A single dose of propofol at the end of surgery for the prevention of emergence agitation in children undergoing strabismus surgery during sevoflurane anesthesia

• Published in: Anesthesiology (Philadelphia) Vol. 107; no. 5; pp. 733 - 738
• Main Authors: AOUAD, Marie T, YAZBECK-KARAM, Vanda G, NASR, Viviane G, EL-KHATIB, Mohamad F, KANAZI, Ghassan E, BLEIK, Jamal H
• Format: Journal Article
• Language: English
• Published: Hagerstown, MD Lippincott 01.11.2007
• Subjects: Anesthesia; Anesthesia Recovery Period; Anesthesia. Intensive care medicine. Transfusions. Cell therapy and gene therapy; Anesthetics, Inhalation - adverse effects; Anesthetics, Intravenous - administration & dosage; Anesthetics, Intravenous - therapeutic use; Biological and medical sciences; Child; Child, Preschool; Double-Blind Method; Female; Humans; Incidence; Length of Stay - statistics & numerical data; Male; Medical sciences; Methyl Ethers - adverse effects; Patient Satisfaction - statistics & numerical data; Propofol - administration & dosage; Propofol - therapeutic use; Prospective Studies; Psychomotor Agitation - epidemiology; Psychomotor Agitation - prevention & control; ROC Curve; Sensitivity and Specificity; Severity of Illness Index; Sodium Chloride - administration & dosage; Strabismus - surgery; Time Factors; Treatment Outcome; Volatile compound; Human; Agitation; Strabismus; Single dose; Prevention; Sevoflurane; Eye disease; General anesthetic; Surgery; Anesthesia; Propofol; Oculomotor syndrome; Child; Halogen Organic compounds
• ISSN: 0003-3022; 1528-1175
• DOI: 10.1097/01.anes.0000287009.46896.a7

Emergence agitation in children after sevoflurane is common. Different drugs have been used to decrease its occurrence with variable efficacy. The authors compared the incidence and severity of emergence agitation in children who received a single dose of propofol at the end of strabismus surgery versus children who received saline. In this prospective, randomized, double-blind study, the authors enrolled 80 healthy children aged 2-6 yr. The children were randomly allocated to the propofol group (n = 41), which received 1 mg/kg propofol at the end of surgery, or to the saline group (n = 39), which received saline. The mean scores on the Pediatric Anesthesia Emergence Delirium scale were significantly lower in the propofol group compared with the saline group (8.6 +/- 3.9 vs. 11.5 +/- 4.5; P = 0.004). Also, the incidence of agitation was significantly lower in the propofol group compared with the saline group (19.5% vs. 47.2%; P = 0.01). A threshold score greater than 10 on the Pediatric Anesthesia Emergence Delirium scale was the best discriminator between presence and absence of emergence agitation. Times to removal of the laryngeal mask airway (10.6 +/- 1.5 vs. 9.4 +/- 1.9 min; P = 0.004) and emergence times (23.4 +/- 5.7 vs. 19.7 +/- 5 min; P = 0.004) were significantly longer in the propofol group. However, discharge times were similar between the two groups (propofol: 34.1 +/- 8.4 min; saline: 34.9 +/- 8.6 min). More parents in the propofol group were satisfied. In children undergoing strabismus surgery, 1 mg/kg propofol at the end of surgery after discontinuation of sevoflurane decreases the incidence of agitation and improves parents' satisfaction without delaying discharge from the postanesthesia care unit.