Article Data

  • Views 746
  • Dowloads 186

Original Research

Open Access Special Issue

Comparison of the effects of desflurane and sevoflurane on emergence characteristics in pediatric patients premedicated with ketamine

  • Hyojoong Kim1
  • Ki Hwa Lee1
  • Yei Heum Park1
  • Soo Jung Lee2
  • Se Hun Kim1
  • Sang Eun Lee1
  • Yong Han Kim1
  • Yu Kyung Jeon1

1Department of Anesthesiology and Pain medicine, Haeundae Paik Hospital, Inje University, Busan, Republic of Korea

2Department of Ophthalmology, Haeundae Paik Hospital, Inje University, Busan, Republic of Korea

DOI: 10.22514/sv.2021.045 Vol.17,Issue 4,July 2021 pp.132-139

Submitted: 25 January 2021 Accepted: 23 February 2021

Published: 08 July 2021

*Corresponding Author(s): Ki Hwa Lee E-mail: tedy333@paik.ac.kr

Abstract

Objectives: Desflurane may be useful for ambulatory anesthesia. However, desflurane-induced airway irritability makes its use challenging, especially in children. Ketamine can be used to reduce separation anxiety and emergence agitation (EA). However, ketamine may increase bronchial secretions. This study compared desflurane with sevoflurane anesthesia, in terms of emergence time and EA, in preschool children with intravenous (IV) ketamine premedication.

Methods: Fifty-six children were scheduled for elective epiblepharon surgery. In the waiting room, ketamine (1 mg/kg) was intravenously administered to patients to reduce separation anxiety. After transport to the operating room, general anesthesia was induced with sevoflurane. The anesthetic agent was changed to desflurane in the desflurane group (group D), while sevoflurane was continued in the sevoflurane group (group S) during surgery. Emergence time (time to gag reflex and time to extubation) and EA (measured using the Pediatric Anesthesia Emergence Delirium [PAED] scale) were compared between the two groups. Respiratory complications were also recorded.

Results: Time to gag reflex (611.1 ± 288.9 s vs. 275.0 ± 126.7 s, P < 0.001) and time to extubation (756.3 ± 267.2 s vs. 425.9 ± 122.9 s, P < 0.001) were significantly shorter in group D than group S. EA did not differ between the two groups. There were no severe respiratory complications.

Conclusions: Emergence time was shorter for desflurane anesthesia than sevoflurane anesthesia in preschool children who received IV ketamine premedication. Desflurane anesthesia with IV 0.1 mg/kg of ketamine premedication could be used safely in pediatric ophthalmic surgery; there were no significant respiratory events.


Keywords

Children; Desflurane; Ketamine; Sevoflurane


Cite and Share

Hyojoong Kim,Ki Hwa Lee,Yei Heum Park,Soo Jung Lee,Se Hun Kim,Sang Eun Lee,Yong Han Kim,Yu Kyung Jeon. Comparison of the effects of desflurane and sevoflurane on emergence characteristics in pediatric patients premedicated with ketamine. Signa Vitae. 2021. 17(4);132-139.

References

[1] Aono J, Ueda W, Mamiya K, Takimoto E, Manabe M. Greater incidence of delirium during recovery from sevoflurane anesthesia in preschool boys. Anesthesiology. 1997; 87: 1298-1300.

[2] Voepel-Lewis T, Malviya S, Tait AR. A prospective cohort study of emergence agitation in the pediatric postanesthesia care unit. Anesthesia and Analgesia. 2003; 96: 1625-1630.

[3] Lin Y, Shen W, Liu Y, Wang Q, Chen Q, Fang Z, et al. Visual preconditioning reduces emergence delirium in children undergoing ophthalmic surgery: a randomised controlled trial. British Journal of Anaesthesia. 2018; 121: 476-482.

[4] Chandler JR, Myers D, Mehta D, Whyte E, Groberman MK, Montgomery CJ, et al. Emergence delirium in children: a randomized trial to compare total intravenous anesthesia with propofol and remifentanil to inhalational sevoflurane anesthesia. Pediatric Anesthesia. 2013; 23: 309-315.

[5] Mion G, Villevieille T. Ketamine pharmacology: an update (pharmaco-dynamics and molecular aspects, recent findings). CNS Neuroscience and Therapeutics. 2013; 19: 370-380.

[6] Kim EH, Song IK, Lee JH, Kim HS, Kim HC, Yoon SH, et al. Desflurane versus sevoflurane in pediatric anesthesia with a laryngeal mask airway: A randomized controlled trial. Medicine. 2017; 96: e7977.

[7] Zwass M, Fisher D, Welborn L, Coté C, Davis P, Dinner M, et al. Induction and maintenance characteristics of anesthesia with desflurane and nitrous oxide in infants and children. Anesthesiology. 1992; 76: 373-378.

[8] Valley RD, Freid EB, Bailey AG, Kopp VJ, Georges LS, Fletcher J, et al. Tracheal extubation of deeply anesthetized pediatric patients: a comparison of desflurane and sevoflurane. Anesthesia and Analgesia. 2003; 96: 1320-1324.

[9] He J, Zhang Y, Xue R, Lv J, Ding X, Zhang Z. Effect of desflurane versus sevoflurane in pediatric anesthesia: a meta-analysis. Journal of Pharmacy & Pharmaceutical Sciences. 2015; 18: 199-206.

[10] Choi GJ, Baek CW, Kang H, Park YH, Yang SY, Shin HY, et al. Emergence agitation after orthognathic surgery: a randomised controlled comparison between sevoflurane and desflurane. Acta Anaesthesiologica Scandinavica. 2015; 59: 224-231.

[11] Kain ZN, Caldwell-Andrews AA, Maranets I, McClain B, Gaal D, Mayes LC, et al. Preoperative anxiety and emergence delirium and postoperative maladaptive behaviors. Anesthesia and Analgesia. 2004; 99: 1648-1654.

[12] Jeong WJ, Kim WY, Moon MG, Min DJ, Lee YS, Kim JH, et al. The effect of ketamine on the separation anxiety and emergence agitation in children undergoing brief ophthalmic surgery under desflurane general anesthesia. Korean Journal of Anesthesiology. 2012; 63: 203-208.

[13] Kim KM, Lee KH, Kim YH, Ko MJ, Jung J, Kang E. Comparison of effects of intravenous midazolam and ketamine on emergence agitation in children: Randomized controlled trial. The Journal of International Medical Research. 2016; 44: 258-266.

[14] Lee SJ, Sung TY. Emergence agitation: current knowledge and unresolved questions. Korean Journal of Anesthesiology. 2020; 73: 471-485.

[15] Sikich N, Lerman J. Development and psychometric evaluation of the pediatric anesthesia emergence delirium scale. Anesthesiology. 2004; 100: 1138-1145.

[16] Wong DL, Baker CM. Pain in children: comparison of assessment scales. Pediatric Nursing. 1988; 14: 9-17.

[17] Ozturk T, Acıkel A, Yılmaz O, Topçu I, Çevıkkalp E, Yuksel H. Effects of low-dose propofol vs ketamine on emergence cough in children undergoing flexible bronchoscopy with sevoflurane-remifentanil anesthesia: a randomized, double-blind, placebo-controlled trial. Journal of Clinical Anesthesia. 2016; 35: 90-95.

[18] Bajwa SA, Costi D, Cyna AM. A comparison of emergence delirium scales following general anesthesia in children. Paediatric Anaesthesia. 2010; 20: 704-711.

[19] Khan KS, Hayes I, Buggy DJ. Pharmacology of anaesthetic agents II: inhalation anaesthetic agents. Continuing Education in Anaesthesia Critical Care & Pain. 2014; 14: 106-111.

[20] Dalal KS, Choudhary MV, Palsania AJ, Toal PV. Desflurane for ambulatory anaesthesia: a comparison with sevoflurane for recovery profile and airway responses. Indian Journal of Anaesthesia. 2017; 61: 315-320.

[21] Tsukamoto M, Yamanaka H, Yokoyama T. Age-related differences in recovery from inhalational anesthesia: a retrospective study. Aging Clinical and Experimental Research. 2018; 30: 1523-1527.

[22] 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: 225-232.

[23] Lim BG, Lee IO, Ahn H, Lee DK, Won YJ, Kim HJ, et al. Comparison of the incidence of emergence agitation and emergence times between desflurane and sevoflurane anesthesia in children: a systematic review and meta-analysis. Medicine. 2016; 95: e4927.

[24] Dahmani S, Delivet H, Hilly J. Emergence delirium in children: an update. Current Opinion in Anaesthesiology. 2014; 27: 309-315.

[25] Jamora C, Iravani M. Unique clinical situations in pediatric patients where ketamine may be the anesthetic agent of choice. American Journal of Therapeutics. 2010; 17: 511-515.

[26] Bell RF, Dahl JB, Moore RA, Kalso E. Peri-operative ketamine for acute post-operative pain: a quantitative and qualitative systematic review (Cochrane review). Acta Anaesthesiologica Scandinavica. 2005; 49: 1405-1428.

[27] White PF, Way WL, Trevor AJ. Ketamine-its pharmacology and therapeutic uses. Anesthesiology. 1982; 56: 119-136.

[28] Park JT, Lim HK, Jang K, Um DJ. The effects of desflurane and sevoflu-rane on the intraocular pressure associated with endotracheal intubation in pediatric ophthalmic surgery. Korean Journal of Anesthesiology. 2013; 64: 117-121.

[29] Arain SR, Shankar H, Ebert TJ. Desflurane enhances reactivity during the use of the laryngeal mask airway. Anesthesiology. 2005; 103: 495-499.

[30] Jindal R, Kumra VP, Narani KK, Sood J. Comparison of maintenance and emergence characteristics after desflurane or sevoflurane in outpatient anaesthesia. Indian Journal of Anaesthesia. 2011; 55: 36-42.

[31] Noda S, Hayasaka S, Setogawa T. Epiblepharon with inverted eyelashes in Japanese children. I. Incidence and symptoms. the British Journal of Ophthalmology. 1989; 73: 126-127.

[32] Cohen IT, Finkel JC, Hannallah RS, Hummer KA, Patel KM. The effect of fentanyl on the emergence characteristics after desflurane or sevoflurane anesthesia in children. Anesthesia and Analgesia. 2002; 94: 1178-1181.

[33] Cohen IT, Hannallah RS, Hummer KA. The incidence of emergence agitation associated with desflurane anesthesia in children is reduced by fentanyl. Anesthesia and Analgesia. 2001; 93: 88-91.


Abstracted / indexed in

Science Citation Index Expanded (SciSearch) Created as SCI in 1964, Science Citation Index Expanded now indexes over 9,200 of the world’s most impactful journals across 178 scientific disciplines. More than 53 million records and 1.18 billion cited references date back from 1900 to present.

Journal Citation Reports/Science Edition Journal Citation Reports/Science Edition aims to evaluate a journal’s value from multiple perspectives including the journal impact factor, descriptive data about a journal’s open access content as well as contributing authors, and provide readers a transparent and publisher-neutral data & statistics information about the journal.

Chemical Abstracts Service Source Index The CAS Source Index (CASSI) Search Tool is an online resource that can quickly identify or confirm journal titles and abbreviations for publications indexed by CAS since 1907, including serial and non-serial scientific and technical publications.

IndexCopernicus The Index Copernicus International (ICI) Journals database’s is an international indexation database of scientific journals. It covered international scientific journals which divided into general information, contents of individual issues, detailed bibliography (references) sections for every publication, as well as full texts of publications in the form of attached files (optional). For now, there are more than 58,000 scientific journals registered at ICI.

Geneva Foundation for Medical Education and Research The Geneva Foundation for Medical Education and Research (GFMER) is a non-profit organization established in 2002 and it works in close collaboration with the World Health Organization (WHO). The overall objectives of the Foundation are to promote and develop health education and research programs.

Scopus: CiteScore 0.5(2019) Scopus is Elsevier's abstract and citation database launched in 2004. Scopus covers nearly 36,377 titles (22,794 active titles and 13,583 Inactive titles) from approximately 11,678 publishers, of which 34,346 are peer-reviewed journals in top-level subject fields: life sciences, social sciences, physical sciences and health sciences.

Embase Embase (often styled EMBASE for Excerpta Medica dataBASE), produced by Elsevier, is a biomedical and pharmacological database of published literature designed to support information managers and pharmacovigilance in complying with the regulatory requirements of a licensed drug.

Submission Turnaround Time

Conferences

Top