The Influence Of Desflurane Combined With Different General Anesthesia On Emergence Agitation And Delirium In School-age Children

Objective:To observe the influence of different combinations of desflurane,sevoflurane,and propofol on emergence agitation and delirium in school-age children,and to seek an anesthesia method that is easy to accept,less traumatic and painful and has a low incidence of emergence agitation and delirium,so as to provide a basis for better anesthesia in children.Methods:Choose elective tonsil and/or adenoidectomy in children with 150 cases,ASA Ⅰ～Ⅱ level,age 5 to 12 years old,were randomly divided into 5 groups:sevoflurane group(group SS)and sevoflurane+ halothane group(group SD),sevoflurane+propofol group(group SP),propofol group(group PP)and propofol+halothane group(group PD).Anesthesia induction:group SS,group SP and group SD were induced by inhalation of sevoflurane.Children in the group PP and group PD were induced by intravenous injection of propofol(2-2.5mg/kg).After sleep,the children were given vecuronium(0.10mg/kg)and sufentanil(0.5g/kg),and then intubated after 3min.Maintenance:1.3MAC(1%-4%)sevoflurane was used in group SS;Propofol(4-12mg/kg.h)was used in group SP and group PP.The group SD and group PD were kept anesthetized with 1.3MAC desflurane(within the range of 2%-6%),and the children in each group were pumped with remifentanil for analgesia.Record general information and operation time;Record into the operating room(TO),anesthesia induced(T1),5 minutes after induction(T2),5 minutes after intubation(T3),surgery(T4),at the beginning of operation after the first 5 minutes(T5),into the PACU(T6),5 minutes after extubation(T7 has),the PACU(T8)of each point in time when the heart rate(HR),systolic blood pressure(SBP):Serum IL-6 levels were detected by ELISA one day before surgery(DO),one day after surgery(D1)and one day after surgery(D2).Record the incidence of agitation and delirium in children during wake-up period;Record wake-up time,extubation time,PACU stay time and postoperative adverse reactions.Results:1.General information:There were no significant differences in the general conditions of gender,age,weight,height,breastfeeding,education years,operation time among the five groups of patients(P>0.05).2.Hemodynamic comparison:(1)Comparison between groups:Compared with the SS group,there was no significant difference in SBP change at each time point between the SP group,SD group,PP group,and PD group(P>0.05).Compared with the SP group,the PP group was at T7.The SBP was decreased at the time point,and the difference was statistically significant(P<0.05).Compared with the PP group,the SBP was increased at the T7 time point in the SP group and the PD group,and the difference was statistically significant(P<0.05).The SS group and SP group There was no statistically significant difference in HR between SD,SD,PP and PD groups at each time point(P>0.05).(2)Comparison within the group:Compared with the SBP at TO,the SBP in the SS,SP,SD,PP,and PD groups decreased at T2,and the difference was statistically significant(P<0.05);compared with the HR at TO The HR of SS group,SP group,SD group,PP group,and PD group all decreased at T2,and there were statistically significant differences in SP group,PP group,and PD group(P<0.05).3.Serum IL-6:The serum IL-6 concentration in the five groups of children at the D1 and D2 time points was significantly higher than the baseline value,and the difference was statistically significant(P<0.05).4.Comparison of agitation:The incidence of emergence agitation in SS group,SP group,SD group,PP group and PD group were 26.7%,16.7%,0,0 and 6.7%respectively.Compared with SS group,the incidence of emergence agitation in SD group,PP group and PD group decreased significantly(P<0.05).There was no significant difference in emergence agitation score among the five groups(P>0.05).5.Comparison of delirium:The incidence of delirium in the SS group,SP group,SD group,PP group,and PD group was 33.3%,23.3%,0,16.7%,and 16.7%,respectively.The incidence of delirium in the SD group was lower than that in the SS and SP groups and the difference was statistically significant(P<0.05);there was no significant difference in the PAED score between the five groups of children(P>0.05).6.Comparison of wake-up time and extubation time:SD group and PD group had shorter wake-up time and extubation time than the other groups,and the differences were statistically significant(P<0.05).7.Comparison of adverse reactions:There was no significant difference in the incidence of adverse reactions such as nausea,vomiting,drowsiness and laryngospasm in the five groups of children(P>0.05).Conclusion:Sevoflurane combined with desflurane anesthesia can reduce the incidence of emergence agitation and delirium in school-age children,and shorten the awakening time and extubation time.