Emergence delirium and postoperative pain in children undergoing adenotonsillectomy: a comparison of propofol vs sevoflurane anesthesia.
BACKGROUND
Emergence delirium (ED) is a frequent postoperative complication in young children undergoing ENT procedures and it may be exacerbated by sevoflurane anesthesia whereas propofol maintenance has been suggested to decrease the incidence of ED. The aim of this randomized, prospective, double-blind study was to evaluate the effect of sevoflurane vs propofol anesthesia on the quality of recovery after adenotonsillectomy.


METHODS
Forty-two patients were randomized to maintenance with either propofol or sevoflurane for adenotonsillectomy. At the conclusion of surgery, patients were extubated awake. ED and pain were assessed using the Pediatric Anesthesia Emergence Delirium (PAED) and the Children's Hospital of Eastern Ontario Scale (CHEOPS), respectively. Higher PAED scores (0-20) indicate greater severity of ED. Nursing and parental satisfaction, hospital length of stay, postoperative nausea and vomiting (PONV), anesthetic complications, and subsequent emergency room admissions were also assessed.


RESULTS
Median PAED score was 14 in the propofol group and 17 in the sevoflurane group (NS). Propofol was associated with less pain medication required during recovery and a lower incidence of PONV (5.3% vs 36.8%, P < 0.05). Nursing and parental satisfaction as well as time spent in recovery room was similar for the two groups.


CONCLUSIONS
Propofol anesthesia does not influence agitation after adenotonsillectomy, as measured by the PAED score. A PAED score of ≥ 10 was not useful in identifying patients with ED. However, propofol maintenance is associated with less need for pain medication in the recovery room and a lower incidence of PONV compared to sevoflurane anesthesia.
Pieters
Benjamin J
BJ
Department of Anesthesiology, Children's Mercy Hospital and Clinics, Kansas City, MO 6410, USA. bjpieters@cmh.edu
Penn
Edward
E
Nicklaus
Pamela
P
Bruegger
Daniel
D
Mehta
Bhavi
B
Weatherly
Robert
R
D000233:Adenoidectomy; D000762:Anesthesia Recovery Period; D000769:Anesthesia, Inhalation / Q000009:adverse effects; D000771:Anesthesia, Intravenous / Q000009:adverse effects; D018685:Anesthetics, Inhalation / Q000009:adverse effects; D018686:Anesthetics, Intravenous / Q000009:adverse effects; D002648:Child; D002675:Child, Preschool; D003258:Consumer Behavior; D003693:Delirium / Q000453:epidemiology* / Q000209:etiology / Q000523:psychology; D006801:Humans; D007902:Length of Stay; D008738:Methyl Ethers / Q000009:adverse effects; D010147:Pain Measurement / Q000187:drug effects; D010149:Postoperative Pain / Q000453:epidemiology*; D010290:Parents; D020250:Postoperative Nausea and Vomiting / Q000453:epidemiology; D015742:Propofol / Q000009:adverse effects; D018570:Risk Assessment; D000077149:Sevoflurane; D014068:Tonsillectomy; D016896:Treatment Outcome
D018685:Anesthetics, Inhalation; D018686:Anesthetics, Intravenous; D008738:Methyl Ethers; D000077149:Sevoflurane; D015742:Propofol