Meyer Roland Richard, Münster Peter, Werner Christian, Brambrink Ansgar Maria
Department of Anesthesiology, Johannes Gutenberg-University, Mainz, Germany.
Paediatr Anaesth. 2007 Jan;17(1):56-60. doi: 10.1111/j.1460-9592.2006.01998.x.
Children may be agitated or even delirious especially when recovering from general anesthesia using volatile anesthetics. Many trials have focused on the newer agents sevoflurane and desflurane but for the widely used isoflurane little is known about its potential to generate agitation. We investigated the emergence characteristics of small children after sevoflurane or isoflurane with caudal anesthesia for postoperative pain control.
After institutional approval and parental consent, anesthesia was randomly performed with sevoflurane (n = 30) or isoflurane (n = 29) in children at the age of 3.8 +/- 1.8 years during surgical interventions on the lower part of the body. After induction, all children received caudal anesthesia with bupivacaine (0.25%, 0.8 ml x kg(-1)). Postoperatively, the incidences of emergence agitation (EA) and emergence delirium (ED) were measured by a blinded observer using a ten point scale (TPS; EA = TPS > 5 ED = TPS > 7) as well as vigilance, nausea/vomiting and shivering.
The two groups were comparable with respect to demographic data, duration of surgery and duration of anesthesia. There were also no differences in the period of time from the end of surgery until extubation, duration of stay in the PACU, postoperative vigilance and vegetative parameters. Incidence of EA was 30% (9/30) for sevoflurane and 34% (10/29) for isoflurane during the first 60 min in the PACU (P = 0.785). Likewise, the incidence of ED was not different between the groups (20% and 24%, respectively).
In our randomized controlled study, we found no difference in the incidence of EA or ED between sevoflurane and isoflurane. Therefore, the decision to use one or the other should not be based upon the incidence of EA or ED.
儿童可能会烦躁不安甚至出现谵妄，尤其是在从使用挥发性麻醉剂的全身麻醉中恢复时。许多试验都集中在新型麻醉剂七氟烷和地氟烷上，但对于广泛使用的异氟烷，其引发躁动的可能性知之甚少。我们研究了七氟烷或异氟烷联合骶管麻醉用于小儿术后疼痛控制后的苏醒特征。
经机构批准并获得家长同意后，在对3.8±1.8岁儿童进行下半身手术干预期间，随机用七氟烷（n = 30）或异氟烷（n = 29）进行麻醉。诱导后，所有儿童均接受布比卡因（0.25%，0.8 ml·kg⁻¹）骶管麻醉。术后，由一名不知情的观察者使用十点量表（TPS；EA = TPS > 5，ED = TPS > 7）以及警觉性、恶心/呕吐和寒战来测量苏醒期躁动（EA）和苏醒期谵妄（ED）的发生率。
两组在人口统计学数据、手术时间和麻醉时间方面具有可比性。从手术结束到拔管的时间、在麻醉后恢复室（PACU）的停留时间、术后警觉性和自主参数方面也没有差异。在PACU的前60分钟内，七氟烷组的EA发生率为30%（9/30），异氟烷组为34%（10/29）（P = 0.785）。同样，两组之间的ED发生率也没有差异（分别为20%和24%）。
在我们的随机对照研究中，我们发现七氟烷和异氟烷之间的EA或ED发生率没有差异。因此，选择使用哪种麻醉剂不应基于EA或ED的发生率。
