Emergence delirium is a common complication after sevoflurane-anesthesia and have a serious impact on children undergoing cleft palate surgery. The aim of this study was to compare the effect of propofol and dexmedetomidine on emergence delirium in children. Ninety children aged 8 to 24 months, underwent cleft palate repair, were enrolled in the study. Children were randomly assigned to 3 groups after the induction: Group C (intravenous infusion 0.9% saline), Group P (intravenous infusion 2 mg/kg/hour propofol), and Group D (intravenous infusion 0.5 μg/kg/hour dexmedetomidine). Emergence delirium was diagnosed using the pediatric anesthesia emergence delirium scale and pain using the face, legs, activity, cry, consolability scale. Heart rate, mean arterial pressure, respiratory recovery time, extubation time, post anesthesia care unit observation time, and adverse events were also evaluated. A total of 86 patients were analyzed. The incidence of emergence delirium was 20.1% in group D, 58.6% in group P and 85.7% in group C (P < 0.05). A lower face, legs, activity, cry, consolability score was seen in group D than in group P and group C (3.9 + 1.1 versus 6.1 ± 0.9 and 7.1 ± 1.0, P < 0.05). The value of heart rate and mean arterial pressure during emergence in group P and group C were significantly higher than that in group D (All P < 0.05). These findings suggest that dexmedetomidine as a sedative, analgesic, and sympatholytic agent was superior to propofol in reducing the incidence of emergence delirium in children undergoing cleft palates surgery with sevoflurane-based anesthesia.
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http://dx.doi.org/10.1097/SCS.0000000000008343 | DOI Listing |
Cureus
December 2024
Anesthesiology and Perioperative Medicine, Medical University of South Carolina, Charleston, USA.
Introduction: Caudal blocks are a common pediatric regional anesthesia technique used to alleviate intra- and postoperative pain following circumcision. The addition of the alpha-2 agonist clonidine has been shown to increase the duration of the block. Another method for prolonging the effect of the block is using a high-volume, low-concentration (HVLC) local anesthetic in the caudal solution.
View Article and Find Full Text PDFJ Anaesthesiol Clin Pharmacol
March 2024
Department of Paediatric Surgery, Dr. S. N. Medical College, Jodhpur, Rajasthan, India.
Background And Aims: 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.
View Article and Find Full Text PDFJ Anaesthesiol Clin Pharmacol
July 2024
Department of Anesthesia, Surgical Intensive Care, and Pain Medicine, Faculty of Medicine, Tanta University, Tanta, Egypt.
Background And Aims: Emergence agitation (EA) is frequently encountered following nasal surgeries, and postoperative pain is a significant contributing element. We aimed to assess the role of suprazygomatic maxillary nerve (MN) block (SMB) guided by ultrasound (US) in lowering EA incidence and enhancing analgesia quality in septorhinoplasty cases.
Material And Methods: Sixty cases aged 18-60 years, of both genders, categorized by the American Society of Anesthesiologists (ASA) I-II and listed for septorhinoplasty, were randomized to receive general anesthesia (GA) with either no block (the control group) or combined with bilateral US-guided SMB (the SMB group).
Br J Anaesth
January 2025
Department of Anaesthesiology, Critical Care and Pain Medicine, Policlinico Umberto I, "Sapienza" University of Rome, Rome, Italy. Electronic address:
There is a complex association between postoperative pain and postoperative delirium, which highlights the need for a more balanced approach to pain management that considers various risk factors. We emphasise the importance of comprehensive documentation and standardised monitoring to improve detection and management of postoperative delirium, ultimately enhancing patient outcomes. We advocate for a precision anaesthesia approach, which tailors care to individual patient profiles, as a potential solution to address these challenges.
View Article and Find Full Text PDFPaediatr Anaesth
January 2025
Department of Anesthesiology, Duke University School of Medicine, Duke University Medical Center, Durham, North Carolina, USA.
Background: In pediatric patients, the use of processed EEG monitoring may reduce the amount of anesthesia administered while maintaining adequate depth of anesthesia.
Aims: The primary aim of this study was to evaluate whether use of a BIS monitor to guide sevoflurane administration might reduce the average end tidal sevoflurane concentration used in children 4-18 years of age.
Methods: Participants in three age groups (4-8, 9-12, and 13-18 years) were randomized to either the BIS guided group or the control group.
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