the end of surgery reduces emergence agitation without delaying the emergence time in children having strabismus surgery with sevoflurane anesthesia. (Anesthesiology 2014; 120:1354-61)

scholarly journals RETRACTED ARTICLE: Desflurane anesthesia worsens emergence agitation in adult patients undergoing thyroid surgery compared to sevoflurane anesthesia

2017 ◽  
Vol 3 (1) ◽  
Author(s):  
Takeshi Suzuki ◽  
Takuya Kurazumi ◽  
Tomomi Ueda ◽  
Hiromasa Nagata ◽  
Takashige Yamada ◽  
...  
Keyword(s):  
Postoperative Pain ◽  
Thyroid Surgery ◽  
Rating Scale ◽  
Numerical Rating Scale ◽  
Pediatric Anesthesia ◽  
Adult Patients ◽  
Sevoflurane Anesthesia ◽  
Emergence Agitation ◽  
Extubation Time ◽  
Group D

Abstract Background The effect of volatile anesthetics on emergence agitation in adults remains unclear. We compared the degree of emergence agitation between desflurane and sevoflurane anesthesia in adults undergoing thyroid surgery. Findings One hundred and sixteen patients with American Society of Anesthesiologists status 1 or 2 were randomized into two groups: the desflurane group (group D) and the sevoflurane group (group S). After induction of anesthesia with fentanyl (1–2 μg/kg) and propofol (1.5–2.5 mg/kg), tracheal intubation was facilitated with suxamethonium (0.5–1.0 mg/kg). In group D, anesthesia was maintained with desflurane in 66% nitrous oxide and 33% oxygen supplemented with fentanyl when necessary; in group S, sevoflurane was used instead of desflurane. After the end of the surgery, emergence agitation was evaluated with a modified pediatric anesthesia emergence delirium scale (ranging from 0 to 16, with higher scores indicating more severe emergence agitation) before extubation. Time to extubation from the end of the surgery, postoperative pain (evaluated by a numerical rating scale [NRS]), and postoperative nausea and vomiting (PONV) after surgery were examined. The degree of emergence agitation was more severe in group D than in group S (median [interquartile range]: 5 [4–7] vs 4 [2–6], p = 0.008). Time to extubation, NRS scores, and PONV rates were similar between the two groups. Conclusions Desflurane anesthesia worsened emergence agitation as compared with sevoflurane in adult patients undergoing thyroid surgery, but did not affect time to extubation, postoperative pain, or PONV. Trial registration UMIN000014215

scholarly journals A Comparative Study of Oral Dexmedetomidine versus Oral Midazolam As preanesthesia Medication in Pediatric Patients to Reduce anxiety

2019 ◽  
Vol 4 (2) ◽  
pp. 724-728
Author(s):  
Sabin Gauchan ◽  
Chitra Thapa ◽  
Abha Prasai
Keyword(s):  
General Anesthesia ◽  
Separation Anxiety ◽  
Elective Surgery ◽  
Sedation Score ◽  
Preoperative Anxiety ◽  
Parental Separation ◽  
Emergence Agitation ◽  
Oral Midazolam ◽  
Significant Difference ◽  
Group D

Introduction: Preoperative period is a stressful period. In children the preoperative anxiety is expressed as difficult separation from parents and difficult mask induction. The level of preoperative anxiety also affects postoperative outcomes. To overcome anxiety premedication is often used by pediatric anesthesiologist. Objective: The objective of this study was to compare the effect of oral midazolam 0.5mg/kg and oral dexmedetomidine 4μg/kg on parental separation, mask induction and postoperative emergence agitation in children undergoing elective surgery under general anesthesia. Methodology: 120 children aged 2-8years undergoing elective surgery under general anesthesia were divided into two groups: Group M and Group D. Patients in group M received oral midazolam 0.5mg/kg and patients in group D received oral dexmedetomidine 4μg/kg. After 45min of premedication sedation score was assessed in both the groups. Ease of parental separation and mask acceptance was compared in both the groups. In the postoperative period occurrence of emergence agitation was compared in both the groups. Results: There was no statistically significant difference in preoperative sedation score in both the groups. Parent separation anxiety score and mask acceptance score were statistically similar in both the groups. But emergence agitation was significantly lesser in patients who received dexmedetomidine premedication. Conclusions: Premedication with oral midazolam as well as oral dexmedetomidine effectively reduces parental separation anxiety and produces satisfactory mask induction in pediatric age group. However, dexmedetomidine is more effective in reducing emergence delirium in comparison to midazolam.

Epileptiform activity during induction of anesthesia with sevoflurane prior to elective carotid endarterectomy

Vascular ◽  
2015 ◽  
Vol 24 (1) ◽  
pp. 96-99 ◽  
Author(s):  
Denise AB Smith ◽  
Jonathan Bath
Keyword(s):  
Carotid Endarterectomy ◽  
Patient Population ◽  
Epileptiform Activity ◽  
Pediatric Anesthesia ◽  
Anesthetic Technique ◽  
High Grade ◽  
Carotid Surgery ◽  
Sevoflurane Anesthesia ◽  
Epileptiform Discharges ◽  
Induction Agents

The optimal anesthetic technique for carotid endarterectomy is still controversial. For general anesthesia, various induction agents have been used. We present two patients with asymptomatic high-grade carotid stenosis where induction with sevoflurane resulted in epileptiform discharges seen on perioperative electroencephalogram monitoring without adverse clinical sequelae. The occurrence of epileptogenic electroencephalogram during sevoflurane anesthesia has been widely described despite its popular use in pediatric anesthesia. This phenomenon, however, has not been previously described during electroencephalogram monitoring in carotid surgery. The authors suggest that induction anesthesia with sevoflurane should be avoided in this patient population especially where routine electroencephalogram monitoring is not performed.

scholarly journals A Comparative Study of Nitroglycerine and Dexmedetomidine for Induced Hypotension in Functional Endoscopic Sinus Surgery

2020 ◽  
Vol 7 (49) ◽  
pp. 2948-2953
Author(s):  
Shruthi M. Shah ◽  
Nidhi Shrenikbhai Reshamwala ◽  
Aakanksha Sanjay Raval ◽  
Krimal Rahulkumar Shah ◽  
Yash Rajendrabhai Joshi
Keyword(s):  
Sinus Surgery ◽  
Haemodynamic Response ◽  
Randomised Control Trial ◽  
Emergence Time ◽  
Induced Hypotension ◽  
Physiological Limits ◽  
Haemodynamic Stability ◽  
Duration Of Surgery ◽  
Surgical Field ◽  
Group D

BACKGROUND We wanted to evaluate the efficacy of IV nitroglycerine and IV dexmedetomidine in achieving and maintaining induced hypotension in patients undergoing FESS under general anaesthesia, compare haemodynamic response in terms of heart rate, blood pressure, mean arterial pressure, compare clarity of the surgical field, compare the effect on duration of surgery and study the intraoperative and postoperative complications, if any. METHODS This is a randomised control trial conducted from 01/01/2018 to 31/12/2018 among 50 patients, ASA 1 & 2 undergoing FESS. They were randomly divided into 2 groups - group D (an infusion of dexmedetomidine was started with a loading dose of 1 μg / Kg over 10 min and thereafter was maintained between 0.5 - 1.0 μg / Kg / h) and group N (an infusion of nitroglycerine was started at the rate of 0.5 μg / Kg / min and was maintained between 0.5 - 2.0 μg / Kg / min). Haemodynamic data was recorded. Both the infusions were titrated to maintain a MAP between 65 and 75 mmHg. The visibility of the surgical site was checked by the surgeon at every 30 minutes using the Fromme and Boezaart scale. RESULTS Both groups consisted of 25 patients each and were demographically similar. In both groups heart rates remained within normal physiological limits, not requiring any pharmacological treatment. Both groups had comparable average MAP during surgery. The group D showed desirable attenuation of haemodynamic response at the time of intubation as well as at extubation. Both groups had comparable duration of surgery. Both the drugs were equally effective in creating clear surgical fields to the surgeons’ satisfaction. Dexmedetomidine provided better intraoperative analgesia and reduced requirement of incremental fentanyl as compared to nitroglycerine. Emergence time was significantly higher in dexmedetomidine group. CONCLUSIONS Both the groups provided comparable clarity of surgical field with comparable haemodynamic parameters during surgery. dexmedetomidine provided better haemodynamic stability and an additional benefit of reduced requirement of intraoperative supplemental analgesia. KEYWORDS Induced hypotension, FESS, Dexmedetomidine, Nitroglycerine

scholarly journals Is Emergence Time Related to Emergence Agitation in Pediatric Patients?

2020 ◽  
Author(s):  
ngamjit pattaravit ◽  
Orarat Karnjanawanichku ◽  
Sirikarn Siripruekpong ◽  
Nalinee Kovitwanawong ◽  
Rongrong Reungchira-Urai ◽  
...  
Keyword(s):  
Pediatric Patients ◽  
Separation Anxiety ◽  
Statistical Significance ◽  
Anesthetic Management ◽  
Multivariate Logistic Regression Analysis ◽  
Behavioral Changes ◽  
Emergence Agitation ◽  
Emergence Time ◽  
Anesthetic Care ◽  
Processed Eeg

Abstract Background: Emergence agitation is one of the unpleasant symptoms after general anesthesia, especially in pediatric patients. This study was designed to evaluate the correlation between emergence time and emergence agitation. The predictors associated with emergence agitation and behavioral changes in children was also determined as specific outcomes.Methods: This prospective cohort study was conducted in children undergoing anesthesia between 3 to 12 years. The preoperative unit nurse evaluated the child's baseline behaviors preoperatively. From pre to post anesthesia period, nurse anesthetist recorded anesthetic management data and clinical emergence time. Meanwhile, the investigator team recorded the Processed-EEG emergence time. At the Post-Anesthetic Care Unit (PACU), the well trained PACU nurse evaluated clinical emergence time and emergence symptoms. For the behavioral symptoms, the investigator team evaluated any changes by telephone interview at postoperative days 1, 3, and 7. Statistical significance was set at p <0.05. Results: Ninety-one pediatric patients were enrolled in the study. Preoperative baseline behaviors were not related to emergence agitation or behavioral changes. There were correlations between clinical emergence time and the incidences of emergence agitation and postoperative separation anxiety. There was no relationship found between processed-EEG emergence time and the incidence of emergence agitation. Multivariate logistic regression analysis showed the significant predictors (ASA physical status, clinical emergence time, and pain) to predict Emergence agitation. (AUC=0.92, sensitivity = 0.89, specificity 0.81). Separation anxiety was significantly higher at postoperative days 1,3 and 7 in the children with emergence agitation (p-values = 0.020, 0.020, and 0.017, respectively).Conclusion: Clinical emergence time significantly related to emergence agitation and postoperative separation anxiety.Trial registration: ClinicalTrials.gov Identifier: NCT03358069. Registered 18 January 2017 - Retrospectively registered, https://register.clinicaltrials.gov/prs/app/action/SelectProtocol?sid=S0007IOW&selectaction=Edit&uid=U0001FGB&ts=2&cx=-7ofx36

scholarly journals Comparison of the Effects of Oral Midazolam and Intranasal Dexmedetomidine on Preoperative Sedation and Anesthesia Induction in Children Undergoing Surgeries

2021 ◽  
Vol 12 ◽  
Author(s):  
Yu-Hang Cai ◽  
Cheng-Yu Wang ◽  
Yang Li ◽  
Jia Chen ◽  
Jun Li ◽  
...  
Keyword(s):  
Primary Outcome ◽  
Separation Anxiety ◽  
Anesthesia Induction ◽  
Inhalation Induction ◽  
Beneficial Effects ◽  
Oral Midazolam ◽  
Sedative Effects ◽  
Drug Regimens ◽  
Group D

Background and Purpose: Premedication with either oral midazolam or intranasal dexmedetomidine prior to surgery remains less than ideal. The aim of this study was to investigate whether the combination of those two drug regimens would have any beneficial effects on the preoperative sedation and the children’s compliance during anesthesia inhalation induction.Experimental Approach: One hundred thirty-eight children aged 2–6 years were randomly allocated into three groups: Group M with oral midazolam 0.5 mg kg−1, Group D with intranasal dexmedetomidine 2 μg kg−1, and Group M + D with intranasal dexmedetomidine 1 μg kg−1 plus oral midazolam 0.5 mg kg−1. The primary outcome was the children’s compliance during inhalation induction with sevoflurane. The secondary outcomes included the preoperative sedative effects, behavior scores, parental separation anxiety scores, and the postoperative incidence of emergence agitation and recovery time.Results: Subjects in Group M + D showed higher satisfaction scores of compliance (p = 0.0049) and mask acceptance (MAS) (p = 0.0049) during anesthesia inhalation induction. Subjects in Group M + D had a significantly shorter time than those in Groups M and D to achieve the desired sedation level (p &lt; 0.001) and remained at a higher sedation score in the holding area and up to the anesthesia induction after drug administration (p &lt; 0.001).Conclusion and Implications: We conclude that pediatric patients premedicated with intranasal dexmedetomidine 1 μg kg−1 plus oral midazolam 0.5 mg kg−1 had significantly improved anesthesia induction compliance, and quicker onset to achieve and maintain a satisfactory level of sedation than those premedicated separately with two drugs. Therefore, the combined premed regimen is a greater choice when we are expecting a higher quality of sedation and a smoother anesthesia induction in children undergoing the surgeries.

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