Anästhesiologisches Management bei Lippen-Kiefer-Gaumen-Spaltoperationen

Emergence agitation after the cleft lip or palate surgery in pediatric patients: a prospective study

OBJECTIVE

The pediatric patients after the cleft lip or palate surgery have high incidences of postoperative complications. Emergence agitation is a common complication. It is also a mild complication compared with lingual swelling and other airway-related complications, which are more often expected in children. However, it can cover signs of hypoxic episodes that appear immediately after surgery, because enough monitoring of an agitated child is not possible. The study aimed to discuss the occurrence of EA after cleft lip or palate surgery in pediatric patients, and further to provide a basis for later interventions.

METHODS

This prospective study included 214 patients aged 3 months to 6 years old at a tertiary stomatological teaching hospital. We calculated the EA scores for every patient when they entered PACU, were in PACU, and left from PACU, and the score ranges from 1 to 5 point. The patients occurred agitation if they scored from 3 to 5 on the 5-point scale, and the patients needed medication and care if they had a score of 4 or 5.

RESULT

The results showed that the EA scores of 69.63% (n = 149) among patients were 3 or higher when they entered PACU, 40.65% (n = 87) were 3 or higher when they were in PACU, and 21.03% (n = 45) were 3 or higher when they left from PACU. Whether they are children with cleft lip, cleft palate, or horizontal cleft, the EA scores had a significant difference among different timings when entering PACU, in PACU, and leaving PACU (P = 0.000). Further comparison showed that the EA score of patients was the highest when entering PACU, and the lowest when leaving PACU. A significant difference in the EA scores was found among the patients with cleft lip, cleft palate, and horizontal cleft when they were in PACU (P = 0.024), further comparison showed that the EA score of the patients with cleft lip was lower than patients with cleft palate or horizontal cleft. While there were no statistical differences in the EA scores among the patients with cleft lip, cleft palate, and horizontal cleft when they entered PACU and left from PACU (P > 0.05).

CONCLUSION

Children had a high incidence of EA after cleft lip or cleft palate or horizontal cleft surgery, especially when they entered PACU. Children after cleft palate and horizontal cleft surgery had higher incidences of EA than cleft lip surgery when they were in PACU.

Effect of dexmedetomidine combined with sufentanil on preventing emergence agitation in children receiving sevoflurane anesthesia for cleft palate repair surgery

The aim of the present study was to observe whether dexmedetomidine (DEX) combined with sufentanil decreased emergence agitation (EA) in children receiving sevoflurane anesthesia for cleft palate repair surgery. Children undergoing elective cleft palate repair surgery were randomly allocated into the DEX + sufentanil group (group DS; n=50) and the normal saline + fentanyl group (group SF; n=50). Patients in group DS were treated with 0.5 µg/kg DEX prior to induction of anesthesia, whereas patients in group SF received an equal volume of normal saline. Sufentanil (0.2 µg/kg) was administered to induce anesthesia, and 30 min before the end of surgery for patients in group DS. Fentanyl (2 µg/kg) was administered at the same time point for patients in group SF. Mean arterial pressure (MAP), heart rate (HR), duration of surgery and anesthesia, and the dosage of remifentanil were assessed. EA score, Pediatric Anesthesia Emergence Delirium (PAED) score and the Children and Infants Postoperative Pain Scale (CHIPPS) score were documented every 15 min in the post-anesthesia care unit (PACU). The number of cases requiring fentanyl (1 µg/kg) and the recovery profile data were analyzed. Compared with group DS (P<0.05) and the baseline (P<0.05), HR and MAP were significantly increased in group SF immediately following tracheal intubation and extubation. Mean values of maximum EA, PAED and CHIPPS scores were significantly reduced in group DS compared with group SF at 0 (P<0.01), 15 (P<0.05), and 30 min (P<0.05) after arrival at PACU. The incidence of EA in group SF was significantly increased compared with group DS (P<0.05). The dosage of remifentanil during the surgery and the number of cases requiring fentanyl (1 µg/kg) in group DS were significantly decreased compared with group SF (P<0.05). The findings of the present study suggested that DEX combined with sufentanil was able to effectively decrease the incidence of EA in children receiving sevoflurane anesthesia for cleft palate repair surgery.