Incidence of Emergence Agitation in Children Receiving General Anesthesia: Risk Assessment and Prophylactic Effect of Propofol
Keywords:
General anesthesia, Inhalational anesthesia, Propofol, Emergence agitation, Incidence, risk factorsAbstract
Background: Postoperative emergence agitation (EA) occurs in up to 80% of children undergoing general anesthesia(GA). Propofol was proposed as a safe and effective agent to reduce, prevent and eliminate Postoperative emergence agitation.
Objective: To assess the incidence of postoperative EA and the effect of Propofol as prophylactic agent
Patients & Methods: A randomized controlled clinical trial conducted at the Central Teaching Hospital of Pediatrics, during a period of 16 months included 100 pediatric patients less than 16 years of age and were scheduled for different surgeries under general anesthesia . Patients equally assigned into two groups to receive either 1 mg/kg Propofol intravenously at 7 minutes before recovery (Propofol group) or receiving 5 ml normal saline (saline group) as control.. All standard procedures and protocols of anesthesia were applied.
Results: The mean PAED score was significantly lower in Propofol group, (8.3 ± 2.4) compared to control group (12.8 ± 3.7) at 5 postoperative minutes, and continue to reduce at the next time; 10 and 15 minutes, (P<0.05). The overall incidence of EA in Propofol group was (14%) vs. (74%), in controls, the relative risk (RR) for the incidence of EA at 5 minutes and 10 minutes was; 0.52 and 0.38, respectively, indicated a protective , prophylactic effect of Propofol (P<0.001).
Conclusions: Propofol was safe and effective agent for prophylaxis and prevention of postoperative emergence agitation. Age is the main risk factor for postoperative agitation,
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References
Dahmani S, Delivet H, Hilly J. Emergence delirium in children: an update. Curr Opin Anesthesiol. 2014;27(3):309–15.
Nair S, Wolf A. Emergence delirium after paediatric anaesthesia: new strategies in avoidance and treatment. Bja Educ. 2018;18(1):30–3.
Mohkamkar M, Farhoudi F, Alam-Sahebpour A, Mousavi SA, Khani S, Shahmohammadi S.
Postanesthetic emergence agitation in pediatric patients under general anesthesia. Iran J Pediatr. 2014;24(2):184–90.
Kuratani N, Oi Y. Greater Incidence of Emergence Agitation in Children after Sevoflurane Anesthesia as Compared with HalothaneA Meta-analysis of Randomized Controlled Trials. Anesthesiol J Am Soc Anesthesiol. 2008;109(2):225–32.
Kanaya A. Emergence agitation in children: risk factors, prevention, and treatment. J Anesth. 2016;30(2):261–7.
Ali M, Abdellatif A. Prevention of sevoflurane related emergence agitation in children undergoing adenotonsillectomy: a comparison of dexmedetomidine and propofol. Saudi J Anaesth. 2013;7(3):296–300.
Jiang S, Liu J, Li M, Ji W, Liang J. The efficacy of propofol on emergence agitation - A meta-analysis of randomized controlled trials. Acta Anaesthesiol Scand. 2015;59(10):1232–45.
Karling M, Stenlund H, Hägglöf B. Child behaviour after anaesthesia: associated risk factors. Acta Paediatr. 2007;96(5):740–7.
Aldakhil SK, Salam M, Albelali AA, Alkanhal RM, Alnemer MJ, Alatassi A. The prevalence of emergence delirium and its associated factors among children at a postoperative unit: A retrospective cohort at a Middle Eastern hospital. Saudi J Anaesth. 2019;14(2):169.
Ward CG, Hines SJ, Maxwell LG, McGowan FX, Sun LS. Neurotoxicity, general anesthesia in young children, and a survey of current pediatric anesthesia practice at US teaching institutions. Pediatr Anesth. 2016;26(1):60–5.
De Francisci G, Papasidero AE, Spinazzola G, Galante D, Caruselli M, Pedrotti D, et al. Update on complications in pediatric anesthesia. Pediatr Rep. 2013;5(1):8–12.
Khan AK, Quddus SR, Khan HK, Ali MS, Kamruzzaman M, Hasan MR, et al. Complications Following General Anaesthesia in Paediatric Patients. Mymensingh Med J MMJ. 2018;27(2):429–36.
Rappaport B, Mellon RD, Simone A, Woodcock J. Defining safe use of anesthesia in children. N Engl J Med. 2011;364(15):1387–90.
Coté CJ, Lerman J, Todres ID. A practice of anesthesia for infants and children E-book: Expert consult: Online and print. Elsevier Health Sciences; 2012.
Flick RP, Wilder RT, Pieper SF, Van Koeverden K, Ellison KM, Marienau MES, et al. Risk factors for laryngospasm in children during general anesthesia. Pediatr Anesth. 2008;18(4):289–96.
Mintz CD, Wagner M, Loepke AW. Preclinical research into the effects of anesthetics on the developing brain: promises and pitfalls. J Neurosurg Anesthesiol. 2012;24(4):362.
Reddy SV. Effect of general anesthetics on the developing brain. J Anaesthesiol Clin Pharmacol.2012;28(1):6.
U.S. Food and Drug Administration. Drug Safety and Availability - FDA Drug Safety
Communication: FDA review results in new warnings about using general anesthetics and sedation drugs in young children and pregnant women.2016;1–11.
Robinson DH, Toledo AH. Historical development of modern anesthesia. J Investig Surg.2012;25(3):141–9.
Becker DE, Rosenberg M. Nitrous oxide and the inhalation anesthetics. Anesth Prog. 2008;55(4):124–31.
Natalini CC. Sevoflurane, Desflurane, and Xenon new inhaled anesthetics in veterinary medicine. Ciência Rural. 2001;31(1):177–83.
Stachnik J. Inhaled anesthetic agents. Am J Heal Pharm. 2006;63(7):623–34.
Edgington TL, Maani C V. Sevoflurane. In: StatPearls. StatPearls Publishing; 2019.
Brioni JD, Varughese S, Ahmed R, Bein B. A clinical review of inhalation anesthesia with sevoflurane: from early research to emerging topics. J Anesth. 2017;31(5):764–78.
DataPharm E. Sevoflurane uses and characteristics [Internet]. Sevoflurane , EMC. 2019, p. 1–5.
Kapoor MC, Vakamudi M. Desflurane-revisited. J Anaesthesiol Clin Pharmacol. 2012;28(1):92.
Khan J, Liu M. Desflurane . StatPearls. StatPearls Publishing; 2019. p. 1–6.
Aronson JK. Meyler’s side effects of drugs: The international encyclopedia of adverse drug
reactions and interactions. Elsevier; 2015.
McKeage K, Perry CM. Propofol. CNS Drugs. 2003;17(4):235–72.
Yau G, Gin T, Ewart MC, Kotur CF, Leung RKW, Oh TE. Propofol for induction and maintenance of anaesthesia at caesarean section a comparison with thiopentone/enflurane. Anaesthesia. 1991;46(1):20–3.
Abhishek K M, Dinesh K, Ravi M, Kiran, N. Antiemetic effect of propofol administered at the end of surgery in laparoscopic assisted vaginal hysterectomy. Korean J Anesthesiol. 2014;66(3):210–5.
Kampo S, Afful AP, Mohammed S, Ntim M, Buunaaim ADB, Anabah TW. Sub-hypnotic dose of propofol as antiemetic prophylaxis attenuates intrathecal morphine-induced postoperative nausea and vomiting, and pruritus in parturient undergoing cesarean section—a randomized control trial.BMC Anesthesiol. 2019;19(1):177.
Cao LQ, Montana MC, Germann AL, Shin DJ, Chakrabarti S, Mennerick S, et al. Enhanced GABAergic actions resulting from the coapplication of the steroid 3α-hydroxy-5α-pregnane-11, 20- dione (alfaxalone) with propofol or diazepam. Sci Rep. 2018;8(1):1–12.
Marik PE. Propofol: therapeutic indications and side-effects. Curr Pharm Des. 2004;10(29):3639–49.
Uezono S, Goto T, Terui K, Ichinose F, Ishguro Y, Nakata Y, et al. Emergence agitation after sevoflurane versus propofol in pediatric patients. Anesth Analg. 2000;91(3):563–6.
Van Hoff SL, O’Neill ES, Cohen LC, Collins BA. Does a prophylactic dose of propofol reduce
emergence agitation in children receiving anesthesia? A systematic review and meta-analysis.
Paediatr Anaesth. 2015;25(7):668–76.
Kim H-J, Kim H-S, Kim S-D, Kim C-S, Kim J-T, Lee K-J, et al. Effects of propofol and nalbuphine on emergence agitation after sevoflurane anesthesia in children for strabismus surgery. Ukr J Orthop Med Sci. 2019;4(4):575–9.
Makkar JK, Bhatia N, Bala I, Dwivedi D, Singh PM. A comparison of single dose dexmedetomidine with propofol for the prevention of emergence delirium after desflurane anaesthesia in children. Anaesthesia. 2016;71(1):50–7.
Cohen I, Drewsen S, Hannallah R. Propofol or midazolam do not reduce the incidence of emergence agitation associated with desflurane anaesthesia in children undergoing adenotonsillectomy. Paediatr Anaesth. 2002;12(5):604–9.
Aouad MT, Yazbeck-Karam VG, Nasr VG, El-Khatib MF, Kanazi GE, Bleik JH. A single dose of propofol at the end of surgery for the prevention of emergence agitation in children undergoing strabismus surgery during sevoflurane anesthesia. Anesthesiology. 2007;107(5):733–8.
Barreto ACTP, Paschoal ACR da R, Farias CB, Borges PSGN, Andrade RGA da C, de Orange FA. Risk factors associated with anesthesia emergence delirium in children undergoing outpatient surgery. Rev Bras Anestesiol. 2018;68(2):162–7.
Costi D, Cyna AM, Ahmed S, Stephens K, Strickland P, Ellwood J, et al. Effects of sevoflurane versus other general anaesthesia on emergence agitation in children. Cochrane Database Syst Rev. 2014;(9).
Jacob Z, Li H, Makaryus R, Zhang S, Reinsel R, Lee H, et al. Metabolomic profiling of children’s brains undergoing general anesthesia with sevoflurane and propofol. Anesthesiology. 2012;117(5):1062–71.
Somaini M, Sahillioğlu E, Marzorati C, Lovisari F, Engelhardt T, Ingelmo PM. Emergence
delirium, pain or both? A challenge for clinicians. Pediatr Anesth. 2015;25(5):524–9.
Picard V, Dumont L, Pellegrini M. Quality of recovery in children: sevoflurane versus propofol. Acta Anaesthesiol Scand. 2000;44(3):307–10.
Stamper MJ, Hawks SJ, Taicher BM, Bonta J, Brandon DH. Identifying Pediatric Emergence Delirium by Using the PAED Scale: A Quality Improvement Project. AORN J . 2014;99(4):480–94.
Dean AG, Sullivan KM, Soe MM. OpenEpi: Open Source Epidemiologic Statistics for Public Health, Version 3.01. updated 2013/04/06. Available at: www.OpenEpi.com, accessed 2018/8/3.
Nakayama S, Furukawa H, Yanai H. Propofol reduces the incidence of emergence agitation in preschool-aged children as well as in school-aged children: a comparison with sevoflurane. J Anesth.2007;21(1):19–23.
Bong CL, Lim E, Allen JC, Choo WLH, Siow YN, Teo PBY, et al. A comparison of single‐dose
dexmedetomidine or propofol on the incidence of emergence delirium in children undergoing
general anaesthesia for magnetic resonance imaging. Anaesthesia. 2015;70(4):393–9.
Kim MS, Moon BE, Kim H, Lee JR. Comparison of propofol and fentanyl administered at the end of anaesthesia for prevention of emergence agitation after sevoflurane anaesthesia in children. Br J Anaesth. 2013;110(2):274–80.
Cohen IT, Finkel JC, Hannallah RS, Hummer KA, Patel KM. Rapid emergence does not explain agitation following sevoflurane anaesthesia in infants and children: A comparison with propofol. Paediatr Anaesth. 2003;13(1):63–7.
Abu-Shahwan I. Effect of propofol on emergence behavior in children after sevoflurane general anesthesia. Paediatr Anaesth. 2008;18(1):55–9.
Malarbi S, Stargatt R, Howard K, Davidson A. Characterizing the behavior of children emerging with delirium from general anesthesia. Pediatr Anesth. 2011;21(9):942–50.
Bong CL, Ng ASB. Evaluation of emergence delirium in Asian children using the Pediatric Anesthesia Emergence Delirium Scale. Paediatr Anaesth. 2009;19(6):593–600.
Mason KP. Paediatric emergence delirium: a comprehensive review and interpretation of the literature. BJA Br J Anaesth. 2017;118(3):335–43.
Vlajkovic GP, Sindjelic RP. Emergence delirium in children: many questions, few answers. Anesth Analg. 2007;104(1):84–91.
Silva LM da, Braz LG, Módolo NSP. Emergence agitation in pediatric anesthesia: current features. J. Pediatr (Rio J). 2008;84(2):107–13.
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