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Transition to propofol after sevoflurane anesthesia to prevent emergence agitation: a randomized controlled trial.

Content Provider	World Health Organization (WHO)-Global Index Medicus
Author	Costi, David Ellwood, James Wallace, Andrew Ahmed, Samira Waring, Lynne Cyna, Allan
Description	Country affiliation: Australia Author Affiliation: Costi D ( Department of Paediatric Anaesthesia, Women's and Children's Hospital, Adelaide, SA, Australia)
Abstract	BACKGROUND: Emergence agitation (EA) is a common behavioral disturbance after sevoflurane anesthesia in children. Propofol 1 mg · kg(-1) bolus at the end of sevoflurane anesthesia has had mixed results in reducing the incidence of EA, whereas propofol infusion throughout anesthesia maintenance seems effective but is more complex to administer. If a simple, short transition to propofol anesthesia was found to be effective in reducing EA, this could enhance the recovery of children following sevoflurane anesthesia. We therefore aimed to determine whether transition to propofol over 3 min at the end of sevoflurane anesthesia reduces the incidence of EA in children. METHODS: In this prospective randomized controlled trial, 230 children aged 1-12 years, undergoing magnetic resonance imaging (MRI) scans under sevoflurane anesthesia were randomized to receive either propofol 3 mg · kg(-1) over 3 min (propofol group), or no propofol (control group), at the end of sevoflurane anesthesia. EA was assessed by a blinded assessor using the Pediatric Emergence Anesthesia Delirium (PAED) scale and the Watcha scale until 30 min after emergence. EA on the PAED scale was defined as a PAED score >12. EA on the Watcha scale was defined as a score ≥ 3. Times to emergence, postanesthesia care unit (PACU) discharge, and discharge home were also recorded. RESULTS: Data were analyzed for 218 children. The incidence of EA was lower in the propofol group on both PAED (29% vs 7%; relative risk = 0.25; 95% confidence interval 0.12-0.52; P < 0.001) and Watcha (39% vs 15%; relative risk = 0.37; 95% confidence interval 0.22-0.62; P < 0.001) scales. Duration and severity of EA were also reduced in the propofol group. Preplanned subgroup analyses for midazolam premedication, preexisting cognitive or behavioral disturbance, and age group did not alter our findings. Emergence time and time in PACU were both increased by a mean of 8 min in the propofol group (P < 0.001) with no difference in time to discharge home. CONCLUSIONS: Transition to propofol at the end of sevoflurane anesthesia reduces the incidence of EA and improves the quality of emergence. There is a small increase in recovery time, but no delay in discharge home.
File Format	HTM / HTML
ISSN	11555645
Issue Number	5
Volume Number	25
e-ISSN	14609592
Journal	Pediatric Anesthesia
Language	English
Publisher	Wiley-Blackwell
Publisher Date	2015-05-01
Publisher Place	France
Access Restriction	One Nation One Subscription (ONOS)
Subject Keyword	Delirium Research Support, Non-u.s. Gov't Prospective Studies Humans Child, Preschool Anesthetics, Intravenous Double-blind Method Infant Male Risk Epidemiology Journal Article Incidence Child Behavior Psychomotor Agitation Female Propofol Child Anesthetics, Inhalation Adverse Effects Prevention & Control Methyl Ethers Pharmacology Randomized Controlled Trial Drug Effects Anesthesia Recovery Period Discipline Anesthetics Causality
Content Type	Text
Resource Type	Article
Subject	Anesthesiology and Pain Medicine Pediatrics, Perinatology and Child Health

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