Department of Anesthesiology and Critical Care, Kırıkkale University School of Medicine, Kırıkkale, Turkey.
Department of Anesthesiology and Critical Care, Diskapi Yildirim Beyazit Training and Research Hospital, Ankara, Turkey.
Ir J Med Sci. 2020 Aug;189(3):1061-1068. doi: 10.1007/s11845-020-02197-4. Epub 2020 Feb 11.
Emergence delirium occurs in children during recovery from general anesthesia. The aim of the study was to examine the effects of mask and intravenous sevoflurane anesthesia induction on emergence delirium in children undergoing tonsillectomy with or without adenoidectomy.
This single-blinded, prospective, randomized clinical trial was conducted in the operating room and the post-operative recovery area at a university hospital. Sixty-seven children (aged 3-12 years) were randomly assigned to receive either mask induction (group M) or intravenous induction (group IV). Vascular access was provided in group M after 8% sevoflurane and 60% nitrous oxide in oxygen were given through a mask. In the IV cohort, an intravenous cannula was inserted prior to induction. The incidence of emergence delirium was assessed using the Pediatric Anesthesia Emergence Delirium (PAED) scale after arrival in the post-anesthesia care unit. Post-operative pain was assessed using the Face, Legs, Activity, Cry, and Consolability (FLACC) scale.
PAED scores were significantly higher in group M at 5 min (group M = 12.2 ± 4.215, group IV = 9.1 ± 4.0; mean difference = 3.094, 95% CI [1.108; 5.081]; P = 0.003), at 15 min (group M = 8.0 ± 2.6, group IV = 5.1 ± 2.3; mean difference = 2.942, 95% CI [1.586-4.301]; P < 0.001), and at 30 min (group M = 5.1 ± 2.8, group IV = 2.5 ± 1.8; mean difference = 2.620, 95% CI [1.457; 3.783]; P < 0.001) than in group IV. The FLACC scale scores were similar between the two groups.
Mask induction for pediatric patients undergoing tonsillectomy with or without adenoidectomy increased Pediatric Anesthesia Emergence Delirium scores more than intravenous induction.
NCT03252405.
全麻苏醒期谵妄发生于儿童。本研究旨在探讨面罩吸入七氟醚和静脉注射七氟醚诱导麻醉对行扁桃体切除术和（或）腺样体切除术患儿苏醒期谵妄的影响。
本单盲、前瞻性、随机临床试验在大学医院的手术室和术后恢复区进行。67 名（年龄 3-12 岁）患儿被随机分为面罩组（M 组）或静脉组（IV 组）。M 组在给予 8%七氟醚和 60%氧化亚氮混合氧气后通过面罩给予血管通路。IV 组在诱导前插入静脉导管。到达麻醉后恢复室后，使用儿科麻醉苏醒期谵妄（PAED）量表评估苏醒期谵妄的发生率。使用面部、腿部、活动、哭泣和安慰（FLACC）量表评估术后疼痛。
M 组在 5 分钟（M 组=12.2±4.215，IV 组=9.1±4.0；平均差异=3.094，95%置信区间[1.108; 5.081]；P=0.003）、15 分钟（M 组=8.0±2.6，IV 组=5.1±2.3；平均差异=2.942，95%置信区间[1.586-4.301]；P<0.001）和 30 分钟（M 组=5.1±2.8，IV 组=2.5±1.8；平均差异=2.620，95%置信区间[1.457; 3.783]；P<0.001）时的 PAED 评分明显高于 IV 组。两组的 FLACC 量表评分相似。
对于行扁桃体切除术和（或）腺样体切除术的患儿，面罩吸入七氟醚诱导较静脉注射七氟醚诱导可使儿科麻醉苏醒期谵妄评分升高。
NCT03252405。
