16th World Congress of Anaesthesiologists

28 August - 2 September 2016
Hong Kong Convention and Exhibition Centre

Norifumi Kuratani

Affiliation: Department of Anesthesia Saitama Children's Medical Center, Saitama-City, Japan;

Connection with WFSA (if any): N/A

Award / titles received: N/A

Statement of expertise for the sub-committee: Pediatric Anesthesia in the OR, procedual sedation, anesthesia in developing countries

Link to department website: https://www.pref.saitama.lg.jp/scm-c/shokai/gekashinryo/02-40-01.html

Biography: EA has become a significant problem in pediatric anesthesia since new, less-soluble volatile agents, such as sevoflurane and desflurane, have been introduced into clinical practice. EA elevates risk of injury to the patient and requires extra nursing care. EA is also a major source of dissatisfaction for parents, nurses, and other caretakers of these children. The reported prevalence of EA covers a wide range and could reach as high as 80%, depending on the research methodology and the definition of EA. The Pediatric Anesthesia Emergence Delirium (PAED) scale has been developed to measure EA reliably. While no single factor can be used to describe the etiology of EA, several factors contribute to its development, including pain, preoperative anxiety, type of surgical procedure, personal character of the patient, overly rapid awakening, and type of anesthetic. The use of sevoflurane as a maintenance anesthetic puts an additional risk of EA to pediatric patients. A meta-analysis of randomized controlled trials comparing the incidence of EA between halothane and sevoflurane clearly showed that sevoflurane anesthesia results in a higher incidence of EA in children1). In order to significantly lower the risk of EA, various strategies have been employed. Obviously, aggressive pain treatment is essential. However, it should be highly emphasized that complete analgesia does not guarantee a calm awakening, especially after sevoflurane anesthesia. A variety of medications, including opioids, sedatives, NSAIDs and α2 agonist, have been tried with various success. The avoidance of sevoflurane use for the maintenance of anesthesia could be a major contributing factor to reduce the risk of EA. In terms of quality of emergence, total intravenous anesthesia with propofol seems to show promising results compared to volatile agents2). If EA occurs, despite maximum preventative measures, it should be treated promptly and appropriately. A calm and happy wake-up from general anesthesia will greatly enhance the parental satisfaction to anesthesia and surgery. REFERENCES 1) Anesthesiology 109:225-32 2) J Anesth. 28:4-11

Disclosure of Interest: None declared

 


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