Emergence agitation in uncooperative children undergoing complete dental rehabilitation: a comparison between sevoflurane and desflurane anesthesia

ABSTRACT

The issue of emergence agitation [EA] following the administration of short-acting anaesthetic agents, sevoflurane and desflurane, has become a controversial issue. The aim of the present study was to evaluate the influence of desflurane versus sevoflurane anaesthesia on EA in behaviorally uncooperative children undergoing complete dental rehabilitation using PAED scale. Thirty eight healthy children [ASAI and II] aged between 2 to 6 years, Frankl behavior category scales 1 or 2 scheduled for complete dental rehabilitation [CDR] under general anaesthesia were enrolled in the study protocol. Children were randomly allocated in a double-blind fashion to one of two groups according to the inhalational anaesthetic used for maintenance of anesthesia. Group S Sevoflurane [1.0 +/- 0.2 MAC, age adjusted, n = 19] or Group D Desflurane [1.0 +/- 0.2MAC, age adjusted, n = 19]. Paediartric Anesthesia Emergence Delirium [PAED] scale was used, a 5-point rating scale with 5 gradations for each item that has been validated to assess EA in children. Scoring was obtained multiple times and the peak was recorded for evaluation. Time to tracheal extubation, emergence behavior, recovery complications, and pain scores were assessed. PAED score at 15 min in the PACU was significantly higher [P < 0.05] in sevoflurane group. Similarly, as regards the peak PAED scale reached, children who received sevoflurane had a significant higher value 10 [3-19] min comparison to those who received desflurane 6 [2 - 14] min. Time to tracheal extubation was shorter in children who received desflurane. One case of vomiting in sevoflurane group and two cases in the desflurane group were encountered. The three cases were considered as grade 1 according to the 4-degree scale No differences were found between the study groups with respect to peak pain, time to discharge from PACU. The need for rescue medication was required for two children in sevoflurane group. In conclusion, maintenance of anaesthesia with desflurane resulted in less severe agitation with faster time for tracheal extubation than sevoflurane anesthesia in behaviorally uncooperative pre-school children undergoing complete dental rehabilitation. Although the time of PACU stay did not differ significantly, a more rapid immediate recovery from anaesthesia could be an additional benefit in such cases in a day-case surgery setup