The effect of propofol on emergence agitation in children receiving sevoflurane for adenotonsillectomy

Abstract

Background: The administration of a single dose of propofol is reported to be effective in decreasing the incidence and severity of emergence agitation (EA) in children following sevoflurane anesthesia. The aim of this study was to investigate the clinical usefulness of a single dose of propofol 1 mg/kg at the end of adenotonsillectomy for reducing the incidence of EA after sevoflurane anesthesia.

Methods: Ninety children, aged 3-8 years, undergoing adenotonsillectomy were randomized into two groups: the propofol group (n = 45) and the saline group (n = 45), of which 88 children completed the study. Anesthesia was maintained with sevoflurane 2-2.5 vol% and nitrous oxide/oxygen (50%/50%). At the completion of adenotonsillectomy, the propofol group patients were given 1 mg/kg of propofol and the saline group patients were given saline 0.1 ml/kg in the same volume. The incidence of EA was assessed with Aono's four point scale and the severity of EA was assessed with pediatric anesthesia emergence delirium (PAED) scale at 5 min (T5), 15 min (T15) and 30 min (T30) after emergence.

Results: Of the 88 patients, the incidence of EA at T5, T15 and T30 was 61.4%, 27.3%, and 4.5% in the propofol group while in the saline group was 68.2%, 29.5%, and 9.1%, respectively. The incidence and severity of EA were not found to be significantly different between the two groups, but the scales in each group decreased significantly over time.

Conclusions: The administration of propofol 1 mg/kg at the end of surgery did not have any significant effect in reducing the incidence and severity of EA in children undergoing adenotonsillectomy under sevoflurane anesthesia.

Keywords: Child; Emergence agitation; Propofol; Sevoflurane.

Figures

Fig. 1

Aono's four point scale at 5 (T5), 15 (T15) and 30 (T30) minutes after emergence. Aono's four point scales significantly decreased over time (P *P < 0.001 in the propofol group and †P < 0.001 in the saline group). Group effect averaged across time did not show significant difference (P = 0.465) and the interaction effect of group and time was also not statistically significant (P = 0.196). Values are presented as mean ± SEM.

Fig. 2

Pediatric anesthesia emergence delirium (PAED) scale at 5 (T5), 15 (T15), and 30 (T30) minutes after emergence. PAED scales significantly decreased over time (P *P < 0.001 in the propofol group, †P < 0.001 in the saline group). Group effect averaged across time did not show significant difference (P = 0.709) and the interaction effect of group and time was not statistically significant (P = 0.093). Values are presented as mean ± SEM.

Fig. 3

Children and infants postoperative pain (CHIPP) scale at 5 (T5), 15 (T15), and 30 (T30) minutes after emergence. CHIPP scales significantly decreased by time (P *P < 0.001 in propofol group, †P < 0.001 in saline group). Group effect averaged across time did not show significant difference (P = 0.428) and the interaction effect of group and time was not statistically significant (P = 0.312). Values are presented as mean ± SEM.

Fig. 4

Ramsay sedation scale at 5 (T5), 15 (T15), and 30 (T30) minutes after emergence. Ramsay sedation scales did not show significant difference over time (P = 0.436). Group effect and interaction effect of group and time were not statistically significant (P = 0.116 and 0.679). Values are presented as mean ± SEM.