Effect of esmolol and lidocaine on agitation in awake phase of anesthesia among children

Abstract

Background: Sevoflurane is widely used to anesthetize children because of its rapid action with minimal irritation of the airways. However, there is a high risk of agitation after emergence from anesthesia. Strabismus surgery, in particular, can trigger agitation because patients have their eyes covered in the postoperative period. The aim of this study was to determine whether or not esmolol and lidocaine could decrease emergence agitation in children. Methods: Eighty-four patients aged 3 to 9 years undergoing strabismus surgery were randomly assigned to a control group (saline only), a group that received intravenous lidocaine 1.5 mg/kg, and a group that received intravenous esmolol 0.5 mg/kg and lidocaine 1.5 mg/kg. Agitation was measured using the objective pain score, Cole 5-point score, and Richmond Agitation Sedation Scale score at the end of surgery, on arrival in the recovery room, and 10 and 30 min after arrival. Results: The group that received the combination of esmolol and lidocaine showed lower OPS and RASS scores than the other two groups when patients awoke from anesthesia (OPS = 0 (0–4), RASS = –4 [(–5)–1]) and were transferred to the recovery room (OPS = 0 (0–8), RASS = –1 [(–5)–3]) ( P < 0.05). There was no significant difference in the severity of agitation among the three groups at other time points ( P > 0.05). Conclusions: When pediatric strabismus surgery is accompanied by sevoflurane anesthesia, an intravenous injection of esmolol and lidocaine could alleviate agitation until arrival in the recovery room. Trial registration: Clinical Research Information Service, No. KCT0002925; https://cris.nih.go.kr/cris/en/search/search_result_st01.jsp?seq=11532

Postoperative emergence delirium in children: a narrative review of recent publications

“…It has been investigated whether ondansetron, a serotonin 5-HT3 receptor antagonist and commonly used antiemetic drug, can reduce the incidence of emergence delirium. An administration of IV ondansetron (100 µg/kg) after induction of sevoflurane anesthesia did not significantly impact the incidence of ED (measured by the PAED scale in 2-12 years old children undergoing strabismus surgery) [50].…”

Comparison of the Agitation-Reducing Effects of Esmolol and Lidocaine in Pediatric Strabismus Surgery: A Double-Blind, Randomized Clinical Study

“…However, another study reported that 1.5 mg/kg of lidocaine did not prevent agitation [38]. A previous study showed that when 1.5 mg/kg lidocaine was administered alone, agitation in children did not reduce [39]. Therefore, based on one study reporting that the administration of lidocaine (2 mg/kg) effectively reduced agitation [12], we set the lidocaine dose at 2 mg/kg in our study.…”

“…In previous study since there was no group administered with esmolol alone, the degree of hemodynamic change and the effects of esmolol administration to reduce agitation were unknown [39].…”

Emergence agitation in paediatric day case surgery

“…Although it is not considered standard practice in the setting of paediatric emergence agitation, it has been used in several emergence agitation studies in both adults and children. 2,18,19 It has the advantage of simplicity, and excellent inter-rater reproducibility, 10,20 even in critically ill postoperative children. 21 The RASS scale is presented in Table 1.…”