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44158 - THE EFFECT OF PROPOFOL ON EMERGENCE AGITATION IN CHILDREN

¹ Children Hospital of Eastern Ontario, Ottawa, ON, Canada
² Children Hospital of Eastern Ontario
³ Children Hospital of Eastern Ontario
⁴ Children Hospital of Eastern Ontario
⁵ Children Hospital of Eastern Ontario

Abstract

Introduction: Emergence agitation (EA) is a postoperative behavior that may occur in children undergoing general anesthesia with inhaled agents. EA is characterized by a period of restlessness, agitation, inconsolable crying, disorientation, delusion, hallucination, and cognitive plus memory impairment (5). The prevalence of EA varies between 20% and 80% depending on the definition of EA used and the monitored time interval after emergence from anesthesia (1). There is no clear and scientifically valid pathophysiologic explanation for this phenomenon. Rapid emergence from general anesthesia in conjunction with psychological immaturity of young children has been postulated for this emergence behavior (2).

Methods: After ethics committee approval and parents/guardian consent we evaluated the effect of adding intravenous propofol on the incidence and severity of emergence agitation in 85 children, ASA I- III, 2 to 7 years of age, undergoing sevoflurane general anesthesia for magnetic resonance imaging as an outpatient procedure. Anesthesia was induced and maintained with sevoflurane. Laryngeal mask airway was used for airway maintenance. No sedative medication was given to any of the children. At the end of the procedure, children in Group P were given 1 mg/kg of propofol (max of 30 mg) and children in Group S were given saline. The pediatric anesthesia emergence delirium scale (PAEDS) was used to assess EA during the first 30 min of admission to the recovery room. Patients were considered agitated if they had a score of 16/20 or higher.

Results: Eighty-three children completed the study. There were 42 children in the propofol group. There were no significantly differences in age, sex, weight, ASA status, and duration of the diagnostic procedure or anesthesia between the two groups. Emergence agitation was diagnosed in 2 children in the propofol group (4.7%) and in 11 children in the placebo group (26.8%). Children in the propofol group were more sedated upon awakening. There was no difference in time to meet recovery room discharge criteria between the two groups.

Discussion: Children may experience a variety of behaviors during emergence from anesthesia. The choice of the anesthetic agent, type of surgery, pain, age, patient temperament, and other factors can affect postoperative behavior in children. The results of our study show that the addition of propofol 1 mg/kg can significantly decrease the incidence of emergence agitation after sevoflurane general anesthesia in children undergoing non-painful procedures.

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