Emergence delirium in children: a randomized trial to compare total intravenous anesthesia with propofol and remifentanil to inhalational sevoflurane anesthesia
Emergence delirium in children: a randomized trial to compare total intravenous anesthesia with propofol and remifentanil to inhalational sevoflurane anesthesia
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DOI：
10.1111/pan.12090
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发表时间：
2013-04-01
影响因子：
1.7
通讯作者：
Ansermino, J. Mark
中科院分区：
文献类型：
--
作者：
Chandler, John R.;Myers, Dorothy;Ansermino, J. Mark
研究背景苏醒期谵妄（艾德）是指麻醉苏醒后儿童常见的一系列行为障碍。使用七氟烷的蒸汽麻醉是最常见的儿科麻醉技术，与ED的发生率最高相关。丙泊酚已被证明可降低艾德，但这些研究在方法学上受到限制。目的比较七氟醚（SEVO）麻醉与丙泊酚-芬太尼全凭静脉麻醉（TIVA）后小儿艾德的发生率。方法112例阿萨Ⅰ ~ Ⅱ级，年龄2 ~ 6岁，行斜视矫正术的患儿，随机分为TIVA组（丙泊酚+瑞芬太尼静脉诱导维持麻醉）和SEVO组（七氟醚吸入诱导维持麻醉）。使用围手术期成人儿童行为互动量表（PACBIS）对亲子诱导行为进行评分。术后，由设盲的研究者使用儿科麻醉紧急谵妄（PA艾德）量表评估艾德，并使用面部、腿部、活动、哭泣、可安慰性（FLACC）量表每5分钟评估一次疼痛。结果94例受试者报告了数据。SEVO组的艾德发生率较高（38.3% vs 14.9%，P=0.018）。PACBIS评分中位数无差异。SEVO组的FLACC评分较高（中位数3 vs 1，P=0.033）。发生艾德的受试者的FLACC评分高于未发生艾德的受试者（中位数7比1，P
Background Emergence delirium (ED) refers to a variety of behavioral disturbances commonly seen in children following emergence from anesthesia. Vapor-based anesthesia with sevoflurane, the most common pediatric anesthetic technique, is associated with the highest incidence of ED. Propofol has been shown to reduce ED, but these studies have been methodologically limited. Objective To conduct a randomized-controlled trial comparing the incidence of ED in children following sevoflurane (SEVO) anesthesia and propofolremifentanil total intravenous anesthesia (TIVA). Methods One hundred and twelve children, ASA I-II, aged 2 and 6years, undergoing strabismus repair, were assigned to receive TIVA (intravenous induction and maintenance of anesthesia with propofol and remifentanil) or SEVO (inhalational induction and maintenance of anesthesia with sevoflurane). Parentchild induction behavior was scored using the Perioperative Adult Child Behavior Interaction Scale (PACBIS). Postoperatively, ED was assessed by a masked investigator using the Pediatric Anesthesia Emergence Delirium (PAED) Scale and pain using the Face, Legs, Activity, Cry, Consolability (FLACC) Scale every 5min. Results Data are reported for 94 subjects. Incidence of ED was higher with SEVO (38.3% vs 14.9%, P=0.018). There was no difference in the median PACBIS score. A higher FLACC score was seen with SEVO (median 3 vs 1, P=0.033). Subjects experiencing ED had higher FLACC scores vs those unaffected by ED (median 7 vs 1, P