Postoperative emergence agitation and intraoperative sevoflurane sedation under caudal block in children: a randomized comparison of two sevoflurane doses

Abstract

Background Sub-umbilical surgery under caudal block in conjunction with sevoflurane sedation may be safe in terms of maintaining spontaneous breathing and avoiding complications associated with general anesthesia. However, sevoflurane-induced emergence agitation (EA) continues to be a clinically important phenomenon in children. To compare the incidence of EA in children undergoing sub-umbilical surgery under caudal block with two different doses of sevoflurane. Methods Forty children (aged 1–5 years) scheduled to undergo inguinal hernia repair under caudal block with sevoflurane sedation via a face mask were randomized into either the low-dose (1.0%) end-tidal sevoflurane concentration group (Group LS) or the high-dose (2.5%) end-tidal sevoflurane concentration group (Group HS). We monitored EA episodes at 5 and 30 min in the post-anesthetic care unit (PACU) by using the fourpoint agitation scale and the Pediatric Anesthesia Emergence Delirium (PAED) scale. Results The four-point agitation scale scores and PAED scores were not different between the groups at 5 min. However, the agitation score was higher in Group HS than in Group LS at 30 min after arriving in the PACU. The time required to recover from sedation was longer in Group HS than in Group LS. Conclusions Face-mask sedation with 1.0% sevoflurane in conjunction with caudal block may be more effective than that with 2.5% sevoflurane in preventing EA.

Effect of Preoperative Clear Liquid Consumption on Postoperative Recovery in Pediatric Patients Undergoing Minimally Invasive Repair of Pectus Excavatum: A Prospective Randomized Controlled Study

“…Studies have revealed a correlation between higher sevoflurane concentrations and increased agitation incidence in children undergoing various surgical procedures. A study comparing agitation scores in children undergoing inguinal hernia repair with caudal block found that children receiving higher doses of end-tidal sevoflurane (2.5%) during face-mask sedation exhibited higher agitation rates compared with children receiving lower doses (1%) [ 18 ]. Another study demonstrated a relationship between the area under the curve of end-tidal sevoflurane concentration over time (EtSevo-time AUC) and ED.…”

The Effects of Different Doses of Alfentanil and Dexmedetomidine on Prevention of Emergence Agitation in Pediatric Tonsillectomy and Adenoidectomy Surgery

“…EA is a common phenomenon with children after sevoflurane anesthesia. A lot of risk factors may be considered during the development of EA, for example, pain, age, different types of surgery and inhaled anesthetics with fast emergence, and anesthetic techniques such as sevoflurane (Choi et al, 2019). In some research studies, the prophylactic use of analgesics successfully reduced EA after sevoflurane anesthesia, showed that pain may be one of the reasons for EA (Lynch et al, 1998;Kosar et al, 2014).…”

LncRNA colorectal neoplasia differentially expressed exacerbates the impairments in learning and memory induced by isoflurane

“…Inhalation anesthetics are widely used in clinical anesthesia, especially in pediatric anesthesia. 14 The neurotoxicity of inhaled anesthetics to surgical patients is one of the hot issues in clinical anesthesia at present, which is mainly manifested as POCD, neurodegenerative lesions of thalamus neurons, and decreased learning ability. 15,16 The immature brain is the critical period of neural development.…”