title: Emergence agitation in preschool children: double-blind, randomized, controlled trial comparing sevoflurane and isoflurane anesthesia.
abstract: BACKGROUND
  This randomized, double-blind controlled trial was conducted to determine whether the association of sevoflurane for induction and isoflurane for anesthesia maintenance resulted in a lower incidence of postoperative agitation compared with sevoflurane as single agent.
  
  
  METHODS
  After Institute Ethics Committee's approval and parental written informed consent, 128 unpremedicated children (1-6 years), ASA I-II, scheduled for elective subumbilical surgery were enrolled. After induction with 8% sevoflurane, patients were randomly allocated to receive sevoflurane or isoflurane 1-1.5 MAC as maintenance agent. The primary endpoint of the study was the incidence of postoperative agitation defined as a screaming and crying child and/or a child that required physical restraint during emergence.
  
  
  RESULTS
  Eighteen children were excluded because they received sedatives, analgesia or anesthesia or because of ineffective regional analgesia before randomization. Fifty-four patients receiving sevoflurane and 56 receiving isoflurane completed the study. Twenty-eight children (95% CI 38-66%) in the sevoflurane group presented with postoperative agitation compared with 18 (95% CI 20-46%) patients receiving isoflurane (P = 0.028). Fifteen minutes after awakening, 11/54 children receiving sevoflurane were agitated compared with 4/56 receiving isoflurane (P = 0.03). Thereafter, there was a gradual reduction in the incidence of postoperative agitation over time.
  
  
  CONCLUSIONS
  The association of sevoflurane for induction and isoflurane for maintenance produced significant less postoperative agitation in preschool children receiving regional anesthesia during subumbilical surgery compared with sevoflurane for induction and maintenance.
authors.affiliation: Primo Servizio di Anestesia e Rianimazione, Azienda Ospedaliera di Parma, Parma, Italy.
authors.forename: Luciano
authors.initials: L
authors.lastname: Bortone
authors.forename: Pablo
authors.initials: P
authors.lastname: Ingelmo
authors.forename: Silvia
authors.initials: S
authors.lastname: Grossi
authors.forename: Cosimo
authors.initials: C
authors.lastname: Grattagliano
authors.forename: Cristina
authors.initials: C
authors.lastname: Bricchi
authors.forename: Daniele
authors.initials: D
authors.lastname: Barantani
authors.forename: Emanuele
authors.initials: E
authors.lastname: Sani
authors.forename: Mario
authors.initials: M
authors.lastname: Mergoni
mesh_terms: D000762:Anesthesia Recovery Period; D019162:Anesthetics, Combined; D018685:Anesthetics, Inhalation; D002648:Child; D002675:Child, Preschool; D003221:Confusion; D004311:Double-Blind Method; D005260:Female; D006801:Humans; D007223:Infant; D007530:Isoflurane; D008297:Male; D008738:Methyl Ethers; D011595:Psychomotor Agitation; D000077149:Sevoflurane
chemical_list: D019162:Anesthetics, Combined; D018685:Anesthetics, Inhalation; D008738:Methyl Ethers; D000077149:Sevoflurane; D007530:Isoflurane