title: Barbiturate Induction for the Prevention of Emergence Agitation after Pediatric Sevoflurane Anesthesia.
abstract: OBJECTIVE
  Emergence agitation (EA) is a common and troublesome problem in pediatric patients recovering from general anesthesia. The incidence of EA is reportedly higher after general anesthesia maintained with sevoflurane, a popular inhalational anesthetic agent for pediatric patients. We conducted this prospective, randomized, double-blind study to test the effect of an intravenous ultra-short-acting barbiturate, thiamylal, administered during induction of general anesthesia on the incidence and severity of EA in pediatric patients recovering from Sevoflurane anesthesia.
  
  
  METHODS
  Fifty-four pediatric patients (1 to 6 years of age) undergoing subumbilical surgeries were randomized into 2 groups. Patients received either intravenous thiamylal 5mg/kg (Group T) or inhalational Sevoflurane 5% (Group S) as an anesthetic induction agent. Following induction, general anesthesia was maintained with Sevoflurane and nitrous oxide (N2O) in both groups. To control the intra- and post-operative pain, caudal block or ilioinguinal/iliohypogastric block was performed. The incidence and severity of EA were evaluated by using the Modified Objective Pain Scale (MOPS: 0 to 6) at 15 and 30 min after arrival in the post-anesthesia care unit (PACU).
  
  
  RESULTS
  Fifteen minutes after arrival in the PACU, the incidence of EA in Group T (28%) was significantly lower than in Group S (64%; p = 0.023) and the MOPS in Group T (median 0, range 0 to 6) was significantly lower than in Group S (median 4, range 0 to 6; p = 0.005). The interval from discontinuation of Sevoflurane to emergence from anesthesia was not significantly different between the 2 groups.
  
  
  CONCLUSIONS
  Thiamylal induction reduced the incidence and severity of EA in pediatric patients immediately after Sevoflurane anesthesia.
authors.affiliation: Department of Anesthesiology, Sasebo Kyosai Hospital, Sasebo, Japan.
authors.forename: Tadasuke
authors.initials: T
authors.lastname: Use
authors.affiliation: Department of Anesthesiology, Sasebo Kyosai Hospital, Sasebo, Japan.
authors.forename: Haruna
authors.initials: H
authors.lastname: Nakahara
authors.affiliation: Department of Anesthesiology, Sasebo Kyosai Hospital, Sasebo, Japan.
authors.forename: Ayako
authors.initials: A
authors.lastname: Kimoto
authors.affiliation: Department of Anesthesiology, Sasebo Kyosai Hospital, Sasebo, Japan.
authors.forename: Yuki
authors.initials: Y
authors.lastname: Beppu
authors.affiliation: Department of Anesthesiology, Sasebo Kyosai Hospital, Sasebo, Japan.
authors.forename: Maki
authors.initials: M
authors.lastname: Yoshimura
authors.affiliation: Department of Pharmacy, Sasebo Kyosai Hospital, Sasebo, Japan.
authors.forename: Toshiyuki
authors.initials: T
authors.lastname: Kojima
authors.affiliation: Department of Anesthesiology, Sasebo Kyosai Hospital, Sasebo, Japan.
authors.forename: Taku
authors.initials: T
authors.lastname: Fukano
keywords: Sevoflurane; anesthesia recovery period; pediatrics; psychomotor agitation; thiamylal