Tharu Vidya, Paliwal Naveen, Bihani Pooja, Janweja Sarita, Jaju Rishabh, Kothari Sunil
Gastroenterology Anaesthesia, Seth GS Medical College and KEM Hospital, Parel, Mumbai, Maharashtra, India.
Department of Anaesthesiology, Dr. S. N. Medical College, Jodhpur, Rajasthan, India.
J Anaesthesiol Clin Pharmacol. 2024 Oct-Dec;40(4):693-698. doi: 10.4103/joacp.joacp_373_23. Epub 2024 Mar 15.
Emergence delirium (ED) during the postanesthesia recovery phase presents significant challenges, especially among pediatric patients, with incidence rates spanning from 2% to 80%. This study sought to assess and compare the effectiveness of propofol and dexmedetomidine in addressing ED in pediatric patients undergoing sevoflurane anesthesia. The primary aim was to ascertain the prevalence of ED in both treatment cohorts, while secondary outcomes encompassed postoperative pain, hemodynamic responses, and the occurrence of complications.
Eighty children aged 2-6 years scheduled for short infraumbilical surgeries under general anesthesia were recruited in this trial. Propofol (1 mg/kg) or dexmedetomidine (0.3 μg/kg) was administered 10 min before completion of surgery. The Paediatric Anaesthesia Emergence Delirium scale was employed to evaluate ED every 5 min following extubation, wherein a score exceeding 12 was indicative of ED. Postoperative sedation was assessed using the Ramsay Sedation Scale, while pain levels were determined through the Face, Legs, Activity, Cry, and Consolability (FLACC) score. Any potential complications were closely monitored.
The incidence of ED at extubation was 2.50% and 70% in group D and P, respectively, and the trend of lower ED incidence was consistently observed at 5, 10, 15, and 30 min postextubation. The relative risk ratio at extubation was 4.103 (95% confidence interval: 2.49-6.76), highlighting a significant reduction of 4.1 times in the risk of ED when dexmedetomidine was administered. The dexmedetomidine group exhibited a lower incidence of postoperative pain.
In comparison to propofol, dexmedetomidine demonstrated superior efficacy in reducing ED and postoperative pain in pediatric patients during general anesthesia, when administered before completion of surgery.
麻醉恢复阶段的苏醒期谵妄（ED）带来了重大挑战，尤其是在儿科患者中，发病率在2%至80%之间。本研究旨在评估和比较丙泊酚和右美托咪定在接受七氟醚麻醉的儿科患者中治疗ED的效果。主要目的是确定两个治疗组中ED的患病率，次要结果包括术后疼痛、血流动力学反应和并发症的发生情况。
本试验招募了80名计划在全身麻醉下进行短脐下手术的2至6岁儿童。在手术结束前10分钟给予丙泊酚（1mg/kg）或右美托咪定（0.3μg/kg）。拔管后每隔5分钟使用小儿麻醉苏醒期谵妄量表评估ED，其中得分超过12分表示存在ED。使用拉姆齐镇静量表评估术后镇静情况，通过面部、腿部、活动、哭闹和安慰度（FLACC）评分确定疼痛程度。密切监测任何潜在并发症。
D组和P组拔管时ED的发生率分别为2.50%和70%，并且在拔管后5、10、15和30分钟时始终观察到ED发生率较低的趋势。拔管时的相对风险比为4.103（95%置信区间：2.49 - 6.76），突出显示给予右美托咪定时ED风险显著降低4.1倍。右美托咪定组术后疼痛发生率较低。
与丙泊酚相比，在手术结束前给予右美托咪定在全身麻醉期间对儿科患者减少ED和术后疼痛方面显示出更好的疗效。
