Electrical stimulation of the heart 7 acupuncture site for preventing emergence agitation in children: A randomised controlled trial
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Published on: January 3, 2025
Toshiyuki Hijikata1, Takahiro Mihara, Nobuhito Nakamura
1From the Department of Anaesthesiology, Itabashi Chuo Medical Centre (TH); Department of Anaesthesiology, Kanagawa Children's Medical Centre (TH, TM, NN, TM, KK); and Department of Anaesthesiology and Critical Care Medicine, Yokohama City University Graduate School of Medicine (TM, KK, TG).
Insights
Electrical stimulation of the heart 7 (HT7) acupuncture site with a peripheral nerve stimulator (PNS) significantly reduced emergence agitation in children after general anesthesia. This intervention offers a promising, non-pharmacological approach to managing post-anesthetic behavioral changes in pediatric patients.
Area of Science:
- Anesthesiology
- Pediatric Anesthesia
- Acupuncture and Neuromodulation
Background:
- Emergence agitation is a frequent complication in children recovering from general anesthesia.
- Preventing emergence agitation is a significant challenge in pediatric anesthesia care.
- Current strategies for managing emergence agitation are limited.
Purpose of the Study:
- To evaluate the efficacy of electrical stimulation of the heart 7 (HT7) acupuncture point using a peripheral nerve stimulator (PNS) for preventing emergence agitation in pediatric patients.
- To assess the impact of HT7 stimulation on post-anesthetic recovery outcomes.
Main Methods:
- A double-blind, randomized, controlled trial was conducted with 120 pediatric patients (18-96 months) undergoing minor elective surgery.
- Patients received either bilateral HT7 stimulation with PNS devices or no stimulation (control group) during general anesthesia.
- Emergence agitation was assessed using the Pediatric Anesthesia Emergence Delirium scale in the post-anesthesia care unit (PACU).
Main Results:
- The incidence of emergence agitation was significantly lower in the HT7 stimulation group (31.7%) compared to the control group (56.7%) (P=0.010).
- The number needed to treat was 4, indicating that 4 patients needed HT7 stimulation to prevent one case of emergence agitation.
- No significant differences were observed in extubation time, PACU stay duration, or postoperative pain scores between the groups.
Conclusions:
- Bilateral electrical stimulation of the HT7 acupuncture site using PNS devices is effective in reducing the incidence of emergence agitation in pediatric patients post-general anesthesia.
- HT7 stimulation presents a viable, non-pharmacological option for managing emergence agitation.
- Further research may explore optimal stimulation parameters and long-term effects.
Background:
Emergence agitation is common in children recovering from general anaesthesia. The prevention of emergence agitation remains an important challenge in the field of paediatric anaesthesia.
Objective:
We aimed to examine the effectiveness of electrically stimulating the heart 7 (HT7) acupuncture site with a peripheral nerve stimulator (PNS) during surgery, for preventing emergence agitation in paediatric patients recovering from general anaesthesia.
Design:
A double-blind, randomised, controlled, parallel-group trial.
Setting:
Kanagawa Children's Medical Centre, Yokohama, Japan.
Patients:
One hundred and twenty patients aged 18 to 96 months (American Society of Anesthesiologists physical status I or II) undergoing minor elective surgery under general anaesthesia with sevoflurane.
Intervention:
Patients were randomly assigned to either undergo bilateral stimulation of HT7 with two PNS devices (1 Hz, 50 mA) during surgery (Group HT7) or a control group that did not undergo electrical stimulation of HT7 during surgery.
Main Outcome Measures:
The primary outcome was the incidence of emergence agitation evaluated in the postanaesthesia care unit (PACU) using the Paediatric Anaesthesia Emergence Delirium scale. The secondary outcomes were the time from operation completion to tracheal extubation, PACU stay duration and postoperative pain scores.
Results:
The incidence of emergence agitation was significantly lower in the HT7 group compared with the control group (31.7 vs. 56.7%, respectively; P = 0.010). The risk ratio was 0.56 (95% confidence interval 0.36 to 0.86) and the number needed to treat was 4 (95% confidence interval 3 to 13). There were no statistically significant differences between groups in time from operation completion to tracheal extubation, PACU stay duration or postoperative pain.
Conclusion:
Bilateral electrical stimulation of HT7 using two PNS devices significantly decreases the incidence of emergence agitation.
Trial Registration:
UMIN Clinical Trial Registry (registry number: UMIN000011704).
