Emergence delirium in children: a comparison of sevoflurane and desflurane anesthesia using the Paediatric Anesthesia Emergence Delirium scale
Emergence delirium in children: a comparison of sevoflurane and desflurane anesthesia using the Paediatric Anesthesia Emergence Delirium scale
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DOI：
10.1111/pan.12038
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发表时间：
2013-04-01
影响因子：
1.7
通讯作者：
Sonzogni, Valter
中科院分区：
文献类型：
--
作者：
Locatelli, Bruno G.;Ingelmo, Pablo M.;Sonzogni, Valter
目的：本随机对照试验旨在评价七氟醚或地氟醚复合有效的尾部阻滞对学龄前儿童浮现性精神障碍(ED)发生率的影响。背景：虽然在接受七氟醚或地氟醚麻醉的儿童中已经描述了ED，但使用有效的ED评估工具对这两种药物进行直接比较之前还没有报道。方法/材料260名择期行脐下手术的学龄前儿童随机分为七氟醚或地氟醚复合尾部麻醉。ED定义为儿科麻醉急性期妄想量表(PAED)10分。根据PAED评分的前三个项目(眼神接触、有目的的行动、对周围环境的认识)和PAED评分的最后两个项目(躁动和不安)计算出妄想特异性评分(ED I)，以检验PAED量表中某些项目可能比其他项目更好地反映临床ED的假设。结果两组均有31例(25%)患儿在清醒后出现ED，地氟醚组持续时间短于七氟醚组。EDI评分为9分时，诊断ED的敏感性为0.93，特异性为0.94。ED II评分为5分时，诊断ED的敏感性为0.34，特异性为0.95。结论七氟醚和地氟醚麻醉在接受有效区域麻醉的脐下手术患儿中发生ED的发生率相似。PAED量表前三项得分高与勃起功能障碍高度相关。躁动和忧郁对ED诊断的敏感性较低。
Objectives/Aim This randomized control trial was designed to evaluate the incidence of emergence delirium (ED) in preschool children receiving sevoflurane or desflurane anesthesia combined with an effective caudal block. Background While ED has been described in children receiving sevoflurane or desflurane anesthesia, a direct comparison between the two agents using a validated ED assessment tool has not been reported previously. Methods/Materials Two hundred and sixty preschool children scheduled for elective sub-umbilical surgery were randomized to receive sevoflurane or desflurane anesthesia combined with a caudal block. ED was defined as a Paediatric Anesthesia Emergence Delirium scale (PAED) 10 points. A delirium-specific score (ED I) was calculated from the first three items of the PAED score (eye contact, purposeful actions, awareness of the surroundings) and a nonspecific score (ED II) from the last two items on the PAED score (restlessness and inconsolability) to test the hypothesis that some items of the PAED scale may better reflect clinical ED than others. Results Thirty-one (25%) children in each group demonstrated ED after awakening with ED being of shorter duration in the desflurane group than the sevoflurane group. An ED I score of nine points had a sensitivity of 0.93 and a specificity of 0.94 for ED. An ED II score of five points had a sensitivity of 0.34 and specificity of 0.95 for ED. Conclusion Sevoflurane and desflurane anesthesia were associated with similar incidences of ED in children undergoing sub-umbilical surgery and receiving effective regional anesthesia. High scores on the first three items of the PAED scale were highly correlated with ED. The items restlessness and inconsolability had lower sensitivity for the diagnosis of ED.