The Effect Of EEG Parameters Guided Anesthesia For Emergence Delirium In Children

BACKGROUND:Emergence Delirium(ED)in children is mainly characterized by acute disorientation,crying,agitation,lack of response to the surrounding environment,inability to recognize familiar people or objects,and other mental and behavioral abnormalities,with an incidence of 10%-80%.Emergence delirium is mostly selflimited(about 5-15 minutes),but its potential damage to the physiology of children can’t be ignored.Children with severe emergence delirium may have body movements,removal of infusion tubes,catheters,and even medical equipment that play important role in the treatment of the disease.once these events occurred,can increase the risk of injury to children and put pressure on doctors,nurses and parents.Therefore,it is an urgent problem for pediatric anesthesiologists to prevent or reduce the emergence delirium in children delirium period.The preventive measures of emergence delirium include drug intervention and non-drug intervention,in which drug intervention includes preoperative or intraoperative use of midazolam,ketamine,dexmedetomidine,melatonin,and so on.However,the use of these drugs may prolong the stay in the postanesthetic recovery room of children,and may increase the risk of many adverse reactions,including postoperative nausea and vomiting,respiratory depression,and other serious adverse events.Therefore,the use of non-drug intervention to prevent delirium during recovery has become a research hotspot in recent years,including observing the epileptic discharge of EEG during induction can predict emergence delirium.However,to date,there are few studies on whether the intraoperative use of EEG parameters to monitor pediatric anesthesia to regulate the dosage of anesthetic drugs can reduce postoperative delirium.Therefore,further research is needed.OBJECTIVE:The main purpose of this study is to use EEG parameters to monitor spectral edge rate(SEF),density array(DSA),EEG,judge and adjust the depth of anesthesia during operation,to guide the dosage of anesthetic drugs in children,and evaluate its role in reducing emergence delirium.By analyzing and comparing the characteristics of intraoperative EEG between children with delirium in emergence period and children without delirium in order to provide evidence for the prediction of children emergence delirium and provide clinical reference.METHODS:Children who underwent elective hypospadias surgery under general anesthesia were selected,ASA gradeⅠ-Ⅱ,age 2-12 years old.The patients were randomly divided into two groups: group E(EEG parameters guided group)and group C(anesthesiologist experience-based group).After entering the room,all the children were connected with routine EEG monitoring and Sed Line monitor.Sevoflurane anesthesia was induced and maintained during operation.Anesthesiologists in group E adjusted the intraoperative drugs according to the changes in intraoperative EEG parameters,and anesthesiologists in group C adjusted the intraoperative drugs according to experience,and the EEG monitor screen was not visible.Children’s emergence was observed in the PACU.Record intraoperative data: MAP,HR,SPO2,sevoflurane endexpiratory concentration.Data related to emergence period: extubation time,awakening time,PAED(Pediatric Anesthesia Emergence Delirium)scores at immediate extubation,5,10,15,20,30 minutes after extubation,and FLACC pain scale(Faces,Legs,Activity,Cry,and Consolability),and discharge time.Offline download and analyze the original EEG and trend table(including SEF,DSA,and other indexes)from anesthesia induction to awakening.RESULTSOur results showed that the incidence of delirium in group E was significantly lower than that in group C(P<0.05),and the dosage of sevoflurane in group E was less than that in group C(P<0.05).There was no significant difference in the incidence of emergence agitation between the two groups(P>0.05).In addition,compared with group C,children’s PAED scores in group E were significantly lower at the moment of extubation and 5 minutes after extubation.The results of EEG parameters analysis showed that the cumulative duration of left SEF<10 and left and right SEF<10 in group E was smaller than that in group C.Compared with the children who have no emergence delirium,the EEG spectrum of the children with emergence delirium showed that the relative alpha power was lower,while the relative delta power was higher.CONCLUSIONThe use of EEG parameters to guide anesthesia can reduce the incidence of emergence delirium in children,reduce the dosage of sevoflurane during maintenance,and effectively reduce the duration of deeper anesthesia(SEF<10),but have no effect on extubation time,recovery time and discharge time.The relative alpha power decreased,and relative delta power increased may have a higher risk of the occurrence of emergence delirium.