Ultrasound-Guided Lumbar Plexus Block Reduces Emergence Agitation in Children Undergoing Hip Surgery: A Prospective Randomized Controlled Trial

Background Emergence agitation (EA) is a common and challenging postoperative problem in children emerging from general anesthesia. It is associated with self-injury, increases stress on healthcare team members and postoperative maladaptive behavioral changes. However, no completely effective prevention has been found for EA. Pain is considered to be an important contributor to EA. Ultrasound-guided lumbar plexus block is a safe and effective anesthetic technique that can provide satisfactory pain relief in pediatric hip surgery. We aim to investigate the effect of ultrasound-guided lumbar plexus block on emergence agitation in children undergoing hip surgery. Methods This prospective, randomized, controlled study was conducted in children aged 1-6 yr undergoing elective hip surgery. Subjects were randomly assigned to receive either ultrasound-guided lumbar plexus block combined with general anesthesia (Group Block, n=60) or routine general anesthesia (Group Control, n=60). The primary outcome was the incidence of EA at 30 min after emergence from general anesthesia, assessed using the Pediatric Anesthesia Emergence Delirium (PAED) scale. The secondary outcomes included the incidence of severe EA, postoperative pain evaluated by the Children’s Hospital of eastern Ontario Pain Scale (CHEOPS) and the incidence of postoperative adverse complications. PAED, CHEOPS were measured at 0, 5, 10, 20, and 30 min after emergence from anesthesia. Results The incidence of EA was significantly lower in Group Block than in Group Control [13.3% vs. 43.3%, odds ratio (OR) 0.201, 95% confidence interval (CI) 0.082to 0.496, p<0.001]. Group Block had a lower incidence of severe EA than Group Control [3.3% vs. 18.3%, odds ratio (OR) 0.154, 95% confidence interval (CI) 0.032 to 0.727, p=0.019]. CHEOPS was lower in Group Block than in Group Control [mean (95%CI), 4.5(4.4-4.6) vs.4.9 (4.8-5.0), p<0.001]. Conclusion Ultrasound-guided lumbar plexus block could decrease the incidence and severity of emergence agitation in children undergoing hip surgery effectively. Trial registration: Chinese Clinical Trial Registry: ChiCTR-INR-17011525 (30/05/2017)

Comparing the effects of propofol and ketamine on the emergence agitation of male children undergoing circumcision

Background Separation from the family, prolonged hunger, inability to perceive the surgical procedure performed, and feeling pain are among the main reasons for agitation in young children. In operations like circumcision, in which all bodily integrity is disrupted and children cannot make sense of it and feel punished, this agitation increases. The aim of the present study was to compare the effects of propofol and ketamine on the emergence agitation (EA) in children undergoing circumcision. Result When the patients were taken to post-anesthesia care unit (PACU), no statistically significant difference was observed between propofol and ketamine groups in the Aono’s four-point scale at minute 0 (p = 0.073). In the 5th minute, it was higher in the ketamine group compared to the propofol group (p < 0.001). With Aono’s four-point scale, EA diagnosis is made in areas with 3 and 4 points. The average Aono’s four-point scale in the ketamine group at the 5th minute was 3.08 ± 1.02. Since the Modified Steward score was ≥ 6, the time taken was longer in the ketamine group compared to the propofol group (p < 0.001). Conclusion EA does not only occur in inhalational anesthetics, it is also seen with ketamine. In view of the fact that ketamine can cause EA in children, it should not be used alone in anesthesia. Propofol provides a safe anesthesia. Instead of inhalational anesthesia, where the type of surgery is suitable, anesthesia with propofol infusion should be applied. Further research is required to investigate EA.

Effect of Different Anesthesia Methods on Emergence Agitation and Related Complications in Postoperative Patients with Osteosarcoma

Purpose. To explore the effect of different anesthesia methods on emergence agitation (EA) and related complications in postoperative patients with osteosarcoma. Methods. According to the order of admission, 115 patients requiring osteosarcoma surgery treated in our hospital from January 2018 to December 2020 were selected as the research object and randomly divided into the control group (n = 57, accepted the general anesthesia with tracheal intubation) and the experimental group (n = 58, accepted the combined spinal-epidural anesthesia) to compare their anesthesia effect, incidence rates of agitation and complications, and other indexes. Results. In terms of the hemodynamic indexes (MAP, HR, and CVP values), both groups had lower ones at T1 than at T0, but the decline of the experimental group was generally lesser than that of the control group; at T2, no statistical difference was shown within the experimental group’s indexes when comparing with those at T1, but the control group obtained a significant increase; at T3 and T4, both groups had their hemodynamic indexes increased, but such increase within the experimental group showed no statistical difference when comparing with those at T0, while the control group achieved obviously higher values at T4 than at T0 (before the anesthesia); and the between-group difference in the hemodynamic indexes at T1 and T4 was significant. Compared with the control group, the experimental group achieved better VAS scores and anesthesia indexes and lower incidence rates of EA and complications such as the hypoxemia, cardiovascular response, delayed recovery, and headache. In addition, the differences in the incidence rates of hypotension and cognitive dysfunction between the two groups were not statistically significant. Conclusion. When comparing with tracheal intubation general anesthesia, the combined spinal-epidural anesthesia has a better effect in osteosarcoma surgery, with less hemodynamics influence on patients, reduced postoperative pain and stress reaction, and lowered incidence rates of postoperative EA and complications, which is worthy of wide application in clinical treatment.

Effects of different doses of dexmedetomidine on postsurgical emergence agitation and oxidative stress in children

Purpose: To study the effects of various dexmedetomidine (DEX) doses on post-surgical emergence agitation (EA) and oxidative stress in children.Methods: At various times, mean arterial pressure (MAP) and heart rate (HR) were measured: prior to anesthesia (T0), during intubation (T1), at onset of operation (T2), and at the end of surgery (T3). The incidence of post-surgical EA was estimated, and the extent of agitation were determined based on pediatric anesthesia emergence delirium (PAED). Post-surgical pain was determined using facial pain scale (FPS). Serum levels of cortisol (Cor), epinephrine (E), and norepinephrine (NE) were quantified at T0 and T3. Extubation time and awakening time, as well as postoperative complications were recorded.Results: At T1, T2 and T3, levels of HR and MAP were significantly increased in all three groups, when compared to the corresponding values at T0, with group C having peak values, followed by A and B. Group B had a lower incidence of EA than groups A and C, but EA incidence was lower in group A than in group C. The lowest scores for PAED and FPS were in group B (p < 0.05). Blood levels of Cor, E and NE at T0 were comparable amongst the three groups. However, at T3, serum levels of these parameters were lower in group B than in each of the other 2 groups.Conclusion: At a dose of 0.5 μg/kg, DEX effectively reduces the incidence of post-surgical EA, improves hemodynamics, and alleviates oxidative stress responses in pediatric anesthesia.

Comparing the effects of dexmedetomidine versus propofol on the treatment of emergence agitation in adult patients after general anesthesia: study protocol for a randomized, superiority, controlled trial (DP-TEA Trial)

Background Emergence agitation (EA) after general anesthesia is a common complication in the post-anesthesia care unit (PACU). Once EA occurs, there are still no guidelines established for the treatment in adults. Propofol is excessively used in managing agitated patients in the PACU, but it lacks analgesia and can result in apnea. Intraoperative infusion of dexmedetomidine has been proven to have a preventive effect on EA, but the treatment effect of dexmedetomidine on EA remains unknown. This study aims to compare the effects between dexmedetomidine and propofol on relieving EA in adult patients after general anesthesia in the PACU. Methods In this randomized, superiority, controlled clinical study, a total of 120 adult patients aged 18–65 years of both genders, with American Society of Anesthesiologists (ASA) classification I or II developing EA in the PACU after general anesthesia, will be enrolled. Patients will be randomized at a 1:1 ratio into two groups, receiving either a single dose of dexmedetomidine (0.7μg/kg) or propofol (0.5 mg/kg). The primary outcome is the proportion of patients having a recurrent EA within 15 min after intervention in the PACU. Discussion Previous studies have focused on premedication for preventing EA, while therapeutics for reliving EA have rarely been reported. To our knowledge, this study is the first randomized, superiority, controlled trial to compare a bolus of dexmedetomidine with the current routine care for this indication. Trial registration ClinicalTrials.govNCT04142840. Registered on October 26, 2019

Penehyclidine for prevention of postoperative nausea and vomiting following bimaxillary orthognathic surgery: a randomized, double-blind, controlled trial

Purpose To investigate the efficacy and safety of low-dose bolus plus continuous infusion of penehyclidine in preventing postoperative nausea and vomiting (PONV) following bimaxillary surgery. Methods Three hundred fifty-four patients were randomly allocated into three groups. In the Control group, placebo (normal saline) was injected before anesthesia and infused over 48 h after surgery; in the Bolus group, 0.5 mg penehyclidine was injected before anesthesia, whereas placebo was infused after surgery; in the Infusion group, 0.25 mg penehyclidine were injected before anesthesia, another 0.25 mg penehyclidine was infused after surgery. The primary endpoint was the incidence of PONV within 72 h. Results A total of 353 patients were included in intention-to-treat analysis. The PONV incidence was 61.0% (72/118) in the Control group, 40.2% (47/117) in the Bolus group, and 28.0% (33/118) in the Infusion group. The incidence was significantly lower in the Bolus group than in the Control group (RR 0.66; 95% CI 0.51–0.86; adjusted P = 0.003) and in the Infusion group than in the Control group (RR 0.46; 95% CI 0.33–0.63; adjusted P < 0.001); the difference between the Infusion and Bolus groups was not statistically significant (RR 0.70; 95% CI 0.48–1.00; adjusted P = 0.144). Emergence agitation occurred more frequently in the Bolus group than in the Control group (36.8% [43/117] vs. 21.2% [25/118], adjusted P = 0.027), but did not differ significantly between the Infusion and Control groups. Conclusions A low-dose bolus plus continuous infusion of penehyclidine was effective in preventing PONV without increasing emergence agitation. Trial registration Clinicaltrials.gov. Identifier: NCT04454866.

Effectiveness of Intravenous Ibuprofen On Emergence Agitation in Children Undergoing Tonsillectomy With Propofol Anesthesia: A Double-Blind, Placebo-Controlled, Randomized Study

Background: Emergence agitation (EA) has a negative effect on recovery from general anesthesia in children. Objectives: This study aimed to evaluate the effectiveness of intravenous ibuprofen in reducing the incidence of EA in children.Methods: This randomized, double-blind, placebo-controlled study analyzed data from patients aged 3–9 years undergoing tonsillectomy with propofol general anesthesia. These patients were randomly assigned to receive either the ibuprofen or the placebo intraoperatively. The primary endpoint was between-group difference in the incidence of EA after surgery. EA was defined as Pediatric Anesthesia Emergence Delirium score ≥ 10. The secondary endpoint included the associated factors of EA.Results: Eighty-nine patients were included in the study. Ibuprofen decreased the incidence of EA (8.9% in the treatment group vs. 34.1% in the control group; odds ratio [OR], 0.261; 95% confidence interval [CI], 0.094–0.724; P = 0.004). After the logistic regression analysis, anxiety behavior pre-anesthesia and high pain score after surgery were the risk factors related to EA (OR, 8.07; 95% CI, 1.12–58.07, P = 0.038 and OR, 2.78; 95% CI, 1.60–4.82, P < 0.001, respectively). Ibuprofen administration was the protective factor related to EA (OR, 0.05; 95% CI, 0.01–0.67, P = 0.023).Conclusions: In our studied cohort, intraoperatively infusing ibuprofen and relieving preoperative anxiety and postoperative pain can significantly reduce the incidence and severity of EA after propofol general anesthesia.Trial registration: ChiCTR2100045128 (07/04/2021)