Ali Monaz Abdulrahman, Abdellatif Ashraf Abualhasan
Department of Anesthesia, Faculty of Medicine, Menoufiya University, Menufia, Egypt.
Saudi J Anaesth. 2013 Jul;7(3):296-300. doi: 10.4103/1658-354X.115363.
Emergence agitation (EA) in children is increased after sevoflurane anesthesia. Propofol and dexmedetomidine have been used for prophylactic treatment with controversial results. The aim of the present study was to compare the effect of a single dose of propofol or dexmedetomidine prior to termination of sevoflurane-based anesthesia on the incidence and severity of EA in children.
One hundred and twenty children, American Society of Anesthesiologists I-II, 2-6 years old undergoing adenotonsillectomy under sevoflurane based anesthesia were enrolled in the study. Children were randomly allocated to one of the three equal groups: (Group C) received 10 ml saline 0.9%, (Group P) received propofol 1 mg/kg or (group D) received dexmedetomidine 0.3 ug/kg(-1). The study drugs were administered 5 min before the end of surgery. In post anesthesia 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 30 min (T30). Extubation time, emergence time, duration of PACU stay and pain were assessed.
The incidence and severity of EA were lower in group P and group D compared to group C at T0, T5 and T15. The incidence and severity of EA in group P were significantly higher than group D at the same times. The incidence and severity of EA decreased significantly over time in all groups. The modified Children's Hospital of Eastern Ontario Pain Scale was significantly lower in group D compared to group C and group P.
Dexmedetomidine 0.3 ug/kg(1) was more effective than propofol 1 mg/kg in decreasing the incidence and severity of EA, when administered 5 min before the end of surgery in children undergoing adenotonsillectomy under sevoflurane anesthesia.
七氟醚麻醉后儿童苏醒期躁动（EA）发生率增加。丙泊酚和右美托咪定已用于预防性治疗，但结果存在争议。本研究的目的是比较在基于七氟醚的麻醉结束前单次使用丙泊酚或右美托咪定对儿童EA发生率和严重程度的影响。
120名年龄在2至6岁、美国麻醉医师协会分级为I-II级、接受七氟醚麻醉下腺样体扁桃体切除术的儿童纳入本研究。儿童被随机分为三组，每组人数相等：（C组）接受10ml 0.9%生理盐水，（P组）接受1mg/kg丙泊酚，或（D组）接受0.3μg/kg右美托咪定。研究药物在手术结束前5分钟给药。在麻醉后护理单元（PACU），采用Aonos四点量表评估EA发生率，采用小儿麻醉苏醒谵妄量表在入院时（T0）、5分钟后（T5）、15分钟后（T15）和30分钟后（T30）评估EA严重程度。评估拔管时间、苏醒时间、PACU停留时间和疼痛情况。
在T0、T5和T15时，P组和D组的EA发生率和严重程度低于C组。在相同时间，P组的EA发生率和严重程度显著高于D组。所有组的EA发生率和严重程度均随时间显著降低。与C组和P组相比，D组的改良安大略东部儿童医院疼痛量表评分显著更低。
在七氟醚麻醉下接受腺样体扁桃体切除术的儿童中，手术结束前5分钟给予0.3μg/kg右美托咪定在降低EA发生率和严重程度方面比1mg/kg丙泊酚更有效。
