Caracterización de los episodios de agitación durante la emergencia de la anestesia general en pediatría / Characterization of agitation episodes during the emergence from general anesthesia in Pediatrics

RESUMEN Introducción: la agitación durante la emergencia de la anestesia general es una complicación frecuente en pediatría que puede causar daños físicos, retrasar el alta y aumentar los costos. Objetivo: caracterizar los episodios anestesia general en el paciente pediátrico. Materiales y métodos: se realizó un estudio descriptivo, prospectivo, longitudinal de 246 pacientes que presentaron anestesia general en el Hospital "Eliseo Noel Caamaño" entre septiembre de 2015 y diciembre de 2018. Se estudiaron las variables: edad, género, ASA, tiempo quirúrgico y tiempo anestésico, tipo de cirugía, método de anestesia, agentes usados para la inducción y el mantenimiento, severidad de los episodios y necesidad de tratamiento. Resultados: la mayoría de los pacientes que presentaron anestesia general tenían entre 2 y 6 años (63,4%), eran masculinos (67,9%), ASA I (78,1%) y fueron operados de excéresis de lesiones de partes blandas (27,6%). El tiempo quirúrgico fue de 31,2 ± 10,4 minutos y el anestésico 43,5±8,8 minutos. El método anestésico más indicado fue la anestesia balanceada (84,2%), como inductor el propofol (86,2%) y para el mantenimiento isoflurano (34,1%) y sevoflurano (26,4%). Predominaron los episodios severos (51,2%) y el 56,9% necesitó intervención farmacológica. Conclusiones: esta anestesia fue más frecuente en los menores de seis años, masculinos, sanos, a los cuales se les realizaron procederes cortos, con anestesia balanceada, se usó propofol para la inducción e isoflurano y sevoflurano para el mantenimiento de la anestesia. Prevalecieron los episodios severos y la mayoría requirió tratamiento farmacológico.

ABSTRACT Introduction: agitation during the emergence from general anesthesia is a frequent complication in Pediatrics that can cause physical damages, delay discharge and increase costs. Objective: to characterize the episodes of general anesthesia in the pediatric patient. Materials and methods: a descriptive, prospective, longitudinal study was carried out with 246 patients who presented general anesthesia in the Hospital "Eliseo Noel Caamaño" from September 2015 to December 2018. The studied variables were age, gender, ASA, surgical time, anesthetic time, kind of surgery, anesthetic method, agents used for the induction and maintenance, episodes severity and treatment necessity. Results: most of patients treated with general anesthesia were aged 2-6 years (63.4 %), male (67.9 %), ASA I (78.1 %), and underwent the removal of soft parts lesions (27.6 %). The average surgical time was 31,2 ± 10,4 minutes and the anesthetics one was 43,5±8,8 minutes. The most used anesthetics method was balanced anesthesia (84.2 %), the most used inductor was propofol (86.2 %) and for the maintenance isoflurane (34,1%) and sevoflurane (26,4%). Severe episodes (51,2%) predominated, and 56.9 % needed pharmacologic intervention. Conclusions: this kind of anesthesia is more frequently used in children aged less than 6 years, male, healthy, who underwent short procedures with balanced anesthesia and the use of propofol for the induction and isoflurane and sevoflurane for maintaining it. Severe episodes predominated, and most of them required pharmacologic treatment.

Effect of Charcoal Filter on the Emergence from Sevoflurane Anesthesia in a Semi-Closed Rebreathing Circuit

PURPOSE: A charcoal filter attached within the anesthetic circuit has been shown to efficiently adsorb halothane or isoflurane, thus hastening anesthetic recovery in low or minimal flow system. This study was intended to demonstrate whether the charcoal filter enhances the recovery time from sevoflurane anesthesia using a semi-closed circuit system. MATERIALS AND METHODS: Thirty healthy patients scheduled for elective surgery under sevoflurane anesthesia were randomly assigned to the charcoal filter or control group. Upon completion of surgery, the end-tidal concentration of sevoflurane was maintained at 2.0 vol%. A charcoal filter was attached to the expiratory limb of the breathing circuit of charcoal filter group subjects. After sevoflurane was discontinued, ventilation was controlled with the same minute volume as the intra-operative period at a fresh gas flow rate of 5 L.min(-1) with 100% O2. The elimination kinetics of sevoflurane from end-tidal concentration, Bispectral index and times of eye opening and extubation were obtained. RESULTS: The exponential time constant (tau) of alveolar sevoflurane concentration in the charcoal filter group was significantly shorter than that in the control group (1.7+/-0.5 vs. 2.5+/-1.1 min, p=0.008). The charcoal filter hastened rapid eye opening (11.1+/-3.8 vs. 14.8+/-3.0 min, p=0.007) and extubation (11.9+/-3.9 vs. 15.3+/-3.2 min, p=0.014), compared to the control group. CONCLUSION: A charcoal filter enhances the recovery from sevoflurane anesthesia with a semi-closed rebreathing circuit.