Emergence agitation after sevoflurane anesthesia in children: prophylactic effect of clonidine versus two doses of fentanyl

ABSTRACT

Sevoflurane anesthesia in preschool children has been associated with an increased incidence of emergence agitation. Many factors may be incriminated in this phenomenon, but most important of them [other than anesthetic technique] is postoperative pain. We designed a study that included a non-surgical procedure in order to eliminate pain and we compared the effects of different drugs to attenuate this anesthesia related complication. Eighty children undergoing examination under anesthesia between the ages of 18 months and 6 years were randomly assigned to receive fentanyl lug/kg, fentanyl 2 ug/kg, clonidine 2 ug/kg or placebo after receiving sevoflurane anesthesia. Blood samples were collected before discharge from the PACU to evaluate the hormonal part of stress response associated with agitation. The children's behavior was assessed with a special agitation scale in the PACU and total hospital discharge time was measured. Clonidine 2ug/kg and fentanyl lug/ kg were found to decrease much the incidence of postoperative agitation without increasing discharge time, vomiting or itching among preschool children exposed to sevoflurane anesthesia in nonpainful procedures