Premedication Propofol Dose to Prevent Emergency Delirium
,
Abstract
Objective: One of the most common complications in general anesthesia is the Emergence delirium (ED). Many agents have been studied for prevention of ED, among which propofol has been successfully used. However, there is no information about the optimal dosage of this agent considering the ultimate outcome and the adverse effects; therefore, aimed to assess in this study.
Method: 70 children undergoing general anesthesia using propofol, fentanyl, and atracurium were assessed. Participants were allocated randomly to treatment with either propofol 1 mg/kg (n = 35) or 0.5 mg/kg (n = 35) by the end of the anesthesia. The Pediatric Anesthesia Emergence Delirium (PAED) Scale, Face, Legs, Activity, Cry, Consolability (FLACC) scale, and the University of Michigan Sedation Scale (UMSS) were assessed by 10-minute intervals. Post-anesthesia care unit (PACU) stay and adverse effects were registered and compared as well.
Results: Duration of PACU stay (P < 0.001), PAED (P = 0.001), and UMSS (P = 0.003) were remarkably lower among low-dose propofol-treated children in the assessment at the 30th minute, while there were no significant differences in FLACC scores between the groups (P > 0.05). Apnea was found in a patient (2.85%) treated with high-dose propofol and decreased oxygen saturation was demonstrated in 5 (14.28%) and 2 (5.71%) participants in high- versus low-dose propofol. None of the patients experienced postoperative nausea and vomiting.
Conclusion: Based on the current study, propofol 0.5 mg/kg by the end of anesthesia could efficiently prevent ED incidence and reduce time of PACU stay and adverse effects compared to a high dose of 1 mg/kg.
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4. 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(6):642-50.
5. Dahmani S, Delivet H, Hilly J. Emergence delirium in children: an update. Curr Opin Anaesthesiol. 2014;27(3):309-15.
6. Kanaya A, Kuratani N, Satoh D, Kurosawa S. Lower incidence of emergence agitation in children after propofol anesthesia compared with sevoflurane: a meta-analysis of randomized controlled trials. J Anesth. 2014;28(1):4-11.
7. Dahmani S, Stany I, Brasher C, Lejeune C, Bruneau B, Wood 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(2):216-23.
8. 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(10):1622-31.
9. Chandler JR, Myers D, Mehta D, Whyte E, Groberman MK, Montgomery CJ, et al. Emergence delirium in children: a randomized trial to compare total intravenous anesthesia with propofol and remifentanil to inhalational sevoflurane anesthesia. Paediatr Anaesth. 2013;23(4):309-15.
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11. Keles S, Kocaturk O. Comparison of oral dexmedetomidine and midazolam for premedication and emergence delirium in children after dental procedures under general anesthesia: a retrospective study. Drug Des Devel Ther. 2018;12:647-53.
12. Kim KM, Lee KH, Kim YH, Ko MJ, Jung JW, Kang E. Comparison of effects of intravenous midazolam and ketamine on emergence agitation in children: Randomized controlled trial. J Int Med Res. 2016;44(2):258-66.
13. Chen JY, Jia JE, Liu TJ, Qin MJ, Li WX. Comparison of the effects of dexmedetomidine, ketamine, and placebo on emergence agitation after strabismus surgery in children. Can J Anaesth. 2013;60(4):385-92.
14. Costi D, Cyna AM, Ahmed S, Stephens K, Strickland P, Ellwood J, et al. Effects of sevoflurane versus other general anaesthesia on emergence agitation in children. Cochrane Database Syst Rev. 2014(9):Cd007084.
15. Kochman A, Howell J, Sheridan M, Kou M, Shelton Ryan EE, Lee S, et al. Reliability of the Faces, Legs, Activity, Cry, and Consolability Scale in Assessing Acute Pain in the Pediatric Emergency Department. Pediatr Emerg Care. 2017;33(1):14-7.
16. Alizadeh Z, Paymard A, Khalili A, Hejr H. A systematic review of pain assessment method in children. Ann Trop Med Pubic Health. 2017;10(4):847-49.
17. Sikich N, Lerman J. Development and psychometric evaluation of the pediatric anesthesia emergence delirium scale. Anesthesiology. 2004;100(5):1138-45.
18. Malviya S, Voepel-Lewis T, Tait AR, Merkel S, Tremper K, Naughton N. Depth of sedation in children undergoing computed tomography: validity and reliability of the University of Michigan Sedation Scale (UMSS). Br J Anaesth. 2002;88(2):241-5.
19. Park SJ, Shin S, Kim SH, Kim HW, Kim SH, Do HY, et al. Comparison of Dexmedetomidine and Fentanyl as an Adjuvant to Ropivacaine for Postoperative Epidural Analgesia in Pediatric Orthopedic Surgery. Yonsei Med J. 2017;58(3):650-7.
20. Makkar JK, Bhatia N, Bala I, Dwivedi D, Singh PM. A comparison of single dose dexmedetomidine with propofol for the prevention of emergence delirium after desflurane anaesthesia in children. Anaesthesia. 2016;71(1):50-7.
21. Kyker M, Burke B. Speeds criteria vs. modified aldrete and fast-track criteria for evaluating recovery in outpatients. Open J Anesthesiol. 2013;3(07):309.
22. Huett C, Baehner T, Erdfelder F, Hoehne C, Bode C, Hoeft A, et al. Prevention and Therapy of Pediatric Emergence Delirium: A National Survey. Paediatr Drugs. 2017;19(2):147-53.
23. Kim YH, Yoon SZ, Lim HJ, Yoon SM. Prophylactic use of midazolam or propofol at the end of surgery may reduce the incidence of emergence agitation after sevoflurane anaesthesia. Anaesth Intensive Care. 2011;39(5):904-8.
24. 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(2):274-80.
25. Ali MA, Abdellatif AA. Prevention of sevoflurane related emergence agitation in children undergoing adenotonsillectomy: A comparison of dexmedetomidine and propofol. Saudi J Anaesth. 2013;7(3):296-300.
26. Bong CL, Lim E, Allen JC, Choo WL, Siow YN, Teo PB, et al. A comparison of single-dose dexmedetomidine or propofol on the incidence of emergence delirium in children undergoing general anaesthesia for magnetic resonance imaging. Anaesthesia. 2015;70(4):393-9.
27. Lee CJ, Lee SE, Oh MK, Shin CM, Kim YJ, Choe YK, et al. The effect of propofol on emergence agitation in children receiving sevoflurane for adenotonsillectomy. Korean J Anesthesiol. 2010;59(2):75-81.
28. Jalili S, Esmaeeili A, Kamali K, Rashtchi V. Comparison of effects of propofol and ketofol (Ketamine-Propofol mixture) on emergence agitation in children undergoing tonsillectomy. Afr Health Sci. 2019;19(1):1736-44.
29. Rad MM, Rashidi M, Nassajian N, Salari A, Mohtadi AR, Hesam S, et al. Comparison Between Administration of Midazolam and Propofol at the End of Anesthesia for Prevention of Emergence Agitation in Children. Iran J Pediatr. 2019;29(5).
30. Viitanen H, Tarkkila P, Mennander S, Viitanen M, Annila P. Sevoflurane-maintained anesthesia induced with propofol or sevoflurane in small children: induction and recovery characteristics. Can J Anaesth. 1999;46(1):21-8.
31. Bal N, Saricaoglu F, Uzun S, Dal D, Celebi N, Celiker V, et al. Perioperative anxiety and postoperative behavioural disturbances in children: comparison between induction techniques. Eur J Anaesthesiol. 2006;23(6):470-5.
2. 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(7):668-76.
3. Moore AD, Anghelescu DL. Emergence Delirium in Pediatric Anesthesia. Paediatr Drugs. 2017;19(1):11-20.
4. 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(6):642-50.
5. Dahmani S, Delivet H, Hilly J. Emergence delirium in children: an update. Curr Opin Anaesthesiol. 2014;27(3):309-15.
6. Kanaya A, Kuratani N, Satoh D, Kurosawa S. Lower incidence of emergence agitation in children after propofol anesthesia compared with sevoflurane: a meta-analysis of randomized controlled trials. J Anesth. 2014;28(1):4-11.
7. Dahmani S, Stany I, Brasher C, Lejeune C, Bruneau B, Wood 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(2):216-23.
8. 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(10):1622-31.
9. Chandler JR, Myers D, Mehta D, Whyte E, Groberman MK, Montgomery CJ, et al. Emergence delirium in children: a randomized trial to compare total intravenous anesthesia with propofol and remifentanil to inhalational sevoflurane anesthesia. Paediatr Anaesth. 2013;23(4):309-15.
10. Nair S, Wolf A. Emergence delirium after paediatric anaesthesia: new strategies in avoidance and treatment. BJA Educ. 2018;18(1):30-3.
11. Keles S, Kocaturk O. Comparison of oral dexmedetomidine and midazolam for premedication and emergence delirium in children after dental procedures under general anesthesia: a retrospective study. Drug Des Devel Ther. 2018;12:647-53.
12. Kim KM, Lee KH, Kim YH, Ko MJ, Jung JW, Kang E. Comparison of effects of intravenous midazolam and ketamine on emergence agitation in children: Randomized controlled trial. J Int Med Res. 2016;44(2):258-66.
13. Chen JY, Jia JE, Liu TJ, Qin MJ, Li WX. Comparison of the effects of dexmedetomidine, ketamine, and placebo on emergence agitation after strabismus surgery in children. Can J Anaesth. 2013;60(4):385-92.
14. Costi D, Cyna AM, Ahmed S, Stephens K, Strickland P, Ellwood J, et al. Effects of sevoflurane versus other general anaesthesia on emergence agitation in children. Cochrane Database Syst Rev. 2014(9):Cd007084.
15. Kochman A, Howell J, Sheridan M, Kou M, Shelton Ryan EE, Lee S, et al. Reliability of the Faces, Legs, Activity, Cry, and Consolability Scale in Assessing Acute Pain in the Pediatric Emergency Department. Pediatr Emerg Care. 2017;33(1):14-7.
16. Alizadeh Z, Paymard A, Khalili A, Hejr H. A systematic review of pain assessment method in children. Ann Trop Med Pubic Health. 2017;10(4):847-49.
17. Sikich N, Lerman J. Development and psychometric evaluation of the pediatric anesthesia emergence delirium scale. Anesthesiology. 2004;100(5):1138-45.
18. Malviya S, Voepel-Lewis T, Tait AR, Merkel S, Tremper K, Naughton N. Depth of sedation in children undergoing computed tomography: validity and reliability of the University of Michigan Sedation Scale (UMSS). Br J Anaesth. 2002;88(2):241-5.
19. Park SJ, Shin S, Kim SH, Kim HW, Kim SH, Do HY, et al. Comparison of Dexmedetomidine and Fentanyl as an Adjuvant to Ropivacaine for Postoperative Epidural Analgesia in Pediatric Orthopedic Surgery. Yonsei Med J. 2017;58(3):650-7.
20. Makkar JK, Bhatia N, Bala I, Dwivedi D, Singh PM. A comparison of single dose dexmedetomidine with propofol for the prevention of emergence delirium after desflurane anaesthesia in children. Anaesthesia. 2016;71(1):50-7.
21. Kyker M, Burke B. Speeds criteria vs. modified aldrete and fast-track criteria for evaluating recovery in outpatients. Open J Anesthesiol. 2013;3(07):309.
22. Huett C, Baehner T, Erdfelder F, Hoehne C, Bode C, Hoeft A, et al. Prevention and Therapy of Pediatric Emergence Delirium: A National Survey. Paediatr Drugs. 2017;19(2):147-53.
23. Kim YH, Yoon SZ, Lim HJ, Yoon SM. Prophylactic use of midazolam or propofol at the end of surgery may reduce the incidence of emergence agitation after sevoflurane anaesthesia. Anaesth Intensive Care. 2011;39(5):904-8.
24. 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(2):274-80.
25. Ali MA, Abdellatif AA. Prevention of sevoflurane related emergence agitation in children undergoing adenotonsillectomy: A comparison of dexmedetomidine and propofol. Saudi J Anaesth. 2013;7(3):296-300.
26. Bong CL, Lim E, Allen JC, Choo WL, Siow YN, Teo PB, et al. A comparison of single-dose dexmedetomidine or propofol on the incidence of emergence delirium in children undergoing general anaesthesia for magnetic resonance imaging. Anaesthesia. 2015;70(4):393-9.
27. Lee CJ, Lee SE, Oh MK, Shin CM, Kim YJ, Choe YK, et al. The effect of propofol on emergence agitation in children receiving sevoflurane for adenotonsillectomy. Korean J Anesthesiol. 2010;59(2):75-81.
28. Jalili S, Esmaeeili A, Kamali K, Rashtchi V. Comparison of effects of propofol and ketofol (Ketamine-Propofol mixture) on emergence agitation in children undergoing tonsillectomy. Afr Health Sci. 2019;19(1):1736-44.
29. Rad MM, Rashidi M, Nassajian N, Salari A, Mohtadi AR, Hesam S, et al. Comparison Between Administration of Midazolam and Propofol at the End of Anesthesia for Prevention of Emergence Agitation in Children. Iran J Pediatr. 2019;29(5).
30. Viitanen H, Tarkkila P, Mennander S, Viitanen M, Annila P. Sevoflurane-maintained anesthesia induced with propofol or sevoflurane in small children: induction and recovery characteristics. Can J Anaesth. 1999;46(1):21-8.
31. Bal N, Saricaoglu F, Uzun S, Dal D, Celebi N, Celiker V, et al. Perioperative anxiety and postoperative behavioural disturbances in children: comparison between induction techniques. Eur J Anaesthesiol. 2006;23(6):470-5.
| Files | ||
| Issue | Vol 17 No 3 (2022) | |
| Section | Original Article(s) | |
| DOI | https://doi.org/10.18502/ijps.v17i3.9730 | |
| Keywords | ||
| Anesthesia Child Delirium General Propofol | ||
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How to Cite
1.
Shafa A, Rajabi F, Golkar K, Habibzadeh MR. Premedication Propofol Dose to Prevent Emergency Delirium. Iran J Psychiatry. 2022;17(3):304-311.
