Correlation Between Pain and Emergence Delirium After Adenotonsillectomy in Preschool Children
Condition: Adenotonsillectomy; Postoperative Pain; Emergence Delirium
MeSH terms: Delirium; Emergence Delirium
Study type: Interventional
Phase: Phase 4

Summary: 
      The purpose of this study is to determine the incidence of pain, emergence delirium and the
      combination of those postoperative negative behaviours during the first 15 minutes after
      awakening from sevoflurane anesthesia in pre-school children. Additionally this study will
      evaluate the relationship between emergence delirium and postoperative pain behaviour after
      adenotonsil surgery.
    

Detailed description: 
      Tonsillectomy and/or adenoidectomy is the most common surgery performed in paediatric
      population. Sevoflurane is the most frequently volatile anaesthetic used in paediatric
      population. It is well tolerated, allows rapid anaesthesia induction, faster emergence,
      orientation. A child who emerges from sevoflurane anaesthesia may experience a variety of
      behavioural disturbances described as "emergence delirium" (ED).

      ED has been described as "a mental disturbance during the recovery from general anaesthesia
      consisting of hallucinations, delusions and confusion manifested by moaning, restlessness,
      involuntary physical activity, and thrashing about in bed" in the immediate post anaesthesia
      period. Additionally paranoid ideation has been observed in combination with these emergence
      behaviours.

      Restless recovery from anaesthesia is an important problem. It may lead, along with injury to
      the child, bleeding from surgical site, to accidental removal of IV catheters and drains.
      Once ED occur, extra nursing care may be necessary, as well as supplemental sedative and/or
      analgesic medications, which may be associated to respiratory depression or airway
      obstruction and may delay patient discharge. Although long-term psychological implications of
      ED remain unknown, children with restless recovery from anaesthesia are seven times more
      likely to have new-onset separation anxiety, apathy, eating and sleep problems.

      ED after sevoflurane anaesthesia has been suggested both to be and not to be associated with
      postoperative pain behaviour. Accordingly, adequate pain relief has been found to reduce or
      have no effect on ED after sevoflurane anaesthesia. Because a self-evaluation is difficult In
      preschool boy observational scales based on behaviour like CHIPPS, FLACC or CHEOPS are used
      for the measurement of pain.

      Given that the child's behaviour evaluation at emergence is made with observational scales, a
      superimposition between ED and pain measurement is possible. Nurses and doctors using
      behavioural scales for the evaluation of ED and pain may not be able to differentiate pain
      from ED during awakening. This may led to the treatment of an autolimitated disturb (ED) or
      to the under treatment of pain after surgery.
    

Intervention name(s): Sevoflurane
Intervention type(s): Drug
Intervention description(s): Anaesthesia induction: sevoflurane 4 to 6% by mask and IV propofol 2-6 mg/kg.
Anaesthesia maintenance: sevoflurane 2-3 %
Intraoperative and postoperative analgesia: IV fentanyl 1,5-2,5 mcg/kg, IV paracetamol 15 mg/kg
Prevention of postoperative nausea and vomiting: dexamethasone 0,1 mg/kg, ondansetron 0,1 mg/kg
Intervention MeSH terms: Sevoflurane
Intervention model: Single Group Assignment
Masking: None (Open Label)
Primary purpose: Diagnostic