Back to Search
Start Over
A Randomized Controlled Trial to Determine the Effect of Depth of Anesthesia on Emergence Agitation in Children
- Source :
- Anesthesia & Analgesia. 122:1141-1146
- Publication Year :
- 2016
- Publisher :
- Ovid Technologies (Wolters Kluwer Health), 2016.
-
Abstract
- The cause of emergence agitation (EA) in children is unknown. Rapid emergence from inhaled anesthesia has been implicated because EA is more common with sevoflurane than with halothane. A dose-dependent effect of sevoflurane, which increases seizure-like electroencephalogram activity, has also been proposed.To determine whether depth of anesthesia as measured by bispectral index (BIS) affects EA, 40 ASA physical status I to II children aged 2 to 8 years undergoing ophthalmic surgery were enrolled in a blinded randomized controlled trial of low-normal (40-45, deep) versus high-normal (55-60, light) anesthesia. To distinguish transient irritability from severe EA, the primary outcome was first-stage postanesthesia care unit (PACU I) peak Pediatric Assessment of Emergence Delirium (PAED) score, with secondary outcomes of PAED and Face, Legs, Activity, Cry, and Consolability scores at emergence, postoperative fentanyl dose, emergence time, and discharge time. Subjects received a standard anesthesia protocol with oral midazolam followed by mask induction with sevoflurane 8%, fentanyl 1 to 1.5 μg/kg IV (then as needed), neuromuscular blockade, and endotracheal intubation. Providers titrated expired sevoflurane (in N2O 67%) from 0.5% to 3% to maintain BIS range. PAED, Richmond Agitation Sedation Scale, and Face, Legs, Activity, Cry, and Consolability scores were measured at emergence, at PACU I arrival, and during PACU I stay.There was little difference between the groups in the primary outcome, peak PACU I PAED score (light: 7.7 ± 4.6; deep: 8.6 ± 5.3; mean difference, 0.9; 95% confidence interval, 4.1 to -2.3; effect size, 0.18). Discharge times were similar between groups. Treatment for severe EA was rare.There was no significant effect of BIS-guided deep versus light anesthesia on severe EA.
- Subjects :
- Male
Methyl Ethers
Psychomotor agitation
MEDLINE
Sevoflurane
law.invention
03 medical and health sciences
Consciousness Monitors
0302 clinical medicine
Randomized controlled trial
030202 anesthesiology
law
medicine
Humans
Single-Blind Method
Prospective Studies
Consciousness monitors
Child
Prospective cohort study
Psychomotor Agitation
business.industry
030208 emergency & critical care medicine
Treatment Outcome
Anesthesiology and Pain Medicine
Child, Preschool
Anesthesia
Female
Halothane
medicine.symptom
Anesthesia, Inhalation
business
Depth of anesthesia
medicine.drug
Subjects
Details
- ISSN :
- 00032999
- Volume :
- 122
- Database :
- OpenAIRE
- Journal :
- Anesthesia & Analgesia
- Accession number :
- edsair.doi.dedup.....4289378d96d1ae403bf4eae9cb52db82