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A Comparison of Emergence Agitation/Delirium in Pediatric Dental Patients with Sevoflurane and using Sevoflurane with a Washout Propofol Technique.

Van Hilsen, Zachary Xavier
http://rave.ohiolink.edu/etdc/view?acc_num=osu1408974076

Abstract Details

2014, Master of Science, Ohio State University, Dentistry.
Abstract Background: Emergence Agitation/Delirium (EA/ED) is a frequent finding in younger children who undergo general anesthesia for surgical procedures. The objective of this double-blind controlled study was to determine if providing for the elimination of sevoflurane prior to the end of the surgery, with a washout propofol technique, is effective at reducing the incidence, severity, and probability of EA/ED. Methods: Twenty children, aged 2-7, who were scheduled for full mouth dental rehabilitation under general anesthesia were enrolled in this study and divided into two groups. The control group received a standard general anesthetic using sevoflurane. In contrast, the test group received the same general anesthetic until the last 30 minutes of the procedure, at this time the sevoflurane was turned off and an adequate level of anesthesia maintained via the intermittent administration of propofol. Using this approach most, if not all, the administered sevoflurane could be eliminated prior to emergence. Primary outcome measures were the incidence of EA/ED using the Watcha scale during the recovery process. Secondary outcome measures were duration of recovery and the incidence of Post-Operative Nausea and Vomiting (PONV). Results: All twenty children completed the study. EA/ED, using a Watcha score of =3, was found in 8 children (50%in the control group, 30% in the test group, P = 0.650). When using a Watcha score of 4, five children were found to exhibit EA/ED (40% in the control group and 10% in the test group (p = 0.305). The probability of a child experiencing EA/ED at any time during recovery using Watcha = 3 was 33.8% in the control/sevoflurane group and 9.94% in the test/Propofol group (P = 0.107). Using a Watcha score of 4, the probability of a child experiencing EA/ED at any time during recovery was 15.1% in the control/sevoflurane group and 1.43% in the test/Propofol group (P = 0.058). The average recovery time for the control group was 34.5 minutes and 41.5 minutes for the test group (P = 0.038). No patient in either group experienced an incidence of PONV. Conclusion: Although this pilot study did not show a statistically significant difference in the incidence, severity, and probability of EA/ED in children recovering from dental surgery under general anesthesia using a standard volatile anesthesia versus the `wash-out’ technique described in this study using propofol, a trend toward a lower incidence of EA/ED in the group receiving propofol was recognizable. The data collected from this small study suggests that the magnitude of improvement may be statistically significant and warrants the extension of this project to include a larger test population.
Simon Prior, BDS, MS, PHD (Advisor)
Megann Smiley, DDS, MS (Committee Member)
William Johnson, PHD (Committee Member)
30 p.
Dentistry; Medicine
Emergence delirium; Emergence Agitation; pediatric; general anesthesia; sevoflurane; propofol

Recommended Citations

Citations

  • Van Hilsen, Z. X. (2014). A Comparison of Emergence Agitation/Delirium in Pediatric Dental Patients with Sevoflurane and using Sevoflurane with a Washout Propofol Technique. [Master's thesis, Ohio State University]. OhioLINK Electronic Theses and Dissertations Center. http://rave.ohiolink.edu/etdc/view?acc_num=osu1408974076

    APA Style (7th edition)

  • Van Hilsen, Zachary. A Comparison of Emergence Agitation/Delirium in Pediatric Dental Patients with Sevoflurane and using Sevoflurane with a Washout Propofol Technique. 2014. Ohio State University, Master's thesis. OhioLINK Electronic Theses and Dissertations Center, http://rave.ohiolink.edu/etdc/view?acc_num=osu1408974076.

    MLA Style (8th edition)

  • Van Hilsen, Zachary. "A Comparison of Emergence Agitation/Delirium in Pediatric Dental Patients with Sevoflurane and using Sevoflurane with a Washout Propofol Technique." Master's thesis, Ohio State University, 2014. http://rave.ohiolink.edu/etdc/view?acc_num=osu1408974076

    Chicago Manual of Style (17th edition)

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This open access ETD is published by The Ohio State University and OhioLINK.