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Comparison of Propofol and Fentanyl for Preventing Emergence Agitation Following Sevoflurane Anesthesia in Pediatric Patients: A Single-Center Study in Bangladesh

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Pharmacology & Pharmacy 2024年第6期15卷 223-235页

作者： Md. Saiful Islam Khan Md. Abir Tazim Chowdhury Farzana Fardousi Munama Magdum Md. Ahaduzzaman Taneem Mohammad Shamima Akter Suriya Akter Md. Saiful Islam Azad Md. Mozaffer Hossain M. Abdur Rahman department of Cardiothoracic Anesthesia Evercare Hospital Dhaka Bangladesh department of Cardiothoracic and Vascular Surgery Evercare Hospital Dhaka Bangladesh department of Pathology National Institute of Cancer Research & Hospital Dhaka Bangladesh department of Preventive and Social Medicine National Institute of Preventive and Social Medicine Dhaka Bangladesh department of Anesthesia Sheikh Sayera Khatun Medical College Gopalgonj Bangladesh department of Anesthesia Dhaka Medical College Dhaka Bangladesh department of Anesthesia Combined Military Hospital Dhaka Bangladesh department of Cardiac Anesthesia National Institute of Cardiovascular Disease Dhaka Bangladesh department of Anesthesia Bangladesh Medical College Dhaka Bangladesh

Background: Emergence agitation (EA) is a common phenomenon observed in pediatric patients following general anesthesia. This study aimed to assess the efficacy of propofol and fentanyl in preventing EA and to compare their associated complications or side effects. Methods: This prospective randomized observational comparative study was conducted at Dhaka Medical College Hospital from July 2013 to June 2014. The study aimed to evaluate the effects of propofol and fentanyl on EA in children aged 18 to 72 months undergoing circumcision, herniotomy, and polypectomy operations. Ninety children were included in the study, with 45 in each group. Patients with psychological or neurological disorders were excluded. Various parameters including age, sex, weight, American Society of Anesthesiologists (ASA) class, duration of anesthesia, Saturation of Peripheral Oxygen (SPO2), heart rate (HR), respiratory rate (RR), Pediatric Anesthesia Emergence Delirium (paed) score, duration of post-anesthesia care unit (PACU) stay, incidence of laryngospasm, nausea, vomiting, and rescue drug requirement were compared between the two groups. Results: Age, sex, weight, ASA class, and duration of anesthesia were comparable between the two groups. Perioperative SpO2 and HR were similar in both groups. However, the paed score was significantly higher in the fentanyl group during all follow-ups except at 30 minutes postoperatively. The mean duration of PACU stay was significantly longer in the fentanyl group. Although the incidence of laryngospasm was higher in the fentanyl group, it was not statistically significant. Conversely, nausea or vomiting was significantly higher in the fentanyl group. The requirement for rescue drugs was significantly higher in the fentanyl group compared to the propofol group. Conclusion: Both propofol and fentanyl were effective in preventing emergence agitation in pediatric patients undergoing various surgical procedures under sevoflurane anesthesia. However, propofol demonstrated a better safety profile with fe

关键词： Emergence Agitation (EA) General Anesthesia Propofol Fentanyl Pediatric Patients Pediatric Anesthesia Emergence Delirium (paed) Score Bangladesh

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Impact of HIV on the health-related quality of life in youth with perinatally acquired HIV

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World Journal of Pediatrics 2019年第5期15卷 492-498页

作者： Isabel Cuéllar-Flores Talís Saínz Carlos Velo María Isabel González-Tomé Cristina García-Navarro Caroclina Fernández-Mcphee Sara Guillén JoséTomás Ramos Pilar Miralles Rafae Rubio JoséIgnacio Bernardino Luis Prieto Pablo Rojo Santiago Jiménez de Ory Maria Luisa Navarro CoRiSpe(FARO and NeuroCoRISpeS projects,RITIP-Traslational Research Network in Pediatric Infectious Diseases) Pediatric department Hospital Clínico San CarlosMadridSpain Infectious Diseases Service Paed DepartmentHospital La PazMadridSpain La Paz Research Institute(IdiPAZ) MadridSpain Infectious Diseases Service Paed DepartmentHospital 12 de OctubreMadridSpain Infectious Diseases Service Paed DepartmentH.Gregorio MaranónMadridSpain paed department Hospital de GetafeMadridSpain Infectious Diseases Service H.Gregorio MaranónMadridSpain HIV Service Hospital 12 de OctubreMadridSpain Infectious Diseases Service Hospital La PazMadridSpain Instituto de Investigación Sanitaria Hospital Gregorio Maranón(IiSGM) MadridSpain Universidad Complutense de Madrid MadridSpain Translational Research Network in Pediatric Infectious Diseases(RITIP) MadridSpain 不详

Background Studies investigating health-related quality of life(HRQoL)in youth with perinatally acquired HIV(PHIV+)are scarce.This study aimed to compare HRQoL of PHIV+to sociodemographic-matched youth not living with HIV(HIV-),Spanish general youth population,and to explore associations between sociodemographic variables,drug consumption,and HRQoL.Methods PHIV+youth were randomly selected from CoRISpe database(Cohort of the Spanish Pediatric HIV Network).HRQoL was evaluated by SF-12v2.Results Thirty-nine PHIV+youth(mean age:23.36 years,SD=3.83)and thirty-nine HIV-youth(mean age:22.97 years,SD=3.80)participated in this study.PHIV+obtained lower scores in SF-12 physical health subscale(PCS)than HIV-(P=0.001)and Spanish general youth population(P=0.006).PHIV+had lower scores on the mental health subscale(MCS)than the Spanish general youth population(P<0.001).PHIV+who were at school obtained better scores than those were not at school.PHIV+youth who had used cocaine and cannabis had lower scores in MCS(P=0.002).Conclusions There is a need for HRQoL management in the associated medical follow-up.

关键词： Drug consumption Health-related quality of life Mental health Perinatally acquired HIV youth

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Effects of propofol combined with lidocaine on hemodynamics, serum adrenocorticotropic hormone, interleukin-6, and cortisol in children

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World Journal of Clinical Cases 2022年第24期10卷 8506-8513页

作者： Song Shi Lu Gan Chun-Nv Jin Rong-Fang Liu department of Anesthesiology Affiliated Hospital of Hebei UniversityBaoding 071000Hebei ProvinceChina department of Anesthesiology Baoding Maternal and Child Health HospitalBaoding 071000Hebei ProvinceChina

BACKGROUND Children are a unique patient population.Anesthesia for pediatric abdominal surgery has long been achieved mainly with intravenous amiodarone and propofol alone or combined with other anesthetics.The incidence of complications and postoperative adverse reactions is relatively high owing to the imperfect development of various protocols for children.Choosing the most appropriate anesthesia program is an important means of reducing adverse reactions.AIM To explore the clinical value of propofol combined with lidocaine-assisted anesthesia in pediatric surgery.METHODS A total of 120 children who underwent abdominal surgery at our hospital from January 2016 to March 2018 were selected and divided into groups A and B using the random number table method,with 60 patients in each group.Group B received ketamine for anesthesia,while group A received ketamine,propofol,and lidocaine.The pre-and postoperative heart rate(HR);mean arterial pressure(MAP);arterial oxygen saturation(SpO_(2));serum adrenocorticotropic hormone(ACTH),interleukin-6(IL-6),and cortisol(Cor)levels;restlessness score during the recovery period[paediatric Anesthesia Emergence Delirium Scale(paed)];and adverse reactions were compared between the two groups.RESULTS The HR,MAP,and SpO_(2) Level at five minutes before initiating anesthesia were compared between groups A and B,and the difference was not statistically significant(P>0.05).At 10 and 20 minutes after anesthesia initiation,the HR and MAP were lower in group A compared with group B(P0.05);however,the postoperative serum ACTH,IL-6,and Cor levels in group A were lower compared with group B(Ppaed score in group A was lower than that in group B(P<0.05),and the incidence of rest

关键词： Ketamine Propofol Lidocaine Anesthesia Children

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Sufentanil reduces emergence agitation in children receiving sevoflurane anesthesia for adenotonsillectomy compared with fentanyl

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Chinese Medical Journal 2011年第22期124卷 3682-3685页

作者： LI Jun HUANG Zhi-lian ZHANG Xu-tong LUO Ke ZHANG Zhan-qin MAO Yi ZHUANG Xiao-biao LIAN Qing-quan CAO Hong department of Anesthesiology Second Affiliated Hospital ＆ Yuying Children＇s Hospital of Wenzhou Medical College Wenzhou Zhejiang 325027 China

Background Emergence agitation is a common problem in pediatric anesthesia, especially after sevoflurane induction and maintenance anesthesia. The purpose of this study was to investigate the effect of sufentanil to reduce emergence agitation after sevoflurane anesthesia in children undergoing adenotonsillectomy compared with fentanyl. Methods One hundred and five children, aged 3-11 years, were randomly allocated to receive normal saline （control group）, sufentanil 0.2 pg/kg （S2） or fentanyl 2 pg/kg （F2） 1 minute after loss of the eyelash reflex. Anesthesia was induced and maintained with sevoflurane. Time to tracheal extubation, recovery time, paediatric Anesthesia Emergence Delirium （paed） scale, and emergence behavior were assessed. Results The incidence of severe agitation was significantly lower in $2 and F2 groups vs. the control group, 4/32 and 15/34 vs. 24/34 respectively, （P=0.002, 0.009, respectively）. paed scales were significantly different among three groups （P=0.007）, and lower in the S2 and F2 groups than in the control group （P=0.007 and P=-0.025, respectively）. And the incidence of severe agitation and the paed scale score was significantly different between the $2 and F2 groups （P=-0.007, P=0.019, respectively）. Time to tracheal extubation and recovery time were similar in all three groups. Conclusions Administration of sufentanil at 0.2 IJg/kg after induction of anesthesia reduced emergence agitation in children receiving sevoflurane anesthesia for adenotonsillectomy compared with fentanyl. This was without delaying the recovery time or causing significant hypotension.

关键词： anesthesia sufentanil fentanyl emergence agitation children

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Postanesthetic Emergence Delirium in Children: Qualitative Differences between Sevoflurane vs Desflurane: A Randomized Clinical Trial

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Open Journal of Anesthesiology 2022年第10期12卷 322-337页

作者： Elena Fernández Dueñas Pascual Sanabria Carretero Francisco Reinoso-Barbero Ana Fernández Dueñas Leopoldo Martínez Martínez department of Pediatric Anesthesia-Critical Care-Pain Treatment La Paz University Hospital Madrid Spain Idipaz Foundation La Paz University Hospital Madrid Spain Directorate General of Public Health Ministry of Health Madrid Spain department of Pediatric Surgery La Paz University Hospital Madrid Spain

Background: Emergence Delirium (ED) is considered a usual complication in pediatric anesthesia. Aim: Analyze the quantitative and qualitative differences in ED in children receiving general anesthesia with sevoflurane or desflurane in day case surgery. Materials and Methods: Two hundred and two children, ASA I-II, who required outpatient elective day case surgery, were assigned to receive anesthesia with sevoflurane or desflurane. ED was assessed by a masked investigator using the Pediatric Anesthesia Emergence Delirium (paed) scale at 5 and 15 minutes (min). Results: Mean time to wake up was shorter with desflurane compared with sevoflurane (6.0 versus 8.3 min, p = 0.0001). The overall incidence of ED was 21.3% and Postoperative Maladaptive Behavior Changes (POMBC) incidence was 22%;however, these were not related. Main factors found to be associated with ED were younger age, postoperative pain and preoperative anxiety. Although there were not statistically significant differences in ED incidence between sevoflurane (26.4%, 95% CI 17.3% - 35.4%) and desflurane anesthesia (16.3%, 95% CI 8.8% - 23.8%) (p = 0.18), scores of items 1 and 2 from paed scale (eye contact and purposeful actions, items related to the patients’ connection with their surroundings) were significantly higher in sevoflurane than in desflurane group (p = 0.034 and p = 0.021 respectively). Conclusion: Recovery after anesthetic maintenance with desflurane is faster and as safe as sevoflurane, including postoperative behavioral disorders. Although desflurane did not statistically decrease ED incidence as compared with sevoflurane, patients who were agitated with desflurane were qualitatively less disoriented and disconnected from their surroundings.

关键词： Inhaled Agents Sevoflurane Desflurane Emergence Agitation Pediatric

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Parental Presence Promoted Children Anesthesia Recovery: A Randomized Controlled Study

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Yangtze Medicine 2020年第1期4卷 54-61页

作者： Rong Hai Liu Zhang Xin Liang Gaijing Wang Zumei Gao department of Medicine Yangtze University Jingzhou China Nursing department of First Affiliated Hospital of Yangtze University Jingzhou China

Objective: There are few studies about restlessness and awakening of children during recovering from anesthesia accompanied by parents. Only one related study was retrieved in China. The purpose of this study is to investigate the effect of awakening, agitation and pain level in children after tonsillectomy accompanied by their parents. Methods: Children who met the inclusion criteria were randomly divided into experimental group and control group according to coin tossing method. There were 30 cases in the experimental group and 32 in the control group. The control group received routine nursing while the experimental group was given parental presence on the basis of routine nursing. Steward awakening score, Pediatric anesthesia emergence delirium (paed), Scale and FLACC pain assessment scale were used to evaluate the children when they entered anesthesia recovery room and awaked respectively. Results: There was no significant difference in the scoring of three scales between the two groups when they entered anesthesia recovery room (P > 0.05). There was significant difference in Steward awakening score and paed scale between the two groups when they came to recovery room (P P > 0.05). Conclusion: Parental presence can improve the recovery effect and reduce the restlessness of children after operation. Our study suggests that anesthetic children should be accompanied by their parents in the future.

关键词： Parental Presence Children Agitation Pain

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Dexmedetomidine versus Ketamine for the Prevention of Emergence Agitation in Pediatric: A Prospective, Randomized, and Controlled Clinical Trial

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Open Journal of Anesthesiology 2020年第5期10卷 203-212页

作者： Elsayed Mohamed Abdelzaam Enas W. Mahdy department of Anesthesiology Faculty of Medicine Benha University Benha Egypt

Background: This study compares the effect of dexmedetomidine versus Ketamine for the prevention of emergence agitation in children undergoing general anaesthesia. Method: 75 Children are randomly allocated into three groups. Group C: Were assigned to receive normal saline. Group K: Were assigned to receive Ketamine 0.25 mg/kg. Group D: assigned to receive 0.25 ug /kg of dexmedetomidine, before the end of surgery. Results: There was no statistically significant difference in demographic data and intraoperative parameters between the three groups. But as regards to time to discharge, there was a significant difference between group C, group K and group D (group C = 39.96 ± 2.84, group K = 37.28 ± 3.80, group D = 35.08 ± 3.36 and P value = 0.0002). FLACC scale was low after extubation, before leaving the operating room and on arrival to PACU (small FLACC scale in group K, D than group C). paed scoreless in Group K and Group D than Group C (postoperative, at 10 minutes, 20 min, 30 min). Conclusion: Ketamine and dexmedetomidine reduced the incidence and severity of emergence delirium effectively when compared to normal saline, and the effects of dexmedetomidine being much superior to Ketamine.

关键词： Emergence Agitation Ketamine Dexmedetomidine

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Prospective, Randomized Comparisons of Induction of Anesthesia with Ketamine, Propofol and Sevoflurane for Quality of Recovery from Short Sevoflurane Anesthesia in Pediatric Patients

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Open Journal of Anesthesiology 2015年第7期5卷 163-169页

作者： Shin Nakayama Hajime Furukawa Hiromune Yanai department of Anesthesiology Iwaki Kyoritsu General Hospital Iwaki Fukushima Japan

Background: Emergence agitation (EA) after sevoflurane anesthesia is common in children. When rapid intravenous induction of general anesthesia is indicated in a brief procedure, the induction agent can reduce the incidence of EA after sevoflurane anesthesia. The aim of this study was to compare the efficacy of intravenous induction with ketamine and propofol for reducing EA in children after short sevoflurane anesthesia. Methods: Children aged 2 to 6 years who were scheduled to undergo inguinal hernia repair were randomly divided into 3 groups to receive 2 mg/kg ketamine iv, 3 mg/kg propofol iv, or inspired concentration of 8% sevoflurane for induction of anesthesia. After a laryngeal mask airway (LMA) insertion, a caudal block was performed in all children. Anesthesia was maintained with 1.5% sevoflurane and 65% nitrous oxide in oxygen with spontaneous ventilation. The recovery characteristics were recorded and EA were evaluated by using the Pediatric Anesthesia Emergence Delirium (paed) scale. Results: One hundred and twenty children were enrolled and randomized to treatment. Children who received ketamine induction had higher incidence of EA than those who received propofol (42% vs 16%, P paed score was significantly lower in children who received propofol induction (6.8 ± 4.0, P < 0.05) than ketamine (11.8 ± 4.1) or sevoflurane (11.6 ± 3.8). Conclusions: Intravenous induction with ketamine does not prevent the incidence of EA and delays recovery. Induction with propofol improves the quality of recovery by reducing the incidence of EA and provides a safe and early recovery.

关键词： Pediatric Anesthesia Emergence Agitation Sevoflurane Propofol Ketamine

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