Emergence agitation in paediatric patients using sevoflurane and isoflurane anaesthesia: a randomised controlled study

Abstract

Background: Emergence agitation (EA) is a well-recognised phenomenon often observed in children following general anaesthesia. The aim of this study was to compare the incidence and severity of EA in the paediatric age group under sevoflurane or isoflurane anaesthesia using the PAED Scale (Pediatric Anaesthesia Emergence Delirium Scale) (the primary outcome) and its correlation with preinduction agitation as well as its association with pain using the FLACC (Face Legs Activity Cry Consolability) score (the secondary outcome).

Method: In this randomised controlled trial, 60 children aged between 2 and 6 years were enrolled and randomly divided into two groups. All patients were induced with sevoflurane, relaxed with atracurium and the airway secured with an appropriate device. Anaesthesia was maintained with O₂, N₂O and sevoflurane or isoflurane. Adequate analgesia was ensured. Post-procedure, they were observed in the post-anaesthesia care unit (PACU) for development of EA. The statistical package SPSS^® version 17 was used and data were analysed using Student’s unpaired t-test and a chi-square test. Statistical significance was accepted at p < 0.05.

Results: The mean PAED scale was 12.9 in the sevoflurane group and 9.4 in the isoflurane group (p < 0.001). The incidence of EA was significantly related to preinduction agitation (p = 0.00). Higher FLACC scores were observed only within the initial 10 min in the sevoflurane group (p = 0.009).

Conclusions: An increased incidence of EA was observed with sevoflurane maintenance anaesthesia, particularly during the initial 10–20 min of the postoperative period. EA was strongly associated with preinduction agitation, but it was poorly correlated to pain, i.e. not all patients who developed EA had a high FLACC score.

Keywords: sevoflurane anaesthesia, emergence agitation, preinduction anxiety, paed scale, preschool children