Ozcan Ayse, Kaya Ayse Gunay, Ozcan Namik, Karaaslan Gul Meltem, Er Esen, Baltaci Bulent, Basar Hulya
Departamento de Anestesiologia e Reanimação, Ankara Training and Research Hospital, Ankara, Turquia.
Departamento de Anestesiologia e Reanimação, Ankara Training and Research Hospital, Ankara, Turquia.
Rev Bras Anestesiol. 2014 Nov-Dec;64(6):377-81. doi: 10.1016/j.bjan.2014.01.004. Epub 2014 Aug 29.
Emergence agitation is a common postanaesthetic problem in children after sevoflurane anaesthesia. We aimed to compare the effects of ketamine and midazolam administered intravenously, before the end of surgery, for prevention of emergence agitation in children who received caudal block for pain relief under sevoflurane anaesthesia.
62 American Society of Anesthesiologists patient classification status I children, aged 2-7 years, scheduled for inguinal hernia repair, circumcision or orchidopexy were enrolled to the study. Anaesthesia was induced with sevoflurane 8% in a mixture of 50% oxygen and nitrous oxide. After achieving adequate depth of anaesthesia, a laryngeal mask was placed and then caudal block was performed with 0.75mLkg(-1), 0.25% bupivacaine. At the end of the surgery, ketamine 0.25mgkg(-1), midazolam 0.03mgkg(-1) and saline were given to ketamine, midazolam and control groups, respectively. Agitation was assessed using Paediatric Anaesthesia Emergence Delirium scale and postoperative pain was evaluated with modified Children's Hospital of Eastern Ontario Pain Scale.
Modified Children's Hospital of Eastern Ontario Pain Scale scores were found higher in control group than in ketamine and midazolam groups. Paediatric Anaesthesia Emergence Delirium scores were similar between groups. Modified Children's Hospital of Eastern Ontario Pain Scale and Paediatric Anaesthesia Emergence Delirium scores showed a significant decrease by time in all groups during follow-up in postanaesthesia care unit. The present study resulted in satisfactory Paediatric Anaesthesia Emergence Delirium scores which are below 10 in all groups. As a conclusion, neither ketamine nor midazolam added to caudal block under sevoflurane anaesthesia did show further effect on emergence agitation. In addition, pain relief still seems to be the major factor in preventing emergence agitation after sevoflurane anaesthesia.
苏醒期躁动是小儿七氟醚麻醉后常见的麻醉后问题。我们旨在比较在手术结束前静脉注射氯胺酮和咪达唑仑对在七氟醚麻醉下接受骶管阻滞镇痛的小儿预防苏醒期躁动的效果。
62例美国麻醉医师协会患者分级为I级、年龄2至7岁、计划行腹股沟疝修补术、包皮环切术或睾丸固定术的儿童纳入本研究。用8%七氟醚与50%氧气和氧化亚氮的混合气体诱导麻醉。达到足够麻醉深度后，置入喉罩，然后用0.75mL/kg、0.25%布比卡因行骶管阻滞。手术结束时，分别给氯胺酮组、咪达唑仑组和对照组静脉注射氯胺酮0.25mg/kg、咪达唑仑0.03mg/kg和生理盐水。使用小儿麻醉苏醒期谵妄量表评估躁动情况，并用改良的东安大略儿童医院疼痛量表评估术后疼痛。
发现对照组的改良东安大略儿童医院疼痛量表评分高于氯胺酮组和咪达唑仑组。各组间小儿麻醉苏醒期谵妄量表评分相似。在麻醉后监护病房随访期间，所有组的改良东安大略儿童医院疼痛量表和小儿麻醉苏醒期谵妄量表评分均随时间显著降低。本研究中所有组的小儿麻醉苏醒期谵妄量表评分均令人满意，低于10分。结论是，在七氟醚麻醉下骶管阻滞中添加氯胺酮或咪达唑仑对苏醒期躁动均无进一步影响。此外，镇痛似乎仍是预防七氟醚麻醉后苏醒期躁动的主要因素。
