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Association of volatile anesthesia exposure and depth with emergence agitation and delirium in children: Prospective observational cohort study
BACKGROUND: Sevoflurane anesthesia is widely used in pediatric ambulatory surgery. However, emergency agitation (EA) and emergency delirium (ED), as major complications following sevoflurane anesthesia in children, pose risks to surgery and prognosis. Identifying the high risk of EA/ED, especially a...
Autores principales: | , , , , , , |
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Formato: | Online Artículo Texto |
Lenguaje: | English |
Publicado: |
Frontiers Media S.A.
2023
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Acceso en línea: | https://www.ncbi.nlm.nih.gov/pmc/articles/PMC10076635/ https://www.ncbi.nlm.nih.gov/pubmed/37033193 http://dx.doi.org/10.3389/fped.2023.1115124 |
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author | Zhang, Yinan Zhang, Qiuying Xu, Shan Zhang, Xiaoxi Gao, Wenxu Chen, Yu Zhu, Zhaoqiong |
author_facet | Zhang, Yinan Zhang, Qiuying Xu, Shan Zhang, Xiaoxi Gao, Wenxu Chen, Yu Zhu, Zhaoqiong |
author_sort | Zhang, Yinan |
collection | PubMed |
description | BACKGROUND: Sevoflurane anesthesia is widely used in pediatric ambulatory surgery. However, emergency agitation (EA) and emergency delirium (ED), as major complications following sevoflurane anesthesia in children, pose risks to surgery and prognosis. Identifying the high risk of EA/ED, especially anesthesia exposure and the depth of anesthesia, may allow preemptive treatment. METHODS: A total of 137 patients were prospectively enrolled in this single-center observational cohort study to assess the incidence of EA or ED. Multivariable logistic regression analyses were used to test the association between volatile anesthesia exposure and depth with EA or ED. The Richmond Agitation and Sedation Scale (RASS), Pediatric Anesthesia Emergence Delirium Scale (PAED) and Face, Legs, Activity, Cry, and Consolability (FLACC) behavioural pain scale was used to assess the severity of EA or ED severity and pain. Bispectral index (BIS) to monitor the depth of anesthesia, as well as Time(LOW−BIS)/Time(ANES) %, EtSevo (%) and EtSevo-time AUC were included in the multivariate logistic regression model as independent variables to analyze their association with EA or ED. RESULTS: The overall prevalence of EA and ED was 73/137 (53.3%) and 75/137 (54.7%) respectively, where 48/137 (35.0%), 19/137 (13.9%), and 6/137 (4.4%) had mild, moderate, and severe EA. When the recovery period was lengthened, the prevalence of ED and extent of FLACC decreased and finally normalized within 30 min in recovered period. Multivariable logistic regression demonstrated that intraoperative agitation [2.84 (1.08, 7.47) p = 0.034], peak FLACC [2.56 (1.70, 3.85) p < 0.001] and adverse event (respiratory complications) [0.03 (0.00, 0.29) p = 0.003] were independently associated with higher odds of EA. Taking EtSevo-time AUC ≤ 2,000 as a reference, the incidence of EA were [15.84 (2.15, 116.98) p = 0.002] times and 16.59 (2.42, 113.83) p = 0.009] times for EtSevo-time AUC 2,500–3,000 and EtSevo-time AUC > 3,000, respectively. Peak FLACC [3.46 (2.13, 5.62) p < 0.001] and intraoperative agitation [5.61 (1.99, 15.86) p = 0.001] were independently associated with higher odds of developing ED. EtSevo (%), intraoperative BIS value and the percentage of the duration of anesthesia at different depths of anesthesia (BIS ≤ 40, BIS ≤ 30, BIS ≤ 20) were not associated with EA and ED. CONCLUSIONS: For pediatrics undergoing ambulatory surgery where sevoflurane anesthesia was administered, EA was associated with surgical time, peak FLACC, respiratory complications, and “EtSevo-time AUC” with a dose-response relationship; ED was associated with peak FLACC and intraoperative agitation. |
format | Online Article Text |
id | pubmed-10076635 |
institution | National Center for Biotechnology Information |
language | English |
publishDate | 2023 |
publisher | Frontiers Media S.A. |
record_format | MEDLINE/PubMed |
spelling | pubmed-100766352023-04-07 Association of volatile anesthesia exposure and depth with emergence agitation and delirium in children: Prospective observational cohort study Zhang, Yinan Zhang, Qiuying Xu, Shan Zhang, Xiaoxi Gao, Wenxu Chen, Yu Zhu, Zhaoqiong Front Pediatr Pediatrics BACKGROUND: Sevoflurane anesthesia is widely used in pediatric ambulatory surgery. However, emergency agitation (EA) and emergency delirium (ED), as major complications following sevoflurane anesthesia in children, pose risks to surgery and prognosis. Identifying the high risk of EA/ED, especially anesthesia exposure and the depth of anesthesia, may allow preemptive treatment. METHODS: A total of 137 patients were prospectively enrolled in this single-center observational cohort study to assess the incidence of EA or ED. Multivariable logistic regression analyses were used to test the association between volatile anesthesia exposure and depth with EA or ED. The Richmond Agitation and Sedation Scale (RASS), Pediatric Anesthesia Emergence Delirium Scale (PAED) and Face, Legs, Activity, Cry, and Consolability (FLACC) behavioural pain scale was used to assess the severity of EA or ED severity and pain. Bispectral index (BIS) to monitor the depth of anesthesia, as well as Time(LOW−BIS)/Time(ANES) %, EtSevo (%) and EtSevo-time AUC were included in the multivariate logistic regression model as independent variables to analyze their association with EA or ED. RESULTS: The overall prevalence of EA and ED was 73/137 (53.3%) and 75/137 (54.7%) respectively, where 48/137 (35.0%), 19/137 (13.9%), and 6/137 (4.4%) had mild, moderate, and severe EA. When the recovery period was lengthened, the prevalence of ED and extent of FLACC decreased and finally normalized within 30 min in recovered period. Multivariable logistic regression demonstrated that intraoperative agitation [2.84 (1.08, 7.47) p = 0.034], peak FLACC [2.56 (1.70, 3.85) p < 0.001] and adverse event (respiratory complications) [0.03 (0.00, 0.29) p = 0.003] were independently associated with higher odds of EA. Taking EtSevo-time AUC ≤ 2,000 as a reference, the incidence of EA were [15.84 (2.15, 116.98) p = 0.002] times and 16.59 (2.42, 113.83) p = 0.009] times for EtSevo-time AUC 2,500–3,000 and EtSevo-time AUC > 3,000, respectively. Peak FLACC [3.46 (2.13, 5.62) p < 0.001] and intraoperative agitation [5.61 (1.99, 15.86) p = 0.001] were independently associated with higher odds of developing ED. EtSevo (%), intraoperative BIS value and the percentage of the duration of anesthesia at different depths of anesthesia (BIS ≤ 40, BIS ≤ 30, BIS ≤ 20) were not associated with EA and ED. CONCLUSIONS: For pediatrics undergoing ambulatory surgery where sevoflurane anesthesia was administered, EA was associated with surgical time, peak FLACC, respiratory complications, and “EtSevo-time AUC” with a dose-response relationship; ED was associated with peak FLACC and intraoperative agitation. Frontiers Media S.A. 2023-03-23 /pmc/articles/PMC10076635/ /pubmed/37033193 http://dx.doi.org/10.3389/fped.2023.1115124 Text en © 2023 Zhang, Zhang, Xu, Zhang, Gao, Chen and Zhu. https://creativecommons.org/licenses/by/4.0/This is an open-access article distributed under the terms of the Creative Commons Attribution License (CC BY) (https://creativecommons.org/licenses/by/4.0/) . The use, distribution or reproduction in other forums is permitted, provided the original author(s) and the copyright owner(s) are credited and that the original publication in this journal is cited, in accordance with accepted academic practice. No use, distribution or reproduction is permitted which does not comply with these terms. |
spellingShingle | Pediatrics Zhang, Yinan Zhang, Qiuying Xu, Shan Zhang, Xiaoxi Gao, Wenxu Chen, Yu Zhu, Zhaoqiong Association of volatile anesthesia exposure and depth with emergence agitation and delirium in children: Prospective observational cohort study |
title | Association of volatile anesthesia exposure and depth with emergence agitation and delirium in children: Prospective observational cohort study |
title_full | Association of volatile anesthesia exposure and depth with emergence agitation and delirium in children: Prospective observational cohort study |
title_fullStr | Association of volatile anesthesia exposure and depth with emergence agitation and delirium in children: Prospective observational cohort study |
title_full_unstemmed | Association of volatile anesthesia exposure and depth with emergence agitation and delirium in children: Prospective observational cohort study |
title_short | Association of volatile anesthesia exposure and depth with emergence agitation and delirium in children: Prospective observational cohort study |
title_sort | association of volatile anesthesia exposure and depth with emergence agitation and delirium in children: prospective observational cohort study |
topic | Pediatrics |
url | https://www.ncbi.nlm.nih.gov/pmc/articles/PMC10076635/ https://www.ncbi.nlm.nih.gov/pubmed/37033193 http://dx.doi.org/10.3389/fped.2023.1115124 |
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