The Prevention of Emergence Agitation With Tropisetron or Clonidine After Sevoflurane Anesthesia in Small Children Undergoing Adenoidectomy

Abstract

Postoperative agitation is a common problem after sevoflurane anesthesia in children. In the present study, we evaluated if tropisetron or clonidine could reduce the incidence of postoperative agitation after day case adenoidectomy in small children. We included 75 unpremedicated children aged 1-7 yr who were randomly assigned to receive either placebo, tropisetron (0.1 mg/kg) or clonidine (1.5 microg/kg) after anesthesia induction. Anesthesia was induced and maintained with sevoflurane. Patients also received alfentanil (20 microg/kg) and diclofenac (1 mg/kg). Postoperative pain was treated with IV oxycodone (0.05 mg/kg). Time to achieve discharge criteria was recorded. Modified pain/discomfort scale was used assess the postoperative behavior. The incidence of postoperative agitation was significantly less (32%, 8/25 patients) in the tropisetron group compared with placebo (62%, 16/26 patients), P < 0.05). Clonidine could not prevent agitation (incidence 54%, 13/24). No adverse effects were noted during the study. Discharge times were similar between the groups (between 80 and 99 min on average). In conclusion, tropisetron 0.1 mg/kg significantly reduced the incidence of postoperative agitation after sevoflurane anesthesia. Clonidine 1.5 microg/kg did not differ from placebo with respect to postoperative agitation.

Magnesium sulphate infusion is not effective on discomfort or emergence phenomenon in paediatric adenoidectomy/tonsillectomy

“…In an effort to decrease these complications, many drugs or interventions have been utilized including opioid analgesics [3][4][5], benzodiazepines [6], non-steroidal anti-inflammatory drugs [7], local anaesthetic infiltration [6,7], non-volatile induction/maintenance [7][8][9], alpha-2 agonists [1,10], tropisetron [11], caudal block [12], and delay of the emergence period [13] with various rates of success reported.…”

Comparison of Oral Clonidine With Oral Midazolam in Managing Agitation Following Sevoflurane Anesthesia – A Prospective, Randomized, Double Blinded Study

“…Lankinen et al had done a study comparing the effects of intravenous clonidine 1.5 mcg/kg and tropisetron 0.1 mg/kg and found that tropisetron was more effective in reducing the incidence of emergence agitation after sevoflurane anesthesia [9]. We think that it could be due to the dosage of clonidine because intravenous clonidine 2 mcg/kg was effective according to Kulka et al, Tesoro et al and Malviya et al, although it was compared with placebo [6][7][8].…”

“…Intravenous administration of clonidine, after induction of anesthesia reduces the incidence of emergence reactions following sevoflurane administration [6][7][8]. Tropisetron, the serotonin antagonist, used as an anti-emetic, also found to be useful in reducing the incidence of the emergence agitation following sevoflurane anesthesia [9]. Midazolam, which is a shortacting benzodiazepine, is commonly used as pre-medication to reduce pre-operative anxiety and for smooth induction of anesthesia.…”

Agitação no despertar da anestesia em crianças: aspectos atuais

“…Tropisetron proved effective for reducing emergency agitation, but clonidine did not. 46 Intravenous clonidine (2 μg/kg -1 ), administered after induction of anesthesia, reduced the incidence of emergence agitation, although there was greater postoperative somnolence, while no adverse cardiorespiratory events were observed. 44 Using more selective α 2 -agonists, an agitation incidence of 4.8% was observed among patients given dexmedetomidine, at a dosage of 1 μg/kg -1 intravenously, compared with 47.6% in a placebo group, without detecting increases in emergence time or intraoperative hemodynamic repercussion.…”