Emergence agitation in children undergoing adenotonsillectomy: A comparison of sevoflurane vs. Sevoflurane-remifentanil administration

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Abstract

Background Sevoflurane is widely used in paediatric anaesthesia but frequently causes emergence agitation (EA). This study evaluated whether limiting the sevoflurane concentration by combining remifentanil with sevoflurane reduced the incidence of EA. Methods Eighty-four preschool children scheduled for adenotonsillectomy were randomly assigned to either the remifentanil or sevoflurane group. In the remifentanil group, anaesthesia was induced with thiopental, rocuronium, and 1% sevoflurane. It was maintained with 1% sevoflurane, 60% nitrous oxide in oxygen, and a continuous infusion of remifentanil. For the sevoflurane group, anaesthesia was induced with thiopental, rocuronium, and 8% sevoflurane, and was maintained with 2-3% sevoflurane. Both groups received ketorolac 1mg/kg and dexamethasone 0.15mg/kg. EA was measured using the paediatric anaesthesia emergence delirium (PAED) scale and a four-point EA scale in the post-anaesthesia care unit. Results The scores on the PAED scales were significantly lower in the remifentanil group than in the sevoflurane group [median (interquartile range); 6 (4.25-10.25) vs. 11 (7.75-14.0), P=0.007], and the proportion of patients with PAED scores ≥10 was significantly lower in the remifentanil group than in the sevoflurane group [15 (35.7%) vs. 27 (64.2%), P=0.009]. The incidence of EA evaluated using the four-point scale was also lower in the remifentanil group [11 (26.1%) vs. 21 (50%), respectively, P=0.025]. Conclusion The incidence of EA was lower in children undergoing adenotonsillectomy who received a lower concentration of sevoflurane combined with remifentanil than in those given a higher concentration of sevoflurane without remifentanil.

Original languageEnglish
Pages (from-to)100-105
Number of pages6
JournalActa Anaesthesiologica Scandinavica
Volume57
Issue number1
DOIs
StatePublished - 1 Jan 2013

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Anesthesia
Pediatrics
Thiopental
Emergence Delirium
remifentanil
sevoflurane
Incidence
Ketorolac
Nitrous Oxide
Preschool Children
Dexamethasone
Oxygen
rocuronium

Cite this

@article{e83dc1a207124698b2c97caf9f7c5cd7,
title = "Emergence agitation in children undergoing adenotonsillectomy: A comparison of sevoflurane vs. Sevoflurane-remifentanil administration",
abstract = "Background Sevoflurane is widely used in paediatric anaesthesia but frequently causes emergence agitation (EA). This study evaluated whether limiting the sevoflurane concentration by combining remifentanil with sevoflurane reduced the incidence of EA. Methods Eighty-four preschool children scheduled for adenotonsillectomy were randomly assigned to either the remifentanil or sevoflurane group. In the remifentanil group, anaesthesia was induced with thiopental, rocuronium, and 1{\%} sevoflurane. It was maintained with 1{\%} sevoflurane, 60{\%} nitrous oxide in oxygen, and a continuous infusion of remifentanil. For the sevoflurane group, anaesthesia was induced with thiopental, rocuronium, and 8{\%} sevoflurane, and was maintained with 2-3{\%} sevoflurane. Both groups received ketorolac 1mg/kg and dexamethasone 0.15mg/kg. EA was measured using the paediatric anaesthesia emergence delirium (PAED) scale and a four-point EA scale in the post-anaesthesia care unit. Results The scores on the PAED scales were significantly lower in the remifentanil group than in the sevoflurane group [median (interquartile range); 6 (4.25-10.25) vs. 11 (7.75-14.0), P=0.007], and the proportion of patients with PAED scores ≥10 was significantly lower in the remifentanil group than in the sevoflurane group [15 (35.7{\%}) vs. 27 (64.2{\%}), P=0.009]. The incidence of EA evaluated using the four-point scale was also lower in the remifentanil group [11 (26.1{\%}) vs. 21 (50{\%}), respectively, P=0.025]. Conclusion The incidence of EA was lower in children undergoing adenotonsillectomy who received a lower concentration of sevoflurane combined with remifentanil than in those given a higher concentration of sevoflurane without remifentanil.",
author = "Na, {Hyo Seok} and Song, {In Ae} and Jung-Won Hwang and Sanghwan Do and Oh, {Ah Young}",
year = "2013",
month = "1",
day = "1",
doi = "10.1111/aas.12006",
language = "English",
volume = "57",
pages = "100--105",
journal = "Acta Anaesthesiologica Scandinavica",
issn = "0001-5172",
publisher = "Blackwell Munksgaard",
number = "1",

}

TY - JOUR

T1 - Emergence agitation in children undergoing adenotonsillectomy

T2 - A comparison of sevoflurane vs. Sevoflurane-remifentanil administration

AU - Na, Hyo Seok

AU - Song, In Ae

AU - Hwang, Jung-Won

AU - Do, Sanghwan

AU - Oh, Ah Young

PY - 2013/1/1

Y1 - 2013/1/1

N2 - Background Sevoflurane is widely used in paediatric anaesthesia but frequently causes emergence agitation (EA). This study evaluated whether limiting the sevoflurane concentration by combining remifentanil with sevoflurane reduced the incidence of EA. Methods Eighty-four preschool children scheduled for adenotonsillectomy were randomly assigned to either the remifentanil or sevoflurane group. In the remifentanil group, anaesthesia was induced with thiopental, rocuronium, and 1% sevoflurane. It was maintained with 1% sevoflurane, 60% nitrous oxide in oxygen, and a continuous infusion of remifentanil. For the sevoflurane group, anaesthesia was induced with thiopental, rocuronium, and 8% sevoflurane, and was maintained with 2-3% sevoflurane. Both groups received ketorolac 1mg/kg and dexamethasone 0.15mg/kg. EA was measured using the paediatric anaesthesia emergence delirium (PAED) scale and a four-point EA scale in the post-anaesthesia care unit. Results The scores on the PAED scales were significantly lower in the remifentanil group than in the sevoflurane group [median (interquartile range); 6 (4.25-10.25) vs. 11 (7.75-14.0), P=0.007], and the proportion of patients with PAED scores ≥10 was significantly lower in the remifentanil group than in the sevoflurane group [15 (35.7%) vs. 27 (64.2%), P=0.009]. The incidence of EA evaluated using the four-point scale was also lower in the remifentanil group [11 (26.1%) vs. 21 (50%), respectively, P=0.025]. Conclusion The incidence of EA was lower in children undergoing adenotonsillectomy who received a lower concentration of sevoflurane combined with remifentanil than in those given a higher concentration of sevoflurane without remifentanil.

AB - Background Sevoflurane is widely used in paediatric anaesthesia but frequently causes emergence agitation (EA). This study evaluated whether limiting the sevoflurane concentration by combining remifentanil with sevoflurane reduced the incidence of EA. Methods Eighty-four preschool children scheduled for adenotonsillectomy were randomly assigned to either the remifentanil or sevoflurane group. In the remifentanil group, anaesthesia was induced with thiopental, rocuronium, and 1% sevoflurane. It was maintained with 1% sevoflurane, 60% nitrous oxide in oxygen, and a continuous infusion of remifentanil. For the sevoflurane group, anaesthesia was induced with thiopental, rocuronium, and 8% sevoflurane, and was maintained with 2-3% sevoflurane. Both groups received ketorolac 1mg/kg and dexamethasone 0.15mg/kg. EA was measured using the paediatric anaesthesia emergence delirium (PAED) scale and a four-point EA scale in the post-anaesthesia care unit. Results The scores on the PAED scales were significantly lower in the remifentanil group than in the sevoflurane group [median (interquartile range); 6 (4.25-10.25) vs. 11 (7.75-14.0), P=0.007], and the proportion of patients with PAED scores ≥10 was significantly lower in the remifentanil group than in the sevoflurane group [15 (35.7%) vs. 27 (64.2%), P=0.009]. The incidence of EA evaluated using the four-point scale was also lower in the remifentanil group [11 (26.1%) vs. 21 (50%), respectively, P=0.025]. Conclusion The incidence of EA was lower in children undergoing adenotonsillectomy who received a lower concentration of sevoflurane combined with remifentanil than in those given a higher concentration of sevoflurane without remifentanil.

UR - http://www.scopus.com/inward/record.url?scp=84871002570&partnerID=8YFLogxK

U2 - 10.1111/aas.12006

DO - 10.1111/aas.12006

M3 - Article

C2 - 23110746

AN - SCOPUS:84871002570

VL - 57

SP - 100

EP - 105

JO - Acta Anaesthesiologica Scandinavica

JF - Acta Anaesthesiologica Scandinavica

SN - 0001-5172

IS - 1

ER -