ﺑﺎﺯﮔﺸﺖ ﺑﻪ ﺻﻔﺤﻪ ﻗﺒﻠﯽ
خرید پکیج
تعداد آیتم قابل مشاهده باقیمانده : 3 مورد
نسخه الکترونیک
medimedia.ir

Interventions for the prevention of emergence delirium in children

Interventions for the prevention of emergence delirium in children
Adjunctive agent Timing of administration
Prevention[1]
Propofol IV
  • TIVA[2,3], a brief infusion of 3 mg/kg IV over three minutes after sevoflurane[4]; a single dose at the end of anesthesia (1 mg/kg IV)[5-9]
Thiopental* IV
  • After sevoflurane induction, 2 to 3 mg/kg IV[1]
Opioid IV
  • Meta-analysis[10] of fentanyl, remifentanil, sufentanil, alfentanil
  • Nalbuphine 0.1 mg/kg IV[11]
Midazolam
  • IV
  • 0.03 to 0.05 mg/kg IV at end of anesthesia[9,12]
  • Oral
  • 0.2 to 0.5 mg/kg orally[13]; 0.5 mg/kg orally with parental presence[14]
Alpha2 agonist
  • IV
  • Clonidine 2 mcg/kg IV at induction[13,15,16]
  • Dexmedetomidine 1 mcg/kg IV followed by 1 mcg/kg/hour[17,18]
  • Meta-analysis dexmedetomidine[19-21]
  • Dexmedetomidine 0.3 to 1 mcg/kg IV at emergence[19,22-25]
  • Caudal
  • Clonidine 1 mcg/kg[26]
  • IN
  • Dexmedetomidine 0.2 mcg/kg[21]
Ketamine IV
  • Ketamine 1 mg/kg IV followed by 1 mg/kg/hour[17] or 0.25 mg/kg[11]
Melatonin oral
  • 0.25 or 0.5 mg/kg premedication orally[27-29]
Tropisetron IV (refer to 5HT3 receptor antagonists IV below)
  • 0.1 mg/kg IV at induction[30]
Magnesium sulfate IV
  • 30 mg/kg IV followed by 10 mg/kg/hour[31]
  • SR and meta-analysis using 10 mg/kg/hour[32]
Regional anesthesiaΔ
  • Infraorbital block[33], fascia iliaca block[34]
Monochromatic blue light
  • Up to 30 minutes in the PACU[35]
Ineffective measures
Midazolam
  • Oral
  • Premedication[14,36,37]
  • PR
  • 0.5 to 1 mg/kg PR[38]
Alpha2 agonist
  • Oral
  • Dexmedetomidine 1 mcg/kg premedication[39]
  • IV
  • Clonidine 1.5 mcg/kg IV at induction[30]
  • Caudal
  • Clonidine 0.75 mcg/kg[26]
Parental presence[14]  
5HT3 receptor antagonists IV
  • Ondansetron 4 mg oral disintegrating tablet preoperatively, 0.1 mg/kg IV[40]
Anecdotal reports
Guanfacine (potency one-tenth of dexmedetomidine)
  • 75 mcg/kg oral premedication, single child report[41]
This table shows the interventions for prevention of ED that have been studied, including the doses of medications studied, and whether interventions were found to be effective or ineffective in those studies.

ED: emergence delirium; IV: intravenous; TIVA: total intravenous anesthesia; IN: intranasal; PR: by rectum.

* Thiopental is not available in the United States or Canada; limited availability elsewhere.

¶ Tropisetron is not available in the United States or Canada.

Δ These studies were complicated by the presence of pain in the control groups greater than in the block group.
References:
  1. Costi D, Cyna AM, Ahmed S, et al. Effect of sevoflurane versus other general anaesthesia on emergence agitation in children. Cochrane Database Syst Rev 2014; 9:CD007084.
  2. Picard V, Dumont L, Pellegrini M. Quality of recovery in children: sevoflurane versus propofol. Acta Anaesth Scand 2000; 44:307.
  3. Uezono S, Goto T, Terui K, et al. Emergence agitation after sevoflurane versus propofol in pediatrics patients. Anesth Analg 2000; 91:563.
  4. Costi D, Ellwood J, Wallace A, et al. Transition to propofol after sevoflurane anesthesia to prevent emergence agitation: a randomized controlled trial. Paediatr Anaesth 2015; 25:517.
  5. Aouad MT, Yazbeck-Karam VG, Nasr VG, et al. A single dose of propofol at the end of surgery for the prevention of emergence agitation in children undergoing strabismus surgery during sevoflurane anesthesia. Anesthesiology 2007; 107:733.
  6. Kim MS, Moon BE, Kim H, Lee JR. Comparison of propofol and fentanyl administered at the end of anaesthesia for prevention of emergence agitation after sevoflurane anaesthesia in children. Br J Anaesth 2013; 110:274.
  7. Abu-Shahwan I. Effect of propofol on emergence behavior in children after sevoflurane general anesthesia. Paediatr Anaesth 2008; 18:55.
  8. van Hoff SL, O'Neill ES, Cohen LC, Collins BA. Does a prophylactic dose of propofol reduce emergence agitation in children receiving anesthesia? A systematic review and meta-analysis. Paediatr Anaesth 2015; 25:668.
  9. Chen J, Li W, Hu X, Wang D. Emergence agitation after cataract surgery in children: a comparison of midazolam, propofol and ketamine. Pediatr Anseth 2010; 20:873.
  10. Tan Y, Shi Y, Ding H, et al. µ-Opioid agonists for preventing emergence agitation under sevoflurane anesthesia in children: a meta-analysis of randomized controlled trials. Paediatr Anaesth 2016; 26:139.
  11. Dalens BJ, Pinard AM, Létourneau DR, et al. Prevention of emergence agitation after sevoflurane anesthesia for pediatric cerebral magnetic resonance imaging by small doses of ketamine or nalbuphine administered just before discontinuing anesthesia. Anesth Analg 2006; 102:1056.
  12. Cho EJ, Yoon SXZ, Cho JE, Lee HW. Comparison of the effects of 0.03 and 0.05 mg/kg midazolam with placebo on prevention of emergence agitation in children having strabismus surgery. Anesthesiology 2014; 120:1354.
  13. Zhang C, Li J, Zhao D, Wang Y. Prophylactic midazolam and clonidine for emergence from agitation in children after emergence from sevoflurane anesthesia: a meta-analysis. Clin Ther 2013; 35:1622.
  14. Arai YC P, Ito H, Kandatsu N, et al. Parental presence during induction enhances the effect of oral midazolam on emergence behavior of children undergoing general anesthesia. Acta Anaesthesiol Scand 2007; 51;858.
  15. Tesoro S, Mezzetti D, Marchesini L, Peduto VA. Clonidine treatment for agitation in children after sevoflurane anesthesia. Anesth Analg 2005; 101:1619.
  16. Malviya S, Voepel-Lewis T, Ramamurthi RJ, Burke C, Tait AR. Clonidine for the prevention of emergence agitation in young children: efficacy and recovery profile. Paediatr Anaesth 2006; 16:554.
  17. Chen JY, Jia JE, Liu TJ, et al. Comparison of the effects of dexmedetomidine, ketamine, and placebo on emergence agitation after strabismus surgery in children. Can J Anesth 2013; 60:385.
  18. Huang L, Wang L, Peng W, Qin C. A Comparison of Dexmedetomidine and Propofol on Emergence Delirium in Children Undergoing Cleft Palate Surgery With Sevoflurane-Based Anesthesia. J Craniofac Surg 2022; 33:650.
  19. Zhu M, Wang H, Zhu A, et al. Meta-analysis of dexmedetomidine on emergence agitation and recovery profiles in children after sevoflurane anesthesia: different administration and different dosage. PloS One 2015; 10:e0123728.
  20. Sun L, Guo R, Sun L. Dexmedetomidine for preventing sevoflurane-related emergence agitation in children: a meta-analysis of randomized controlled trials. Acta Anaesthesiol Scand 2014; 58:642.
  21. Rao Y, Zeng R, Jiang X, et al. The Effect of Dexmedetomidine on Emergence Agitation or Delirium in Children After Anesthesia-A Systematic Review and Meta-Analysis of Clinical Studies. Front Pediatr 2020; 8:329.
  22. Guler G, Akin A, Tosun Z, et al. Single-dose dexmedetomidine reduces agitation and provides smooth extubation after pediatric adenotonsillectomy. Paediatr Anaesth 2005; 15:762.
  23. Erdil F, Demirbilek S, Begec Z, et al. The effects of dexmedetomidine and fentanyl on emergence characteristics after adenoidectomy in children. Anaesth Intensive Care 2009; 37:571.
  24. Hauber JA, Davis PJ, Bende LP, et al. Dexmedetomidine as a rapid bolus for treatment and prophylactic prevention of emergence agitation in anesthetized children. Anesth Analg 2015; 121:1308.
  25. Makkar JK, Bhatia N, Bala I, et al. A comparison of single dose dexmedetomidine with propofol for the prevention of emergence delirium after desflurane anaesthesia in children. Anaesthesia 2016; 71:50.
  26. Ghosh SM, Agarwala RB, Pandey M, Vajifdar H. Efficacy of low-dose caudal clonidine in reduction of sevoflurane-induced agitation in children undergoing urogenital and lower limb surgery: a prospective andomized double-blind study. Eur J Anaesthesiol 2011; 28:329.
  27. Kain ZN, MacLaren JE, Herrmann L, et al. Preoperative melatonin and its effects on induction and emergence in children undergoing anesthesia and surgery. Anesthesiology 2009; 111:44.
  28. Singla L, Mathew PJ, Jain A, et al. Oral melatonin as part of multimodal anxiolysis decreases emergence delirium in children whereas midazolam does not: A randomised, double-blind, placebo-controlled study. Eur J Anaesthesiol 2021; 38:1130.
  29. Mihara T, Nakamura N, Ka K, et al. Effects of melatonin premedication to prevent emergence agitation after general anaesthesia in children: A systematic review and meta-analysis with trial sequential analysis. Eur J Anaesthesiol 2015; 32:862.
  30. Lankinen U, Avela R, Tarkkila P. The prevention of emergence agitation with tropisetron or clonidine after sevoflurane anesthesia in small children undergoing adenoidectomy. Anesth Analg 2006; 102:1383.
  31. Abdulatif M, Ahmed A, Mukhtar A, Badawy S. The effect of magnesium sulphate infusion on the incidence and severity of emergence agitation in children undergoing adenotonsillectomy using sevoflurane anaesthesia. Anaesthesia 2013; 68:1045.
  32. Shen QH, Xu-Shen, Lai L, et al. The effect of magnesium sulfate on emergence agitation in children undergoing general anesthesia: A systematic review and meta-analysis. J Clin Anesth 2022; 78:110669.
  33. Wang H, Liu G, Fu W, Li S. The effect of intraorbital nerve block on emergence agitation in children undergoing cleft lip surgery under general anesthesia with sevoflurane. Paediatr Anaesth 2015; 25:906.
  34. Kim HS, Kim CS, Kim SD, Lee JR. Fascia iliaca compartment block reduces emergence agitation by providing effective analgesic properties in children. J Clin Anesth 2011; 23:119.
  35. Adler AC, Nathanson BH, Chandrakantan A. Monochromic light reduces emergence delirium in children undergoing adenotonsillectomy; a double-blind randomized observational study. BMC Anesthesiol 2021; 21:217.
  36. Dahmani S, Stany I, Brasher C, et al. Pharmacological prevention of sevoflurane- and desflurane-related emergence agitation in children: a meta-analysis of published studies. Br J Anaesth 2010; 104:216.
  37. El Batawi HY. Effect of preoperative oral midazolam sedation on separation anxiety and emergence delirium among children undergoing dental treatment under general anesthesia. J Int Soc Prev Community Dent 2015; 5:88.
  38. Breschan C, Platzer M, Jost R, et al. Midazolam does not reduce emergence delirium after sevoflurane anesthesia in children. Paediatr Anaesth 2007; 17:347.
  39. Keles S, Kocaturk O. The Effect of Oral Dexmedetomidine Premedication on Preoperative Cooperation and Emergence Delirium in Children Undergoing Dental Procedures. Biomed Res Int 2017; 2017:6742183.
  40. Hosten T, Solak M, Elemen L, et al. Ondansetron does not modify emergence agitation in children. Anaesth Intens Care 2011; 39:640.
  41. Harvey S, Blair J. Guanfacine for emergence delirium in children-a case report in twins. Society for Neuroscience in Anesthesia and Critical Care (SNACC) 2013 (abstract).
Graphic 109281 Version 8.0

آیا می خواهید مدیلیب را به صفحه اصلی خود اضافه کنید؟