Agitation sevoflurane

Sevoflurane often causes postoperative delirium and agitation in children, and this may be severe. The effect of intravenous clonidine 2 pg/kg on the incidence and severity of postoperative agitation has been assessed in a double-blind, randomized, placebo-controlled trial in 40 boys who had anesthetic induction with sevoflurane after oral midazolam premedication (32). There was agitation in 16 of those who received placebo and two of those who received clonidine the agitation was severe in six of those given placebo and none of those given clonidine. 

The effect of a single bolus dose of midazolam before the end of sevoflurane anesthesia has been investigated in a double-blind, randomized, placebo-controlled trial in 40 children aged 2-7 years (33). Midazolam significantly reduced the incidence of delirium after anesthesia. However, when it was used for severe agitation, midazolam only reduced the severity of agitation without abolishing it. 

Delirium during emergence from sevoflurane anesthesia has often been documented. Four patients, an adult and three children aged 3-8 years, who were able to recount the experience, have been reported (599). They had full recall of postoperative events, were terrified, agitated, and distressed, and hence presented with acute organic mental state dysfunction which was short-lived. Two were disoriented and had paranoid ideation. They were not in any pain or were not distressed by pain if it was present. The authors hypothesized that misperception of environmental stimuli associated with sevoflurane s particular mode of action may have been the underlying cause of this phenomenon. Anxiolytic premedication and effective analgesia did not necessarily prevent the problem. 

The effects of intravenous and caudal epidural clonidine on the incidence and severity of postoperative agitation have been assessed in a randomized, double-blind study in 80 children, all of whom received sevoflurane as the sole general anesthetic for induction and maintenance... 

Kulka PJ, Bressem M, Tryba M. Clonidine prevents sevoflurane-induced agitation in children. Anesth Analg 2001 93(2) 335-8. 

Kim JY, Chang YJ, Lee JY, Park HY, Kwak HJ. Post-induction alfentanil reduces sevoflurane-associated emergence agitation in children undergoing an adeno-tonsillectomy. Acta Anaesthesiol Scand 2009 53(5) 678-81. 

Kuratani N, Oi Y. Greater incidence of emergence agitation in children after sevoflurane anesthesia as compared with halothane a meta-analysis of randomized controlled trials. Anesthesiology 2008 109 (2) 225-32. 

Kim MS, Moon BE, Kim H, Lee JR. Comparison of propofol and fentanyl administered at the end of anaesthesia for prevention of emergence agitation after sevoflurane anaesthesia in children. Br J Anaesth 2013 110 274-80. 

Ali MA, Abdellatif AA. Prevention of sevoflurane related emergence agitation in children imdergoing adenotonsiUectomy a comparison of dexmedetomidine and propofol. Saudi J Anaesth 2013 7 296-300. 

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