Emergence agitation is the most common reason for post-anesthesia care unit delay. Sevoflurane is used frequently inhalational anaesthetic agent to provide pediatric anaesthesia because of the nonirritant nature. It has been successfully used for keeping spontaneous breathing without tracheal intubation. However, sevoflurane may cause emergence agitation as the incidence varied from 10%-80%. Although there are many sedative agents to reduce its incidence, such as propofol, midazolam, a2 adrenergic receptor agonists and ketamine, the efficacy remains limited. Ketamine, a neuroleptic anesthetic agent, contains two optical isomers, s(+)-ketamine (esketamine) and R(-)-ketamine. Esketamine is a right-handed split of ketamine, which has enhanced analgesic potency and lower incidence of psychotropic side effects compared to ketamine. It stimulate breathing due to N-Methyl-D-Aspartate receptor blockade, and could even effectively countered remifentanil-induced respiratory depression. The investigators compared the effectiveness of esketamine and sevoflurane in reducing the incidence of emergence agitation after painless ophthalmological procedure in pediatric patients.
Ophthalmological procedure such as suture remove, intraocular pressure (IOP) measurement, slit-lamp and fundoscopy are most frequently performed in operation with minor surgical stimulus, and the the duration of surgery is very short. Several anesthestic agents are available,but it is hard to balance short effect and fast rotation in post-anesthesia care unit. Emergence agitation is the most common reason for post-anesthesia care unit delay. Sevoflurane is used frequently inhalational anaesthetic agent to provide pediatric anaesthesia because of the nonirritant nature. It has been successfully used for keeping spontaneous breathing without tracheal intubation. However, sevoflurane may cause emergence agitation as the incidence varied from 10%-80%. Although there are many sedative agents to reduce its incidence, such as propofol, midazolam, a2 adrenergic receptor agonists and ketamine, the efficacy remains limited. Ketamine, a neuroleptic anesthetic agent, contains two optical isomers, s(+)-ketamine (esketamine) and R(-)-ketamine. Esketamine is a right-handed split of ketamine, which has enhanced analgesic potency and lower incidence of psychotropic side effects compared to ketamine. It stimulate breathing due to N-Methyl-D-Aspartate receptor blockade, and could even effectively countered remifentanil-induced respiratory depression. Additionally, several studies have reported ketamine could reduced agitation, but there is no study about esketamine on emergence agitation. The investigators compared the effectiveness of esketamine and sevoflurane in reducing the incidence of emergence agitation after painless ophthalmological procedure in pediatric patients.
Study Type
INTERVENTIONAL
Allocation
RANDOMIZED
Purpose
TREATMENT
Masking
QUADRUPLE
Enrollment
116
0.25 mg/kg esketamine for induction and 0.25 mg/kg esketamine at the beginning of surgery
4% sevoflurane for induction and 2-4% sevoflurane for maintain
Anesthesiology Department of Affiliated Eye and ENT Hospital, Fudan University
Shanghai, Shanghai Municipality, China
the incidence of respiratory depression
respiratory rate \<12 times per min or weak chest undulation
Time frame: duration from the time patient received induction to the time of leaving to the ward, average 1 hour
the incidence of desaturation
the incidence of oxygen saturation below 95% caused by anesthetic agent.
Time frame: duration from the time patient received induction to the time of leaving to the ward, average 1 hour
the incidence of hypotension
the incidence of systolic blood pressure\< 30% of basal systolic blood pressure and lasted \>5 minutes.
Time frame: duration from the time patient received induction to the end of the anesthesia, average 15 minutes.
the incidence of hypertension
the incidence of systolic blood pressure \> 30% of basal systolic blood pressure
Time frame: duration from the time patient received induction to the end of the anesthesia, average 15 minutes.
the incidence of tachycardia
the incidence of heart rate increase over 30% of pre-induction and\>120 beats per minute.
Time frame: duration from the time patient received induction to the end of the anesthesia, average 15 minutes.
the incidence of bradycardia
the incidence of heart rate less than 60 beats per minute
Time frame: duration from the time patient received induction to the end of the anesthesia, average 15 minutes.
the incidence of emergence agitation
the incidence of emergence agitation
Time frame: duration from the time patients arrived the post-anesthesia care unit to the time of leaving to the ward, average 20 minutes
length of stay in the post-anesthesia care unit
the time of patients staying in post-anesthesia care unit
Time frame: duration from the time patients arrived the post-anesthesia care unit to the time of leaving to the ward, average 20 minutes
CPS score
The Cole 5-point scale CPS) score included five behaviors: 1=sleeping; 1=awake,calm;3=irritable, crying;4=inconsolable crying; 5=severe restlessness, disorientation.
Time frame: scores at the time point of 1 minutes after extubation
intraocular pressure
intraocular pressure after induction
Time frame: the time after intubation and topical anesthesia within 1 minute
diastolic pressure
diastolic pressure
Time frame: 1minutes before induction; 1minutes before intubation; 1minutes after intubation; 3 minutes after intubation
systolic pressure
systolic pressure
Time frame: 1minutes before induction; 1minutes before intubation; 1minutes after intubation; 3 minutes after intubation
heart rate
heart rate
Time frame: 1minutes before induction; 1minutes before intubation;1minutes after intubation,3 minutes after intubation
extubation time
extubation time
Time frame: duration from the time that patients arrived in post-anesthesia care unit to the time of extubation, average 10 minutes
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