Anesth Pain Med.  2019 Oct;14(4):434-440. 10.17085/apm.2019.14.4.434.

Postoperative emergence agitation and intraoperative sevoflurane sedation under caudal block in children: a randomized comparison of two sevoflurane doses

Affiliations
  • 1Department of Anesthesiology and Pain Medicine, Yeungnam University College of Medicine, Daegu, Korea.
  • 2Department of Anesthesiology and Pain Medicine, Dongsan Hospital, Keimyung University School of Medicine, Daegu, Korea.
  • 3Department of Anesthesiology and Pain Medicine, School of Medicine, Kyungpook National University, Daegu, Korea. sspark@knu.ac.kr

Abstract

BACKGROUND
Sub-umbilical surgery under caudal block in conjunction with sevoflurane sedation may be safe in terms of maintaining spontaneous breathing and avoiding complications associated with general anesthesia. However, sevoflurane-induced emergence agitation (EA) continues to be a clinically important phenomenon in children. To compare the incidence of EA in children undergoing sub-umbilical surgery under caudal block with two different doses of sevoflurane.
METHODS
Forty children (aged 1-5 years) scheduled to undergo inguinal hernia repair under caudal block with sevoflurane sedation via a face mask were randomized into either the low-dose (1.0%) end-tidal sevoflurane concentration group (Group LS) or the high-dose (2.5%) end-tidal sevoflurane concentration group (Group HS). We monitored EA episodes at 5 and 30 min in the post-anesthetic care unit (PACU) by using the four-point agitation scale and the Pediatric Anesthesia Emergence Delirium (PAED) scale.
RESULTS
The four-point agitation scale scores and PAED scores were not different between the groups at 5 min. However, the agitation score was higher in Group HS than in Group LS at 30 min after arriving in the PACU. The time required to recover from sedation was longer in Group HS than in Group LS.
CONCLUSIONS
Face-mask sedation with 1.0% sevoflurane in conjunction with caudal block may be more effective than that with 2.5% sevoflurane in preventing EA.

Keyword

Caudal extradural; Child; Emergence delirium; Sevoflurane

MeSH Terms

Anesthesia
Anesthesia, General
Child*
Delirium
Dihydroergotamine*
Hernia, Inguinal
Humans
Incidence
Masks
Respiration
Dihydroergotamine

Figure

  • Fig. 1 Flow diagram of the study design and patient enrollment.

  • Fig. 2 Heart rate changes. Values are expressed as mean ± SEM. Group LS: low-dose (1.0%) end-tidal sevoflurane concentration group, Group HS: high-dose (2.5%) end-tidal sevoflurane concentration group, T0: arrival at the operation room, T1: immediately before caudal block, T2: immediately after caudal block, T3: 5 min after returning to the supine position, T4: 15 min after returning to the supine position, T5: 5 min before the end of surgery, T6, T7, and T8: 5, 15, and 30 min, respectively, after arrival in the post-anesthetic care unit.

  • Fig. 3 Mean blood pressure changes. Values are expressed as mean ± SEM. Group LS: low-dose (1.0%) end-tidal sevoflurane concentration group, Group HS: high-dose (2.5%) end-tidal sevoflurane concentration group, T0: arrival at the operation room, T1: immediately before caudal block, T2: immediately after caudal block, T3: 5 min after returning to the supine position, T4: 15 min after returning to the supine position, T5: 5 min before the end of surgery, T6, T7, and T8: 5, 15, and 30 min, respectively, after arrival in the post-anesthetic care unit.


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