A Comparison of Emergence Agitation by Sevoflurane for Intraoperative Sedation Associated With Caudal Block
Condition: Emergence Agitation
MeSH terms: Psychomotor Agitation; Emergence Delirium
Study type: Interventional

Summary: 
      This study was performed to compare the incidence of EA between two dose of sevoflurane for
      sedation with caudal block in children, and intended to find the optimal dose for prevention
      of sevoflurane induced emergence agitation
    

Detailed description: 
      After approval Institutional Review Board of our institute, informed consent was obtained
      from the parents of all pediatric patients. 40 children, aged up to 5 yr, undergoing elective
      subumbilical surgery were enrolled. Children with development delay, anxiety disorder, or a
      history of allergy to any study drugs, or severe systemic disease were excluded from this
      study. By a computer generated schedule, children were randomized to either the low dose
      (1.0%) end tidal concentration of sevoflurane group (Group LS) or the high dose (2.5%) end
      tidal concentration of sevoflurane group (Group HS). The patients were sedated with
      intravenous ketamine 2 mg/kg and midazolam 0.05 mg/kg at waiting room and checked the loss of
      response to verbal or gentle touch. Then the patients were into the operating room, applied
      electrocardiography (ECG), pulse oximetry, and noninvasive blood pressure. Respiratory rate
      and end tidal carbon dioxide (CO2) were monitored via face mask. After baseline vital signs
      were monitored, the patient was posed in lateral Sims position, and 1 ml/kg lidocaine 1% with
      5 μg/ml epinephrine was injected into the caudal space using a 22 G needle under 100% oxygen
      with each sevoflurane concentration according to group through a face mask. All of these
      procedures were performed by one skilled anesthesiologist who blinded about the study group.
      After caudal block was performed, the patients were returned in supine position, and
      maintained on spontaneous ventilation under 100% oxygen and each sevoflurane concentration
      according to group via face mask to conduct sedation during operation. If oxygen saturation
      decreases lesser than 90% due to over sedation or breathe holding caused by procedural pain,
      ventilation was assisted. If analgesia was insufficient for operation, fentanyl 0.5-1 μg/kg
      was administrated properly.

      In the postanesthetic care unit (PACU), the investigators observed EA episodes at 5 and 30
      min after PACU arrival using Four-point agitation scale and Pediatric Anesthesia Emergence
      Delirium (PAED) scale, and if a total score of PAED scale is higher than 15, which is
      prescribed a severe agitation, and then propofol 0.5 mg/kg was administered. EA was
      considered as an Four-point agitation scale > 3 or PAED scale > 10.
    

Intervention name(s): low dose sevoflurane group; high dose sevoflurane group
Intervention type(s): Drug; Drug
Intervention description(s): low volume volatile anesthetics (1.0%); high volume volatile anesthetics (2.5%)
Other intervention name(s): 1.0 %sevoflurane; 2.5% sevoflurane
Intervention MeSH terms: Sevoflurane
Allocation: Randomized
Intervention model: Parallel Assignment
Masking: Triple (Participant, Investigator, Outcomes Assessor)
Primary purpose: Prevention
Keywords: emergence agitation; sevoflurane; children