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[Emergence agitation in pediatric anesthesia]
1Department of Anesthesiology, Saitama Medical School, Saitama 350-0495.
Insights
Emergence agitation in children after anesthesia is common with sevoflurane. Strategies like pain management and alternative anesthetics may reduce this issue, improving patient recovery and satisfaction.
Area of Science:
- Anesthesiology
- Pediatric Medicine
Background:
- Emergence agitation in children following general anesthesia is a growing concern.
- Sevoflurane, a popular anesthetic, is associated with a higher incidence of emergence agitation compared to halothane.
- The exact causes for this increased incidence remain unclear.
Purpose of the Study:
- To review the incidence, risk factors, and prevention strategies for emergence agitation in pediatric anesthesia.
- To discuss the role of sevoflurane and alternative anesthetic agents in emergence agitation.
- To highlight the importance of appropriate management for patient safety and parental satisfaction.
Main Methods:
- Literature review of studies comparing anesthetic agents for pediatric anesthesia.
- Analysis of risk factors associated with emergence agitation, including age, pain, and preoperative anxiety.
- Evaluation of various pharmacological and non-pharmacological interventions for prevention and treatment.
Main Results:
- Sevoflurane anesthesia is linked to a higher incidence of emergence agitation in children compared to halothane.
- Risk factors include patient age, surgical procedure, pain intensity, and preoperative anxiety.
- Effective pain management, judicious use of medications (opioids, sedatives, alpha-2 agonists), and considering alternative anesthetics like propofol can mitigate agitation.
Conclusions:
- Avoiding sevoflurane for maintenance anesthesia may reduce emergence agitation.
- Propofol anesthesia shows promise for improved emergence quality, particularly in imaging procedures.
- Appropriate treatment of emergence agitation is crucial for patient safety and enhancing parental satisfaction with anesthesia and surgery.
Abstract:
Emergence agitation following general anesthesia in children is an evolving problem, since sevoflurane has become a popular anesthetic for pediatric anesthesia. Several studies comparing incidence of emergence agitation between halothane and sevoflurane showed that sevoflurane anesthesia would result in higher chance of emergence agitation. The reasons of higher incidence of emergence agitation following sevoflurane anesthesia remain unknown. Other risk factors of emergence agitation include age of patients, operative procedure, pain, preoperative anxiety and so on. Several methods are advocated to prevent emergence agitation. The aggressive treatment of surgical pain is essential to avoid screaming on emergence. In addition, varieties of medication, including opioid, sedatives and alpha-2 agonist, have been tried with various success. The avoidance of sevoflurane use for maintenance of anesthesia could be a major contributing factor to reduce the risk of emergence agitation. In the light of quality of emergence, propofol anesthesia seems to be favorable for sedation in imaging procedures. Emergence agitation should be treated appropriately, since it could injure the patient him/herself or caregiver. The calm wake-up from general anesthesia will greatly enhance the parental satisfaction to anesthesia and surgery.
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