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

作　　者：Elena Fernández Dueñas Pascual Sanabria Carretero Francisco Reinoso-Barbero Ana Fernández Dueñas Leopoldo Martínez Martínez 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)

机构地区：[1]Department of Pediatric Anesthesia-Critical Care-Pain Treatment, La Paz University Hospital, Madrid, Spain [2]Idipaz Foundation, La Paz University Hospital, Madrid, Spain [3]Directorate General of Public Health, Ministry of Health, Madrid, Spain [4]Department of Pediatric Surgery, La Paz University Hospital, Madrid, Spain

出　　处：《Open Journal of Anesthesiology》2022年第10期322-337,共16页麻醉学期刊（英文）

摘　　要：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.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 

分 类 号：R61[医药卫生—外科学]