الفهرس 
Pediatric anesthesiaOnly 14 pages are availabe for public view
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Abstract
Pediatric patients present unique anatomic, physiologic and
pharmacological consideration. So they deserve special care with respect to
these differences from adults.
Occurrence of emergence agitation in children after sevoflurane
anesthesia is common, with an incidence ranging between 10% and 80%.
EA is characterized by a variety of presentations including crying,
excitation, agitation, and delirium occurring during the early stage of
emergence from anaesthesia in children. It can also lead to lost intravenous
catheters, and disconnected cables and monitoring instruments
ED was defined as “a disturbance in a child’s awareness of and
attention to his/her environment with disorientation and perceptual
alterations including hypersensitivity to stimuli and hyperactive motor
behavior in the immediate postanesthesia period” . The term “delirium” is
often replaced with the descriptive terms “agitation” or “excitation” as it is
not feasible to fully evaluate a young child’s psychological state during
emergence.
ED usually occurs within the first 30 min of recovery from
anesthesia, is self-limited (5–15 min), and often resolves spontaneously.
However agitation and regressive behavior that lasted up to 2 days.
Several factors have been implicated in the etiology of emergence
agitation and their effect has been extensively studied in the literature
through randomized clinical trials.eg. Age (2-6 years have higher rate of EA), Preoperative anxiety , Parental presence during recovery, Surgical
procedure, Pain, Inhalation and intravenous anesthetics.
In recent studies, there is a higher incidence of postanesthetic
agitation has been attributed to the use of sevoflurane. However, the exact
etiology of restlessness after sevoflurane anesthesia is still not known.
Postoperative agitation may be caused by hypoxemia, metabolic
disturbances, pain and the effect of drugs.
Fentanyl is a potent opioid, which can decrease EA following
sevoflurane and desflurane anesthesia by its high efficacy on preoperative
analgesia as well as its sedative effect
The incidence and duration of emergence agitation in patients
receiving sevoflurane without surgery was significantly decreased by the
addition of 1μg/kg fentanyl 10 minutes before the end of anesthesia. The
addition of a small dose of fentanyl to an anesthetic using sevoflurane
should be considered, even when expected postoperative pain is minimal, to
decrease emergence agitation.
Propofol has become the induction drug of choice for many forms of
anesthesia, especially when rapid and complete awakening is considered
essential.
Propofol delays or modifies emergence and decreases emergence
agitation depending on the time of administration. Being a short acting
medication, propofol given at induction could not prevent emergence
agitation. Several studies have shown a decrease in EA following propofol
administration (1 mg/kg) at the end of surgery, as plasma concentration of
propofol can be effective. In this study we investigated the incidence of EA in three groups
underwent sevoflorane anesthesia : saline (with induction), propofol (at end
of surgery ) & fentanyl (with induction) groups , and compared the efficacy
of propofol versus fentanyl to decrease the incidence of EA using the same
age group, surgical procedure and emergence behavior scales (PAED & 4
point scale).
As regarding the demographic data there was no significant difference
, also the duration of surgery , the duration of anesthesia and the duration of
sefvoflurane administration were not statistically different between the three
groups .
the time to remove the LMA was longer in the propofol group
compared with the other groups.
propofol delays the emergence time more than fentanyl more than
control group.
Both propofol and fentanyl delay the onset of agitation.
Regarding the duration of EA there was no statistically significant
difference between the three groups.
the incidence of EA in the control group was 46.9 % ,in the propofol
group was 18.8% and the fentanyl group was 12.5 % .
The parent satisfaction was statistically comparable , it was the best
with the fentanyl group and less with propofol , while the worst with control
group , with a percentage of 43.8% excellent for control group , 75%
excellent for propofol group & 81.2 % excellent for fentanyl group. There was a difference when using propofol or fentayl as both
decrease the incidence and the severity of EA , but ther is no reliable
significans when comparing both drugs.
We recommend furthere studies to declare other drugs that have
potency to decrease the incidence and to treat the EA.