Emergence Delirium
Conditions
Keywords
Delirium, Emergence delirium, Paediatric patient, Anaesthesia
Brief summary
Postoperative emergence delirium (ED) is a severe postoperative complication in paediatric anaesthesia. ED is defined as a state with psychomotor disturbance, perception disorder and state of excitation and anxiety. The incidence of ED in paediatric patients can be up to 80%. ED is associated with the increased morbidity of paediatric patients in the postoperative period. One of the potential triggers of ED is sevoflurane. Currently, there are only limited data about comparing the influence of anesthesiologic management on the ED incidence. The possible ED reduction could lead to reduced stay in a post-anaesthesia care unit (PACU), postoperative nausea and vomiting (PONV) incidence and the overall reduction of the postoperative adverse events incidence together with the higher satisfaction and the patients and the legal guardians.
Detailed description
This prospective randomized interventional single-blind study aims to compare the influence of the anaesthesiology management no the incidence of ED in the postoperative period in paediatric patients. Elective paediatric patients (2-10 years) scheduled for the planned adenoidectomy or adenoidectomy + micro-otoscopy/adenoidectomy + frenulum linguae discission will be included in the trial after signed informed consent form the legal guardian. In all patients, the 2 Eutectic Mixture of Local Anesthetics (EMLA) patch will be applied on the predefined skin area ( visible vein for venepuncture) between 45 minutes to 60 minutes before anaesthesia. The patients will be randomized at the operating theatre (allocation 1:1) into the experimental group (intravenous induction with propofol + opioid and anaesthesia maintenance according to this set bispectral index value with desflurane) and the control group (inhalation induction with sevoflurane mixed with air and oxygen and anaesthesia maintenance with sevoflurane). The primary aim of the study will be the incidence of ED defined by The Pediatric Anesthesia Emergence Delirium (PAED) scale, which will be measured at the , at the admission to PACU and in the 5th, 10th, 15th, 30th minute and at the moment of dismission from PACU. The secondary aim will be the time to oral intake (from the end of the surgery), the incidence of adverse events (PONV, bradycardia, hypotension), the need for concomitant medication (analgesic medication, sedative medication, antiemetic medication).
Interventions
PROCEDUREIntravenous induction and desflurane anaesthesia maintenance
Anaesthesia will be inducted with intravenous propofol + opioid and maintained with desflurane according to the BIS levels
PROCEDUREInhalation induction with sevoflurane and anaesthesia maintenance with sevoflurane
Anaesthesia will be inducted with sevoflurane and maintained with sevoflurane according to the BIS levels
Sponsors
Brno University Hospital
Study design
Allocation
RANDOMIZED
Intervention model
PARALLEL
Primary purpose
OTHER
Masking
SINGLE (Outcomes Assessor)
Masking description
The participants will be blinded by the arm inclusion. The outcomes will be measured by the blinded nurse in the PACU
Intervention model description
A prospective interventional single-blind randomized trial
Eligibility
Sex/Gender
ALL
Age
2 Years to 10 Years
Healthy volunteers
No
Inclusion criteria
* age between 2-10 years * signed informed consent * paediatric patient for elective adenoidectomy, or adenoidectomy with micro-otoscopy and/or frenulum discission
Exclusion criteria
* allergy and hypersensitivity on local anaesthetics in EMLA patch, general anaesthetics, or soya beans or peanuts * venepuncture refusal · neuromuscular disorder with the contraindication of inhalation anaesthetics
Design outcomes
Primary
| Measure | Time frame | Description |
|---|---|---|
| Emergence delirium incidence | postoperative period, up to 1 hour postoperatively | The incidence of emergence delirium based on PAED score |
Secondary
| Measure | Time frame | Description |
|---|---|---|
| Time to first oral intake | postoperative period, up to 1 hour postoperatively | The interval between the end of surgery and first oral intake will be measured |
| Adverse events incidence | postoperative period, up to 1 hour postoperatively | The adverse events in the postoperative period will be evaluated - postoperative nausea and vomiting, bradycardia, hypotension, anxiety |
| The need for concomitant medication in PACU | postoperative period, up to 1 hour postoperatively | The need for concomitant medication in PACU - analgesic, sedative, antiemetic medication |
Countries
Czechia
Contacts
Primary ContactPetr Stourac, assoc.Prof.MD.Ph.D
Backup ContactJozef Klučka, MD
Outcome results
None listed