Matthias W. König MD, Department of Anesthesiology, Cincinnati Children’s Hospital Medical Center, MLC 2001, 3333 Burnet Avenue, Cincinnati, OH 45229-3039, USA (email: [email protected]).

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Summary

Background: Pediatric dental procedures are increasingly performed under general anesthesia because of the inability to cooperate, situational anxiety, or other behavioral problems. Volatile anesthetics have been associated with emergence delirium in children, whereas the use of propofol for anesthetic maintenance has been shown to reduce the incidence of emergence delirium after other types of surgeries. The aim of this study is to compare a sevoflurane-based anesthetic with a propofol-based technique as it relates to the incidence of emergence delirium and the quality of recovery after pediatric dental surgery, in patients who present with risk factors for perioperative behavioral issues.

Methods: We prospectively collected data of 179 pediatric patients scheduled for ambulatory dental surgery using a double-blind and randomized trial design. Subjects were anesthetized following standardized protocols for either a sevoflurane- or a propofol-based technique. The incidence of emergency delirium, as measured by the Pediatric Anesthesia Emergence Delirium score, was the primary outcome. Secondary outcomes included the incidence of postoperative nausea and vomiting (PONV), number of nursing interventions in the recovery room, time to discharge readiness, and parental satisfaction.

Results: We found no difference in the incidence of emergence delirium after both types of anesthesia. However, use of sevoflurane significantly increased both the risk of PONV and the number of postoperative nursing interventions. Discharge criteria were met about 10 min earlier in patients anesthetized with sevoflurane. Parental satisfaction was equally high with both anesthesia regimens.

Conclusions: A propofol-based anesthetic technique did not lead to a lower incidence of emergence delirium after dental surgery in children but did result in significantly less PONV and fewer postoperative nursing interventions.

References

1 American Academy on Pediatric Dentistry Ad Hoc Committee on Sedation and Anesthesia; American Academy on Pediatric Dentistry Council on Clinical Affairs. Policy on the use of deep sedation and general anesthesia in the pediatric dental office. Pediatr Dent 2008–2009; 30(.Suppl.7): 66–67.
Google Scholar
2 Hosey MT, Macpherson LM, Adair P et al. Dental anxiety, distress at induction and postoperative morbidity in children undergoing tooth extraction using general anaesthesia. Br Dent J 2006; 200: 39–43; Discussion 27; Quiz 50.
10.1038/sj.bdj.4813123
CAS PubMed Web of Science® Google Scholar
3 Atan S, Ashley P, Gilthorpe MS et al. Morbidity following dental treatment of children under intubation general anaesthesia in a day-stay unit. Int J Paediatr Dent 2004; 14: 9–16.
10.1111/j.1365-263X.2004.00520.x
CAS PubMed Google Scholar
4 Cuthbert MI, Melamed BG. A screening device: children at risk for dental fears and management problems. ASDC J Dent Child 1982; 49: 432–436.
CAS PubMed Web of Science® Google Scholar
5 Voepel-Lewis T, Malviya S, Tait AR. A prospective cohort study of emergence agitation in the pediatric postanesthesia care unit. Anesth Analg 2003; 96: 1625–1630; table of contents.
10.1213/01.ANE.0000062522.21048.61
PubMed Web of Science® Google Scholar
6 Keaney A, Diviney D, Harte S et al. Postoperative behavioral changes following anesthesia with sevoflurane. Pediatr Anesth 2004; 14: 866–870.
10.1111/j.1460-9592.2004.01310.x
CAS PubMed Web of Science® Google Scholar
7 Strauss JM, Giest J. [Total intravenous anesthesia. On the way to standard practice in pediatrics]. Anaesthesist 2003; 52: 763–777.
CAS PubMed Web of Science® Google Scholar
8 Grundmann U, Uth M, Eichner A et al. Total intravenous anaesthesia with propofol and remifentanil in paediatric patients: a comparison with a desflurane-nitrous oxide inhalation anaesthesia. Acta Anaesthesiol Scand 1998; 42: 845–850.
10.1111/j.1399-6576.1998.tb05332.x
CAS PubMed Web of Science® Google Scholar
9 Kain ZN, Mayes LC, Wang SM et al. Parental presence during induction of anesthesia versus sedative premedication: which intervention is more effective? Anesthesiology 1998; 89: 1147–1156.
10.1097/00000542-199811000-00015
CAS PubMed Web of Science® Google Scholar
10 Steur RJ, Perez RS, De LangeJJ. Dosage scheme for propofol in children under 3 years of age. Pediatr Anesth 2004; 14: 462–467.
10.1111/j.1460-9592.2004.01238.x
CAS PubMed Web of Science® Google Scholar
11 McFarlan CS, Anderson BJ, Short TG. The use of propofol infusions in paediatric anaesthesia: a practical guide. Paediatr Anaesth 1999; 9: 209–216.
10.1046/j.1460-9592.1999.00364.x
CAS PubMed Web of Science® Google Scholar
12 Sikich N, Lerman J. Development and psychometric evaluation of the pediatric anesthesia emergence delirium scale. Anesthesiology 2004; 100: 1138–1145.
10.1097/00000542-200405000-00015
PubMed Web of Science® Google Scholar
13 Hollander M, Wolfe DA. Nonparametric Statistical Methods. New York, NY: John Wiley & Sons, 1999.
Google Scholar
14 Iman RL, Conver WJ. The use of the rank transform in regression. Technometrics 1979; 21: 499–509.
10.1080/00401706.1979.10489820
Web of Science® Google Scholar
15 Moore EW, Pollard BJ, Elliott RE. Anaesthetic agents in paediatric day case surgery: do they affect outcome? Eur J Anaesthesiol 2002; 19: 9–17.
10.1097/00003643-200201000-00002
CAS PubMed Web of Science® Google Scholar
16 Morton NS. Total intravenous anaesthesia (TIVA) in paediatrics: advantages and disadvantages. Paediatr Anaesth 1998; 8: 189–194.
10.1046/j.1460-9592.1998.00759.x
CAS PubMed Web of Science® Google Scholar
17 Eckenhoff JE, Kneale DH, Dripps RD. The incidence and etiology of postanesthetic excitment. A clinical survey. Anesthesiology 1961; 22: 667–673.
10.1097/00000542-196109000-00002
CAS PubMed Web of Science® Google Scholar
18 Vlajkovic GP, Sindjelic RP. Emergence delirium in children: many questions, few answers. Anesth Analg 2007; 104: 84–91.
10.1213/01.ane.0000250914.91881.a8
PubMed Web of Science® Google Scholar
19 Mayer J, Boldt J, Rohm KD et al. Desflurane anesthesia after sevoflurane inhaled induction reduces severity of emergence agitation in children undergoing minor ear-nose-throat surgery compared with sevoflurane induction and maintenance. Anesth Analg 2006; 102: 400–404.
10.1213/01.ane.0000189561.44016.99
CAS PubMed Web of Science® Google Scholar
20 Ozdemir Kol I, Egilmez H, Kaygusuz K et al. Open-label, prospective, randomized comparison of propofol and sevoflurane for laryngeal mask anesthesia for magnetic resonance imaging in pediatric patients. Clin Ther 2008; 30: 175–181.
10.1016/j.clinthera.2008.01.008
CAS PubMed Web of Science® Google Scholar
21 Aono J, Ueda W, Mamiya K et al. Greater incidence of delirium during recovery from sevoflurane anesthesia in preschool boys. Anesthesiology 1997; 87: 1298–1300.
10.1097/00000542-199712000-00006
CAS PubMed Web of Science® Google Scholar
22 Manworren RC, Paulos CL, Pop R. Treating children for acute agitation in the PACU: differentiating pain and emergence delirium. J Perianesth Nurs 2004; 19: 183–193.
10.1016/j.jopan.2004.03.004
PubMed Google Scholar
23 Voepel-Lewis T, Burke C. Differentiating pain and delirium is only part of assessing the agitated child. J Perianesth Nurs 2004; 19: 298–299; author reply 299.
10.1016/j.jopan.2004.07.001
PubMed Google Scholar
24 Cheng SS, Yeh J, Flood P. Anesthesia matters: patients anesthetized with propofol have less postoperative pain than those anesthetized with isoflurane. Anesth Analg 2008; 106: 264–269, table of contents.
10.1213/01.ane.0000287653.77372.d9
PubMed Web of Science® Google Scholar
25 Cohen IT, Finkel JC, Hannallah RS et al. The effect of fentanyl on the emergence characteristics after desflurane or sevoflurane anesthesia in children. Anesth Analg 2002; 94: 1178–1181, table of contents.
10.1097/00000539-200205000-00023
CAS PubMed Web of Science® Google Scholar
26 Cohen IT, Hannallah RS, Hummer KA. The incidence of emergence agitation associated with desflurane anesthesia in children is reduced by fentanyl. Anesth Analg 2001; 93: 88–91.
10.1097/00000539-200107000-00019
CAS PubMed Web of Science® Google Scholar
27 Cox RG, Nemish U, Ewen A et al. Evidence-based clinical update: does premedication with oral midazolam lead to improved behavioural outcomes in children?: [Mise a jour basee sur des donnees probantes : Ameliore-t-on le comportement des enfants par une premedication au midazolam par la bouche ?]. Can J Anaesth 2006; 53: 1213–1219.
10.1007/BF03021583
PubMed Web of Science® Google Scholar
28 Arai YC, Ito H, Kandatsu N et al. Parental presence during induction enhances the effect of oral midazolam on emergence behavior of children undergoing general anesthesia. Acta Anaesthesiol Scand 2007; 51: 858–861.
10.1111/j.1399-6576.2007.01339.x
CAS PubMed Web of Science® Google Scholar
29 Breschan C, Platzer M, Jost R et al. Midazolam does not reduce emergence delirium after sevoflurane anesthesia in children. Pediatr Anesth 2007; 17: 347–352.
10.1111/j.1460-9592.2006.02101.x
CAS PubMed Web of Science® Google Scholar
30 Enever GR, Nunn JH, Sheehan JK. A comparison of post-operative morbidity following outpatient dental care under general anaesthesia in paediatric patients with and without disabilities. Int J Paediatr Dent 2000; 10: 120–125.
10.1046/j.1365-263x.2000.00180.x
CAS PubMed Google Scholar
31 Henzi I, Walder B, Tramer MR. Dexamethasone for the prevention of postoperative nausea and vomiting: a quantitative systematic review. Anesth Analg 2000; 90: 186–194.
10.1097/00000539-200001000-00038
CAS PubMed Web of Science® Google Scholar
32 Numazaki M, Fujii Y. Reduction of postoperative emetic episodes and analgesic requirements with dexamethasone in patients scheduled for dental surgery. J Clin Anesth 2005; 17: 182–186.
10.1016/j.jclinane.2004.06.018
CAS PubMed Web of Science® Google Scholar
33 Fazi L, Watcha MF. The economics of newer anaesthetic drugs: should we take the Rolls-Royce or the bicycle today? Paediatr Anaesth 1999; 9: 181–185.
10.1046/j.1460-9592.1999.00339.x
CAS PubMed Web of Science® Google Scholar

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Volume19, Issue8

August 2009

Pages 748-755

Quality of recovery from two types of general anesthesia for ambulatory dental surgery in children: a double-blind, randomized trial

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Quality of recovery from two types of general anesthesia for ambulatory dental surgery in children: a double-blind, randomized trial

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