Ayse Ozcan , Ayse Gunay Kaya , Namik Ozcan , Gul Meltem Karaaslan , Esen Er , Bulent Baltaci , Hulya Basar
{"title":"氯胺酮和咪达唑仑对七氟醚麻醉后儿童尾流阻塞发生率的影响:一项随机研究","authors":"Ayse Ozcan , Ayse Gunay Kaya , Namik Ozcan , Gul Meltem Karaaslan , Esen Er , Bulent Baltaci , Hulya Basar","doi":"10.1016/j.bjanes.2014.01.004","DOIUrl":null,"url":null,"abstract":"<div><h3>Background and objectives</h3><p>Emergence agitation is a common postanaesthetic problem in children after sevoflurane anaesthesia. We aimed to compare the effects of ketamine and midazolam administered intravenously, before the end of surgery, for prevention of emergence agitation in children who received caudal block for pain relief under sevoflurane anaesthesia.</p></div><div><h3>Methods</h3><p>62 American Society of Anesthesiologists patient classification status<!--> <span>i</span> children, aged 2-7<!--> <!-->years, scheduled for inguinal hernia repair, circumcision or orchidopexy were enrolled to the study. Anaesthesia was induced with sevoflurane 8% in a mixture of 50% oxygen and nitrous oxide. After achieving adequate depth of anaesthesia, a laryngeal mask was placed and then caudal block was performed with 0.75<!--> <!-->mL<!--> <!-->kg<sup>−1</sup>, 0.25% bupivacaine. At the end of the surgery, ketamine 0.25<!--> <!-->mg<!--> <!-->kg<sup>−1</sup>, midazolam 0.03<!--> <!-->mg<!--> <!-->kg<sup>−1</sup> and saline were given to ketamine, midazolam and control groups, respectively. Agitation was assessed using Paediatric Anaesthesia Emergence Delirium scale and postoperative pain was evaluated with modified Children's Hospital of Eastern Ontario Pain Scale.</p></div><div><h3>Results and conclusions</h3><p>Modified Children's Hospital of Eastern Ontario Pain Scale scores were found higher in control group than in ketamine and midazolam groups. Paediatric Anaesthesia Emergence Delirium scores were similar between groups. Modified Children's Hospital of Eastern Ontario Pain Scale and Paediatric Anaesthesia Emergence Delirium scores showed a significant decrease by time in all groups during follow-up in postanaesthesia care unit. The present study resulted in satisfactory Paediatric Anaesthesia Emergence Delirium scores which are below 10 in all groups. As a conclusion, neither ketamine nor midazolam added to caudal block under sevoflurane anaesthesia did show further effect on emergence agitation. In addition, pain relief still seems to be the major factor in preventing emergence agitation after sevoflurane anaesthesia.</p></div>","PeriodicalId":100199,"journal":{"name":"Brazilian Journal of Anesthesiology (Edicion en Espanol)","volume":"64 6","pages":"Pages 377-381"},"PeriodicalIF":0.0000,"publicationDate":"2014-11-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://sci-hub-pdf.com/10.1016/j.bjanes.2014.01.004","citationCount":"0","resultStr":"{\"title\":\"Efectos de la ketamina y el midazolam sobre la incidencia de agitación postanestesia con sevoflurano en niños sometidos al bloqueo caudal: estudio aleatorizado\",\"authors\":\"Ayse Ozcan , Ayse Gunay Kaya , Namik Ozcan , Gul Meltem Karaaslan , Esen Er , Bulent Baltaci , Hulya Basar\",\"doi\":\"10.1016/j.bjanes.2014.01.004\",\"DOIUrl\":null,\"url\":null,\"abstract\":\"<div><h3>Background and objectives</h3><p>Emergence agitation is a common postanaesthetic problem in children after sevoflurane anaesthesia. We aimed to compare the effects of ketamine and midazolam administered intravenously, before the end of surgery, for prevention of emergence agitation in children who received caudal block for pain relief under sevoflurane anaesthesia.</p></div><div><h3>Methods</h3><p>62 American Society of Anesthesiologists patient classification status<!--> <span>i</span> children, aged 2-7<!--> <!-->years, scheduled for inguinal hernia repair, circumcision or orchidopexy were enrolled to the study. Anaesthesia was induced with sevoflurane 8% in a mixture of 50% oxygen and nitrous oxide. After achieving adequate depth of anaesthesia, a laryngeal mask was placed and then caudal block was performed with 0.75<!--> <!-->mL<!--> <!-->kg<sup>−1</sup>, 0.25% bupivacaine. At the end of the surgery, ketamine 0.25<!--> <!-->mg<!--> <!-->kg<sup>−1</sup>, midazolam 0.03<!--> <!-->mg<!--> <!-->kg<sup>−1</sup> and saline were given to ketamine, midazolam and control groups, respectively. Agitation was assessed using Paediatric Anaesthesia Emergence Delirium scale and postoperative pain was evaluated with modified Children's Hospital of Eastern Ontario Pain Scale.</p></div><div><h3>Results and conclusions</h3><p>Modified Children's Hospital of Eastern Ontario Pain Scale scores were found higher in control group than in ketamine and midazolam groups. Paediatric Anaesthesia Emergence Delirium scores were similar between groups. Modified Children's Hospital of Eastern Ontario Pain Scale and Paediatric Anaesthesia Emergence Delirium scores showed a significant decrease by time in all groups during follow-up in postanaesthesia care unit. The present study resulted in satisfactory Paediatric Anaesthesia Emergence Delirium scores which are below 10 in all groups. As a conclusion, neither ketamine nor midazolam added to caudal block under sevoflurane anaesthesia did show further effect on emergence agitation. In addition, pain relief still seems to be the major factor in preventing emergence agitation after sevoflurane anaesthesia.</p></div>\",\"PeriodicalId\":100199,\"journal\":{\"name\":\"Brazilian Journal of Anesthesiology (Edicion en Espanol)\",\"volume\":\"64 6\",\"pages\":\"Pages 377-381\"},\"PeriodicalIF\":0.0000,\"publicationDate\":\"2014-11-01\",\"publicationTypes\":\"Journal Article\",\"fieldsOfStudy\":null,\"isOpenAccess\":false,\"openAccessPdf\":\"https://sci-hub-pdf.com/10.1016/j.bjanes.2014.01.004\",\"citationCount\":\"0\",\"resultStr\":null,\"platform\":\"Semanticscholar\",\"paperid\":null,\"PeriodicalName\":\"Brazilian Journal of Anesthesiology (Edicion en Espanol)\",\"FirstCategoryId\":\"1085\",\"ListUrlMain\":\"https://www.sciencedirect.com/science/article/pii/S2255496314000142\",\"RegionNum\":0,\"RegionCategory\":null,\"ArticlePicture\":[],\"TitleCN\":null,\"AbstractTextCN\":null,\"PMCID\":null,\"EPubDate\":\"\",\"PubModel\":\"\",\"JCR\":\"\",\"JCRName\":\"\",\"Score\":null,\"Total\":0}","platform":"Semanticscholar","paperid":null,"PeriodicalName":"Brazilian Journal of Anesthesiology (Edicion en Espanol)","FirstCategoryId":"1085","ListUrlMain":"https://www.sciencedirect.com/science/article/pii/S2255496314000142","RegionNum":0,"RegionCategory":null,"ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":null,"EPubDate":"","PubModel":"","JCR":"","JCRName":"","Score":null,"Total":0}
引用次数: 0
摘要
背景与目的涌现性躁动是儿童七氟醚麻醉后常见的麻醉后问题。我们的目的是比较手术结束前静脉注射氯胺酮和咪达唑仑对预防七氟醚麻醉下接受尾侧阻滞止痛的儿童出现躁动的效果。方法入选62例美国麻醉医师学会患者分类状态2-7岁腹股沟疝修补术、包皮环切术或睾丸切除术患儿。麻醉用8%的七氟醚在50%氧气和氧化亚氮的混合物中诱导。麻醉达到足够深度后，放置喉罩，然后用0.75 mL kg - 1,0.25%布比卡因进行尾侧阻滞。手术结束时，氯胺酮组、咪达唑仑组和对照组分别给予氯胺酮0.25 mg kg - 1、咪达唑仑0.03 mg kg - 1和生理盐水。躁动采用儿科麻醉出现性谵妄量表评估，术后疼痛采用改进的东安大略儿童医院疼痛量表评估。结果与结论对照组患者疼痛量表评分高于氯胺酮和咪达唑仑组。小儿麻醉出现性谵妄评分组间相似。经修订的东安大略儿童医院疼痛量表和儿科麻醉出现性谵妄评分在麻醉后护理病房随访期间，各组均随时间显著下降。本研究结果令人满意的儿科麻醉出现谵妄评分在所有组低于10。综上所述，在七氟醚麻醉下，氯胺酮或咪达唑仑加入尾侧阻滞后，对出现性躁动没有进一步的影响。此外，疼痛缓解似乎仍然是预防七氟醚麻醉后出现躁动的主要因素。
Efectos de la ketamina y el midazolam sobre la incidencia de agitación postanestesia con sevoflurano en niños sometidos al bloqueo caudal: estudio aleatorizado
Background and objectives
Emergence agitation is a common postanaesthetic problem in children after sevoflurane anaesthesia. We aimed to compare the effects of ketamine and midazolam administered intravenously, before the end of surgery, for prevention of emergence agitation in children who received caudal block for pain relief under sevoflurane anaesthesia.
Methods
62 American Society of Anesthesiologists patient classification status i children, aged 2-7 years, scheduled for inguinal hernia repair, circumcision or orchidopexy were enrolled to the study. Anaesthesia was induced with sevoflurane 8% in a mixture of 50% oxygen and nitrous oxide. After achieving adequate depth of anaesthesia, a laryngeal mask was placed and then caudal block was performed with 0.75 mL kg−1, 0.25% bupivacaine. At the end of the surgery, ketamine 0.25 mg kg−1, midazolam 0.03 mg kg−1 and saline were given to ketamine, midazolam and control groups, respectively. Agitation was assessed using Paediatric Anaesthesia Emergence Delirium scale and postoperative pain was evaluated with modified Children's Hospital of Eastern Ontario Pain Scale.
Results and conclusions
Modified Children's Hospital of Eastern Ontario Pain Scale scores were found higher in control group than in ketamine and midazolam groups. Paediatric Anaesthesia Emergence Delirium scores were similar between groups. Modified Children's Hospital of Eastern Ontario Pain Scale and Paediatric Anaesthesia Emergence Delirium scores showed a significant decrease by time in all groups during follow-up in postanaesthesia care unit. The present study resulted in satisfactory Paediatric Anaesthesia Emergence Delirium scores which are below 10 in all groups. As a conclusion, neither ketamine nor midazolam added to caudal block under sevoflurane anaesthesia did show further effect on emergence agitation. In addition, pain relief still seems to be the major factor in preventing emergence agitation after sevoflurane anaesthesia.
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