Delirium
Conditions
Keywords
Emergence delirium, Sevoflurane, Pediatric anesthesia
Brief summary
The investigators aim to reduce the incidence of emergence delirium in children aged 2-7 years old by using two different doses of sevoflurane during inhalatory induction of anesthesia.
Detailed description
Sevoflurane is an inhalational agent widely used in general anesthesia, both for induction and maintenance of anesthesia. It is not irritative on the airways and has a pleasant smell. Within their properties are: low partition coefficient blood / gas (rapid induction and awakening), low heart, liver and kidney toxicity. Inhalational induction in pediatric anesthesia with this agent is frequent to avoid vein puncture in awake patients and is generally done with maximum doses available to obtain a fast loss of consciousness. Emergence delirium (ED) is frequent in children. It is defined as a mental disorder during recovery from general anesthesia that may include hallucinations, delusions and confusion expressed by crying, restlessness and involuntary physical activity. It usually lasts for 30 minutes and is not necessarily related to pain. During this episodes, children can hurt themselves or others, lose vascular catheters or other invasive devices. ED can generate anxiety and stress in caretakers, delay transfer from Post-Anesthesia Care Units (PACU), increase costs of medical attention and increase use of opioids or other sedatives. Many interventions have been used to decrease the appearance of ED such as dexmedetomidine, clonidine, benzodiazepines, propofol among others but with no consistent results. The use of sevoflurane has been linked with ED in children and it can induce seizures in high doses (over 2 MAC). The aim of this study is to test whether using a lower dose of sevoflurane (5%) during induction of anesthesia in children results in less ED than using higher doses (8%).
Interventions
OTHERSevoflurane 8%
Sevoflurane 8% (high dose) during anesthesia induction
OTHERSevoflurane 5%
Sevoflurane 5% (low dose) during anesthesia induction
Sponsors
Pontificia Universidad Catolica de Chile
Study design
Allocation
RANDOMIZED
Intervention model
PARALLEL
Primary purpose
PREVENTION
Masking
TRIPLE (Subject, Caregiver, Outcomes Assessor)
Eligibility
Sex/Gender
ALL
Age
2 Years to 7 Years
Healthy volunteers
No
Inclusion criteria
* Surgery with caudal block: circumcision (phimosis), hernioplasty (inguinal hernia) * American Society of Anesthesiologists (ASA) classification of I or II
Exclusion criteria
* Use of Total Intravenous Anesthesia (TIVA) * Familiar or personal history of Malignant Hyperthermia * Contraindication to caudal block * Parents or legal guardians do not sign informed consent
Design outcomes
Primary
| Measure | Time frame | Description |
|---|---|---|
| Emergence delirium | From end of gas administration up to 2 hours after surgery | Emergence delirium will be evaluated with the Pediatric Anesthesia Emergence Delirium scale every 15 minutes |
Secondary
| Measure | Time frame | Description |
|---|---|---|
| Pain | From end of gas administration up to 2 hours after surgery | Pain will be evaluated according to age of children: CHIPPS scale for under 3 years, faces for children between 4 and 6 years old, Visual Analogue Scale (VAS) with older children. |
| Bispectral Index | From start of induction until end of surgery | Bispectral Index (BIS) monitoring will be used during surgery and recorded at following times: after insertion of IV access, after insertion of laryngeal mask, after caudal block, after lowering dose of sevoflurane to 0.75 MAC, after skin incision, at the end of surgery |
| Heart rate | From start of induction until end of surgery | Measured with pulse oximetry, recorded at following times: after insertion of IV access, after insertion of laryngeal mask, after caudal block, after lowering dose of sevoflurane to 0.75 MAC, after skin incision, at the end of surgery |
| Blood pressure | From start of induction until end of surgery | Measured with non-invasive blood pressure cuff, recorded at following times: after insertion of IV access, after insertion of laryngeal mask, after caudal block, after lowering dose of sevoflurane to 0.75 MAC, after skin incision, at the end of surgery |
Countries
Chile
Contacts
Primary ContactNicolas Aeschlimann, MD
Outcome results
None listed