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Effect of Controlled versus Spontaneous Ventilation on Postoperative Emergence Agitation in 2-4-Year-Old Children
Taymaz Amiraslani1, Salumeh Sehat Kashani1, Mohammad Ghaemi1
1Department of Anesthesiology and Pain Medicine, School of Medicine, Iran University of Medical Sciences, Tehran, Iran.
Insights
Controlled mechanical ventilation (CMV) significantly reduces emergence agitation (EA) and postoperative pain in children after sevoflurane anesthesia compared to spontaneous ventilation (SV). This ventilation strategy shortens recovery time and is recommended for adenotonsillectomy patients.
Area of Science:
- Anesthesiology
- Pediatric Surgery
- Critical Care Medicine
Background:
- Emergence agitation (EA) is a common issue in children post-sevoflurane anesthesia, potentially leading to complications.
- The mode of ventilation during anesthesia is an under-investigated factor in EA.
- Adenotonsillectomy is a frequent pediatric surgical procedure associated with EA.
Purpose of the Study:
- To compare the effects of controlled mechanical ventilation (CMV) versus spontaneous ventilation (SV) on EA in children aged 2-4 years.
- To evaluate the impact of ventilation mode on postoperative pain, recovery time, and other outcomes.
- To investigate the role of ventilation strategy in managing emergence agitation.
Main Methods:
- A randomized double-blind trial involving 79 children (2-4 years) undergoing adenotonsillectomy.
- Patients were randomized to either CMV or SV during anesthetic emergence.
- Emergence agitation was assessed using the Richmond Agitation-Sedation Scale (RASS).
Main Results:
- Controlled mechanical ventilation (CMV) group showed significantly lower EA incidence and agitation scores (P=0.001).
- The CMV group experienced reduced postoperative pain (P=0.001) and shorter recovery duration (P=0.001).
- Lower EtCO₂ levels were observed in the CMV group (P=0.001), with comparable oxygen saturation and postoperative nausea.
Conclusions:
- CMV significantly reduces emergence agitation, postoperative pain, and recovery time compared to SV in pediatric adenotonsillectomy patients.
- CMV may prevent EA by mitigating hypercapnia and stabilizing physiological parameters.
- CMV is recommended as a preferred ventilation strategy for this patient population.
Background:
Emergence agitation (EA), characterized by restlessness and inconsolable behavior, is a common postoperative complication in children after sevoflurane anesthesia, potentially causing secondary injuries and prolonged PACU stays. While its etiology is multifactorial, the mode of ventilation during anesthesia may be a contributing yet under-investigated factor. This study aimed to compare the effects of controlled mechanical ventilation (CMV) versus spontaneous ventilation (SV) on EA, pain, recovery time, and related outcomes in children aged 2-4 years undergoing adenotonsillectomy.
Methods:
This randomized double-blind trial enrolled 79 children (2-4 years, ASA I) undergoing adenotonsillectomy. Patients were randomized to controlled mechanical ventilation (CMV) or spontaneous ventilation (SV) during emergence. Anesthesia was standardized with sevoflurane and reversal with neostigmine/atropine. The primary outcome was emergence agitation assessed via the Richmond Agitation-Sedation Scale (RASS). Statistical analysis involved Analysis of covariance (ANCOVA), independent t-tests, and Chi-square or Fisher's exact tests. The P<0.05 was considered a statistically significant level.
Results:
The mean age was significantly higher in the controlled ventilation group compared to the spontaneous breathing group (40.75 ± 4.73 vs. 37.31 ± 5.80 months, P=0.005). EA incidence and agitation scores were significantly lower in the CMV group (0.60 ± 0.63 vs. 1.21 ± 0.61, P=0.001). Postoperative pain was reduced (VAS 2.80 ± 1.18 vs. 5.15 ± 1.69, P=0.001), recovery duration was shorter (38.98 ± 6.96 min vs. 44.72 ± 6.57 min, P=0.001), and EtCO₂ levels were lower (34.43 ± 2.52 mmHg vs. 36.82 ± 1.83 mmHg, P=0.001) in the CMV group. Oxygen saturation, neuromuscular monitoring, and postoperative nausea were comparable between groups. No delirium cases were observed.
Conclusion:
CMV significantly reduces EA, postoperative pain, and PACU stay duration compared with SV in children undergoing adenotonsillectomy, likely by preventing hypercapnia and stabilizing physiological parameters. CMV is recommended as the preferred ventilation strategy in this population, while the absence of delirium confirms the low inherent neurological risk in children less than 5 years.
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