Post Anesthesia Emergence and Behavioral Changes in Children Undergoing MRI
| Status: | Terminated |
|---|---|
| Conditions: | Psychiatric |
| Therapuetic Areas: | Psychiatry / Psychology |
| Healthy: | No |
| Age Range: | 2 - 12 |
| Updated: | 2/15/2017 |
| Start Date: | January 2014 |
| End Date: | December 2014 |
Post Anesthesia Emergence and Behavioral Changes in Children Undergoing MRI: Comparative Study Using Propofol, Sevoflurane and Isoflurane
Children who receive general anesthesia may become agitated (emergence delirium) in the
recovery period. This occurs more often after inhalational anesthetics, particularly
sevoflurane and desflurane than after propofol. However, agitation after anesthesia in
children may be difficult to distinguish from pain; accordingly studies are ideally designed
during MRI to obviate the contribution of pain during emergence. Airway complications have
been reported after LMA and isoflurane more commonly than with IV propofol and nasal prongs.
Whether the airway complications were due to the LMA or the isoflurane was unclear.
Therefore, this study was designed to study the incidence of 1. agitation after sevoflurane
compared with IV propofol and 2. airway complications after LMA or nasal prongs.
recovery period. This occurs more often after inhalational anesthetics, particularly
sevoflurane and desflurane than after propofol. However, agitation after anesthesia in
children may be difficult to distinguish from pain; accordingly studies are ideally designed
during MRI to obviate the contribution of pain during emergence. Airway complications have
been reported after LMA and isoflurane more commonly than with IV propofol and nasal prongs.
Whether the airway complications were due to the LMA or the isoflurane was unclear.
Therefore, this study was designed to study the incidence of 1. agitation after sevoflurane
compared with IV propofol and 2. airway complications after LMA or nasal prongs.
180 children, ASA physical status 1 or 2 will be recruited for elective MRI scan. Randomized
after consent is obtained to one of four groups. Anxiety will be assessed preoperatively
using the modified Yale preoperative anxiety scale. Children will be accompanied by one
parent to MRI scanner where monitors are applied. All children will have anesthesia induced
with nitrous oxide and oxygen followed by sevoflurane until IV is established. Thereupon,
they will be managed by their randomization assignment. The propofol pump will be concealed
at all times. If propofol was used, it will be disconnected from the patient and residual
propofol in the line flushed so prevent unblinding the patient's assignment. A blinded
observer will be present to evaluate the patient when emergence begins. The single blinded
observer will follow the patient from the MRI scanner through recovery room evaluating vital
signs as well as emergence delirium (using the PAED scale). A PAED score > 12 at any time
during emergence period will confirm the diagnosis of emergence delirium. After discharge
from hospital, a post-discharge questionnaire will be completed at 12, 24 and 48 hours after
discharge. All parents will be called to retrieve the questionnaire results after 48 hours
after discharge from hospital.
after consent is obtained to one of four groups. Anxiety will be assessed preoperatively
using the modified Yale preoperative anxiety scale. Children will be accompanied by one
parent to MRI scanner where monitors are applied. All children will have anesthesia induced
with nitrous oxide and oxygen followed by sevoflurane until IV is established. Thereupon,
they will be managed by their randomization assignment. The propofol pump will be concealed
at all times. If propofol was used, it will be disconnected from the patient and residual
propofol in the line flushed so prevent unblinding the patient's assignment. A blinded
observer will be present to evaluate the patient when emergence begins. The single blinded
observer will follow the patient from the MRI scanner through recovery room evaluating vital
signs as well as emergence delirium (using the PAED scale). A PAED score > 12 at any time
during emergence period will confirm the diagnosis of emergence delirium. After discharge
from hospital, a post-discharge questionnaire will be completed at 12, 24 and 48 hours after
discharge. All parents will be called to retrieve the questionnaire results after 48 hours
after discharge from hospital.
Inclusion Criteria:
- Age 2-12yrs,
- ASA Class I-II,
- Fasting,
- Unmedicated,
- Elective MRI scan
Exclusion Criteria:
- Cognitive impairment,
- On psychotropic medications,
- Taking multiple (>2) antiepileptic medications,
- Requiring endotracheal intubation for GA
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