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Randomized controlled trial of acupuncture to prevent emergence delirium in children undergoing myringotomy tube
Christine S Martin1, N David Yanez2, Miriam M Treggiari3
1Department of Anesthesia and Perioperative Medicine, Oregon Health and Science University, Portland, OR, USA - martich@ohsu.edu.
Insights
Intraoperative acupuncture did not reduce emergence delirium in children undergoing myringotomy tube placement. This study suggests acupuncture at specific points is not effective for managing sevoflurane-induced emergence delirium in pediatric patients.
Area of Science:
- Pediatric Anesthesiology
- Integrative Medicine
- Pain Management
Background:
- Emergence delirium is a common complication following sevoflurane anesthesia in pediatric patients undergoing myringotomy tube placement.
- This can lead to patient harm and increased nursing care requirements.
- Investigating novel interventions to mitigate emergence delirium is crucial.
Purpose of the Study:
- To determine if intraoperative acupuncture reduces emergence delirium in children undergoing myringotomy tube placement compared to standard care.
- To evaluate the effect of acupuncture on post-discharge agitation and sleep quality.
Main Methods:
- A single-center, randomized controlled trial included 99 children aged 1-6 years undergoing myringotomy tube placement.
- Participants were randomized to receive intraoperative acupuncture (bilateral Heart 7 and ear Shen Men points) or standard anesthesia care.
- Emergence delirium was assessed using the Pediatric Anesthesia Emergence Delirium (PAED) scale by a blinded observer.
Main Results:
- No significant difference in the highest PAED scores was observed between the acupuncture and standard care groups (overall difference 0.33, P=0.723).
- PAED scores were comparable regardless of midazolam premedication status.
- No significant reduction in emergence delirium was found with intraoperative acupuncture at the specified points.
Conclusions:
- Intraoperative acupuncture at the Heart 7 and ear Shen Men points did not effectively reduce emergence delirium after myringotomy tube placement under sevoflurane anesthesia.
- The findings suggest that a larger trial with the same design is unlikely to show a significant benefit.
- Further research exploring different acupuncture points or techniques may be warranted.
Background:
Myringotomy tube placement is a pediatric procedure frequently performed under inhalational anesthesia without intravenous line placement. Emergence delirium is common following sevoflurane anesthesia, and can lead to patient harm and escalation of nursing care. Our goal was to determine if intraoperative acupuncture, compared to standard of care, reduces emergence delirium in children undergoing myringotomy tube placement.
Methods:
Single center, randomized, controlled trial at a university hospital, including children ages 1-6 years with ASA physical status 1-3 scheduled for myringotomy tube placement. Participants were stratified based on midazolam premedication and randomized to intraoperative acupuncture (AC, N.=49) or standard anesthesia care (SC, N.=50). Acupuncture needles were placed in bilateral Heart 7 (HT7) and ear Shen Men points after anesthesia induction. A blinded observer in the PACU assessed emergence delirium using the Pediatric Anesthesia Emergence Delirium (PAED) scale. Endpoints were highest PAED score in the recovery room and post-discharge agitation and sleep quality.
Results:
Patient baseline characteristics were similar between treatment groups. With midazolam premedication, the highest PAED score was 11.6 in patients receiving AC and 12.0 for SC. Without midazolam premedication, the highest PAED was 11.8 in patients receiving AC and 10.7 for SC. The overall PAED score difference between AC and SC groups was 0.33 (95% CI -1.5, 2.2, P=0.723).
Conclusions:
Intraoperative acupuncture at HT7 and ear Shen Men did not reduce PAED scores after myringotomy tube placement. Based on these data, it is therefore unlikely that a larger study of the same design would demonstrate a significant effect of intraoperative acupuncture on emergence delirium after brief sevoflurane anesthesia. However, other acupuncture points or techniques could be considered.
