جستجوی مقالات مرتبط با کلیدواژه « emergence agitation » در نشریات گروه « پزشکی »

Emergence agitation (EA), a short‑lived, self‑limiting phenomenon, arises frequently after the use of inhalational agents and hampers the implementation of pediatric ambulatory surgery in spite of using so many drugs with variable efficacy.

In this prospective, double‑blinded, parallel group study (2008–2009), 80 children of both sex aged 3–7 years, with American Society of Anesthesiologists (ASA) physical status grade I-II, undergoing sevoflurane‑based general anesthesia for elective day care surgery were randomly assigned into groups C or D. Group C received 4 µg/kg intranasal clonidine, whereas group D received 1 µg/kg intranasal dexmedetomidine, 45 min before induction of anesthesia. In postanesthesia care unit (PACU), the incidence of EA was assessed with Aonos four‑point scale and the severity of EA was assessed with pediatric anesthesia emergence delirium scale upon admission (T0), after 5 min (T5), 15 min (T15), and 25 min (T25). Extubation time, emergence time, duration of PACU stay, dose and incidence of fentanyl use for pain control were noted.

Based on comparable demographic profiles, the incidence and severity of EA were significantly lower in group D as compared to group C at T0, T5, T15, and T25. But time of regular breathing, awakening, extubation, and emergence were significantly delayed in group D than C. The number and dose of fentanyl used in group C were significantly higher than group D. PACU and hospital stay were quite comparable between groups.

Intranasal dexmedetomidine 1 µg/kg was more effective than clonidine 4 µg/kg in decreasing the incidence and severity of EA, when administered 45 min before the induction of anesthesia with sevoflurane for pediatric day care surgery. Dexmedetomidine also significantly reduced fentanyl consumption in PACU.

 Comparison of midazolam and propofol has been done hoping to reduce the incidence rates of emergence agitation (EA) after anesthesia. Both drugs however, are still under inspection as for their effect on EA after using Isoflurane for maintenance of anesthesia.

 This study was designed for measuring the effect of either propofol or midazolam near the end of tonsillectomy operation on incidence of EA during the recovery phase.

 In this randomized, double-blind study, 90 children, aged 5 to 15, undergoing anesthesia with Isoflurane were randomly assigned to three groups receiving either propofol (group P), midazolam (group M) or saline (group S) near the end of anesthesia. Severity and incidence of EA were then calculated using the pediatric anesthesia emergence delirium (PAED) scale.

 The mean PAED score in group P was (2.87 ± 2.69) and (1.90 ± 2.55) in group M. Both were significantly lower than group S (7.60 ± 3.78) (P < 0.05). However, there was no statistical difference in the duration of post-anesthesia care unit (PACU) stay between groups P (42.50 ± 12.58) and M (48.33 ± 24.26), groups P and S (52.00 ± 10.64) and between groups M and S (P > 0.05). No significant difference was found between all groups for apnea and laryngospasm (P > 0.05).

 Administration of either midazolam or propofol near the end of operation may result in reduction of EA in children undergoing tonsillectomy after Isoflurane anesthesia.

Nowadays, propofol total intravenous anesthesia (propofol TIVA) is a very attractive choice for routine pediatric anesthesia practice. To compare propofol- vs. sevoflurane-based anesthesia for pediatrics undergoing cleft palate repair in emergence characteristics and respiratory adverse effects. Eighty infants, aged from six months to one year, scheduled for cleft palate repair surgery, were randomly divided into two groups (40 patients each). The group I received general anesthesia induced with intravenous propofol 2.5 mg/kg, 0.1 mg/kg of lidocaine, fentanyl one µg/kg and cisatracurium 0.15 mg/kg, and maintained by a continuous infusion of propofol 9 mg/kg/hr and cisatracurium 3 µg/kg/hr. While in the group II, general anesthesia induced by O2/sevoflurane, intravenous fentanyl one µg/kg and cisatracurium 0.15 mg/kg then the maintenance was carried out by O2/air, sevoflurane 2 MAC, and cisatracurium three µg/kg/hr. Postoperative FLACC behavioral pain assessment Scale, modified Hannallah score, postoperative laryngeal spasm incidence, the recovery time, time to extubation, and postoperative complication were recorded. The quality of emergence was assessed by modified Hannallah score, there was a significant decrease in the number of patients developed agitation after propofol TIVA in comparison to sevoflurane anesthesia (P < 0.001) with a significant decrease in the number of patients developed postoperative laryngeal spasm (P < 0.047). On the other hand, a significantly prolonged time of extubation was observed in the propofol TIVA group (P < 0.001). Propofol TIVA regimen was the more peaceful recovery approach with less perioperative respiratory complications than sevoflurane-based anesthesia in infants undergoing cleft palate repair surgery.

Strabismus surgery under general anesthesia is one of the most common ophthalmic procedures in children with emergence delirium as an important post-operative complication. Additionally, postoperative pain is another important issue which is considered as a contributing factor to emergence delirium. We conducted a study to compare meperidine with paracetamol on postoperative pain and emergence delirium.
This double blind randomized clinical trial was carried out on 60 children underwent elective strabismus surgery under general anesthesia. Patients were randomly allocated in two groups of 30 that received intravenous meperidine (1mg/kg) or paracetamol (15 mg/kg). Severity of pain were assessed one minute after extubation and every 5 minutes up to 1 hour by using CHEOPS and PAED was used for assessment of emergence delirium by time interval of every 10 minutes up to 30 minutes. Other complications such as bronchospasm, laryngospasm, nausea and vomiting were also recorded.
Pain severity was significantly higher is in paracetamol group while in meperidine group no patients received additional fentanyl in recovery room and emergence delirium was lower 30 minutes after surgery.
Although meperidine and paracetamol are both effective in reducing incidence of emergence delirium and controlling postoperative pain after strabismus surgery, meperidine is significantly more efficient.

Emergence Agitation (EA) is a common problem in pediatric anesthesia. The current study evaluated the effect of intravenous lidocaine combined with propofol or thiopental sodium to control EA by sevoflurane in children. The current study aimed to compare the effectiveness of two anesthesia regimen propofol–lidocaine and thiopental sodium lidocaine to control sevoflurane-induced emergence agitation in children.Patients and The study enrolled 120 children aged 12 to 36 months with retinoblastoma who underwent induction of anesthesia with sevoflurane for Eye Examination Under Anesthesia (EUA). Sampling was done at Rasoul-Akram Hospital in Tehran, Iran. The subjects were randomly assigned into four groups including: group one (thiopental sodium-lidocaine [TL]), group two (thiopental sodium-saline [TS]), group three (propofol-lidocaine [PL]), and group four (propofol-saline [PS]). Emergence agitation was assessed by using a five-point scoring scale, every 10 minutes during the first 30 minutes after admission to the recovery room. EA occurred in 24 cases (20%) of children. Incidence of EA in the TS, TL, PS, and PL groups were 21 (70%), 2 (6.7%), 1 (3.3%), and 0 (0%), respectively (P < 0.001). Nausea and vomiting after anesthesia did not occur in any of the patients. After removal of the endotracheal tube, laryngospasm complication occurrence in the TS group (10 cases) was higher than the other groups and no statistically significant difference was observed (P = 0.1). Propofol–lidocaine anesthesia regimen was more effective to control the pediatric emergence agitation than the other combinations.

Postanesthetic emergence agitation is a common problem in pediatric postanesthetic care unit with an incidence ranging from 10 to 80%. This study was done to determine the prevalence of emergence agitation and associated risk factors in pediatric patients who underwent general anesthesia. This cross-sectional descriptive and analytic study was performed on 747 pediatric patients aged 3- 7 years that underwent general anesthesia for various elective surgeries at Bou-Ali Sina Hospital in Sari, Iran between January 2010 and January 2011. A non-probability quota sampling technique was used. The presence of emergence agitation was recorded using Pediatric Anesthesia Emergence Delirium Scale. The factors linked with Emergence Agitation were recorded in a questionnaire. The data were analyzed using SPSS software 16 and independent sample t-test, χ2 and binary logistic regression. P-values less than 0.05 were considered as significant. One hundred thirty-four (17.9%) children had emergence agitation. The most frequent surgical procedures were ENT surgical procedures 315 (42.2%), abdominal surgery 177 (23.7%), orthopedic surgery 137 (18.3%), urology 97 (13%) and ophthalmic surgery 24 (3.2%). Otorhinolaryngological surgical procedures (P=0.001), pain (P<0.05) and induction behavior of children (P<0.005) were associated with higher rates of post anesthetic emergence agitation (P=0.001). This study identified the multiple independent risk factors which are associated with emergence agitation in children. To minimize the incidence of postanesthetic emergence agitation, these risk factors should be considered in the routine care by care providers in postanesthetic care unit.