The Effects Of Pretreatment With Hydromorphone On Emergence Agitation In Pediatric Adenotonsillectomy Under TIVA

Objective : Through the observation of the effects of pretreatment with hydromorphone on emergence agitation in pediatric adenotonsillectomy under TIVA, this study aims to study the efficacy and safety of hydromorphone on the prevention of emergence agitation in pediatric adenotonsillectomy under TIVA.Methods:We chose 60 patients with ASA Ⅰ-Ⅱ at the ages of 3- 6 who would undergo elective adenotonsillectomy. With random number table, 60 patients were randomly devided into an experimental group and a control group.Each group had 30 patients. Both groups received the same pre-anesthesia preparation, anesthesia induction and maintenance of anesthesia. Patients of the experimental group were administered intravenously 0.01mg/kg hydromorphone 15 min before the end of surgery. Patients of the control group were administered intravenously the equivoluminal normal saline 15 min before the end of surgery. NIBP, ECG, HR, Sp O2, PETCO2 and BIS were monitored continuously during the surgery. The start time of anesthesia, the start time of operation, the end time of operation, the time of entering the PACU, recovery time, the time of extubation, the time of leaving the PACU were recorded. The basal NIBP, HR and Sp O2 of all the patients before the operation were record.The time of the beginning of the operation, that of entering the PACU, of waking up, extubation, and that of leaving the PACU in all the children’s NIBP, HR and Sp O2 were recorded. We also observed and recorded the scores of PAED,Ramsay and FLACC at each time point of children’s waking up, extubation, 10 minutes after extubation, 20 minutes after extubation, 30 minutes after extubation and leaving the PACU. The occurrence of adverse reactions such as nausea, vomiting, respiratory depression, drowsiness, skin itching, etc. We also observed and recorded the statistical analyses were made by SPSS 19.0software. Measurement data were expressed by x ±s and analyzed by T-test.Analyses between groups were made by using analysis of variance and t test,count data were made by using χ2 test, P < 0.05 considered statistically significant.Results:1.There are not statistically significant differences between the two groups in the patients’ age, sex, weight, ASA classification, the duration of surgery, the duration of anesthesia, the duration of PACU, the time of recovery(P > 0.05).2.With comparison between the groups, there are not statistically significant differences in MAP, HR and Sp O2 at each time point(P>0.05). With comparison of the group, compared with the preoperative baseline indicators,two groups of patients with MAP、HR are all decreased at the beginning of the operation and when entering the PACU(P<0.05). HR is higher than it is before surgery at the beginning of the operation, when waking up, extubation(P <0.05). 3. In the experimental group, the scores of PAED are significantly lower than those of the control group at the time of children’s waking up, extubation,10 minutes after extubation, 20 minutes after extubation, 30 minutes after extubation. The difference is statistically significantly(P<0.05). The score of PAED of the experimental group is slightly lower than that of the control group when patients leave the PACU, but the difference is not statistically significant(P>0.05). The incidence of EA in the experimental group is significantly lower than that of the control group, and the difference is statistically significant(P<0.05).4. The scores of Ramsay at each time point in the experimental group are higher than those in the control group, and the differences are statistically significant(P < 0.05).5. The scores of FLACC at each time point in the experimental group are significantly lower than those in the control group, and the difference has statistically significant(P < 0.05).6. The incidence of postoperative nausea, vomiting and sleepiness in the experimental group is higher than that in the control group, but there is not significant difference between the two groups(P > 0.05). There is not incidence of respiratory depression and skin itching and other adverse reactions between two groups.Conclusion:Pretreatment with hydromorphone on emergence agitation inpediatric adenotonsillectomy under TIVA can obtain good sedative and analgesic effects, and reduce the incidence of EA. The incidence of postoperative adverse reaction is low. In consequence, hydromorphone applied to pediatric anesthesia is safe.