Choi Eun Kyung, Lee Shiback, Kim Won Jae, Park Sang-Jin
Department of Anesthesiology and Pain Medicine, Yeungnam University College of Medicine, Daegu, Korea.
Department of Ophthalmology, Yeungnam University College of Medicine, Daegu, Korea.
Paediatr Anaesth. 2018 Aug;28(8):739-744. doi: 10.1111/pan.13446. Epub 2018 Jul 13.
Emergence delirium is a common complication of sevoflurane anesthesia in children.
We examined the effects of maintaining remifentanil infusion during the recovery period on the incidence of emergence delirium in preschool-age children undergoing strabismus surgery under sevoflurane anesthesia.
Eighty children (aged 3-7 years) were randomly assigned to either the control group (group C; intraoperative remifentanil infusion) or the intervention group (group R; intraoperative remifentanil infusion followed by remifentanil maintenance during the recovery phase). Intraoperative remifentanil infusion (0.2 μg/kg/min) was discontinued upon surgery completion in the group C, and was maintained until the discharge criteria were met at a dose of 0.05 μg/kg/min in the group R. The incidence of emergence delirium was assessed using a five-point agitation scale and the Pediatric Anesthesia Emergence Delirium scale after arrival in the postanesthesia care unit. Postoperative pain was assessed using the Children's Hospital of Eastern Ontario Pain Scale.
The incidence of emergence delirium according to the five-point agitation scale (scores ≥ 4) was lower in the group R (33.3%) compared to the group C (68.3%) (odds ratio 0.206; 95% CI 0.080 to 0.531; P = 0.002). Similar results were obtained using the Pediatric Anesthesia Emergence Delirium scale (scores > 12), with an incidence of 5.1% in the group R and 34.0% in the control group (odds ratio 0.104; 95% CI 0.022 to 0.497; P = 0.001). The Children's Hospital of Eastern Ontario Pain Scale scores and occurrence of postoperative adverse events including laryngospasm, desaturation, nausea, and vomiting were similar between the two groups.
Maintaining a low dose of remifentanil (0.05 μg/kg/min) throughout the recovery phase attenuated the incidence of emergence delirium in children undergoing strabismus surgery under sevoflurane anesthesia.
苏醒期谵妄是儿童七氟醚麻醉常见的并发症。
我们研究了在苏醒期持续输注瑞芬太尼对接受七氟醚麻醉的学龄前斜视手术患儿苏醒期谵妄发生率的影响。
80名3至7岁儿童被随机分为对照组（C组；术中输注瑞芬太尼）或干预组（R组；术中输注瑞芬太尼，苏醒期继续维持输注）。C组手术结束后停止术中瑞芬太尼输注（0.2μg/kg/min），R组则维持输注直至达到出院标准，剂量为0.05μg/kg/min。到达麻醉后护理单元后，使用五点躁动量表和小儿麻醉苏醒期谵妄量表评估苏醒期谵妄的发生率。使用东安大略儿童医院疼痛量表评估术后疼痛。
根据五点躁动量表（评分≥4），R组苏醒期谵妄的发生率（33.3%）低于C组（68.3%）（比值比0.206；95%可信区间0.080至0.531；P = 0.002）。使用小儿麻醉苏醒期谵妄量表（评分>12）也得到了类似结果，R组发生率为5.1%，对照组为34.0%（比值比0.104；95%可信区间0.022至0.497；P = 0.001）。两组间东安大略儿童医院疼痛量表评分以及包括喉痉挛、低氧血症、恶心和呕吐在内的术后不良事件发生率相似。
在整个苏醒期维持低剂量瑞芬太尼（0.05μg/kg/min）可降低接受七氟醚麻醉的斜视手术患儿苏醒期谵妄的发生率。
