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Jeremy N. DRISCOLL 1, Brian M. BENDER 2, Carlos A. ARCHILLA 2, Carol M. KLIM 2, J. HOSSAIN 3, George MYCHASKIW II 4, Julie L. WEI 5
1 College of Medicine, University of Central Florida, Orlando, FL, USA; 2 Department of Anesthesiology, Nemours Children’s Hospital, Orlando, FL, USA; 3 Division of Bioinformatics, Alfred I. DuPont Hospital for Children, Wilmington, DE, USA; 4 Burrell College of Osteopathic Medicine, New Mexico State University, Las Cruces, NM, USA; 5 Division of Otolaryngology, Department of Surgery, Nemours Children’s Hospital, Orlando, FL, USA
BACKGROUND: Emergence delirium (ED) is a state of aggressive agitation that can occur temporarily in the process of emerging from anesthesia in children exposed to volatile or intravenous anesthetics. Emergence delirium is typically assessed using the published and validated pediatric emergence delirium (PAED) scale. Due to some variation in properties between sevoflurane and desflurane for maintenance of anesthesia after standard sevoflurane induction, we designed a prospective study to examine potential differences in emergence behavior and incidence of ED in children undergoing elective ear-nose-throat (ENT) surgery.
METHODS: 46 children aged 12 months – 7 years were randomly assigned to receive either sevoflurane (n = 23) or desflurane (n = 23) for maintenance of general anesthesia. All patients were extubated awake in the OR, and upon arrival in the PACU, PAED scores were assessed every 15 minutes until discharged. In addition to PAED scores, time to tracheal extubation, emergence behavior, pain scores, and recovery complications were recorded.
RESULTS: We found no significant difference in incidence of ED or peak PAED scores between sevoflurane and desflurane groups (12 [0-18] versus 12 [0-20]; p=0.79). There were no significant differences between desflurane and sevoflurane with respect to incidence of adverse events, such as nausea, vomiting, laryngospasm, or excessive secretions.
CONCLUSION: In conclusion, the use of desflurane for maintenance of anesthesia did not significantly affect the incidence or duration of ED when compared to sevoflurane. However, desflurane did not demonstrate any increase in adverse events, which may support its’ routine use in this patient population.