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| Name | Class |
|---|---|
| Odense Patient Data Explorative Network | OTHER |
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Emergence agitation is a significant and persistent challenge in paediatric anaesthesia, especially in children of preschool age.
In this study, the investigators examined whether anaesthesia titration with either a sleep depth monitor or a pain monitor would result in changed postoperative agitation rates, measured via the Richmond Agitation and Sedation Score (RASS).
93 children participated. The participants were divided into three groups: A conventional anaesthesia group, an EEG (Electroencephalography)- monitored and a pain-monitored group. The pain-monitored children received the most pain medication but were discharged at the same rate as the other children with unchanged rates of nausea and vomiting and less agitation than the sleep-monitored children.
Healthy preschool outpatients assigned for abdominal/inguinal hernia and cryptorchidism repairs participated after parental consent.
One group received standard anaesthesia induction and maintenance, according to the usual ward regimen. This was done with sevoflurane inhalation, fentanyl bolus and a laryngeal mask airway (Standard group, STD group)
The second group received standard anaesthesia as well only this time the sevoflurane titration was guided via the Nacotrend bispectral index monitor, towards a narcotrend index of 2-4. (Narcotrend group, NCT group)
The third group also received standard anaesthesia and was additionally monitored with a Mdoloris Anaesthesia Nociception Index (ANI) monitor for perioperative nociception. When a nociceptive threshold was exceeded, an extra bolus of fentanyl of 1 mcg/kg was given (ANI group)
All children were then escorted to the postoperative care unit for wakeup. A Richmond Agitation Sedation Scale score (RASS-score) was made every 15 minutes until discharge. This was analysed with Kaplan-Meyer mortality graph, along with usual statistics of secondary outcomes.
The children in the ANI group received the least fentanyl and were discharged no later than all the other children.
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| Label | Type | Description | Intervention Names |
|---|---|---|---|
| Standard (STD) | No Intervention | Standard anaesthesia with Sevoflurane Inhalation anaesthesia, fentanyl and a laryngeal mask | |
| Narcotrend (NCT) | Experimental | Standard anaesthesia with Sevoflurane inhalation anaesthesia, fentanyl and a laryngeal mask. Sevoflurane concentration was titrated via a Narcotrend bispectral anaesthesia monitor. |
|
| Anaesthesia Nociception Index Monitor (ANI) | Experimental | Standard anaesthesia with Sevoflurane inhalation anaesthesia, fentanyl and a laryngeal mask. Fentanyl dosage titrated with guidance from Mdoloris ANI monitor, a heart rate variability-based nociception monitor. When a threshold value is exceeded, additional fentanyl 1 mcg/kg is given |
|
| Name | Type | Description | Arm Group Labels | Other Names |
|---|---|---|---|---|
| Narcotrend bispectral index anaesthesia monitor | Device | A bispectral index anaesthesia monitor collects simplified EEG via forehead electrodes and displays an index of 0-100, where an index of 40-60 is considered optimal |
| Measure | Description | Time Frame |
|---|---|---|
| Richmond Agitation Sedation Scale Score | Scoring system for sedation and agitation from -5 til +4. | During postoperative care unit (PACU) stay within 0-8 hours |
| Measure | Description | Time Frame |
|---|---|---|
| Time consumption | Time spent with anesthesia, PACU stay and total time. | Within 48 hours of hospital admission |
| Fentanyl consumption | Given during the anesthesia against postoperative pain |
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Inclusion Criteria:
Exclusion Criteria:
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| Name | Affiliation | Role |
|---|---|---|
| Line Gry Larsen | Anaeshtesiologic Intensive Ward V, Odense University Hospital | Principal Investigator |
| Facility | Status | City | State | ZIP | Country | Contacts |
|---|---|---|---|---|---|---|
| Odense University Hospital | Odense | 5000 | Denmark |
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| Mdoloris Anaesthesia Nociception Monitor | Device | A heart rate variability-based nociception monitor collects ECG-signal from electrodes on the patient's chest and displays an index of 0-100 where an index below 50 is considered nociceptive. |
|
| Within 48 hours of hospital admission |
| Nurse-VAS | A Visual-Analogue-Scale score (VAS score) assessed by PACU nurses. A score from 0-10 where 10 represents worst pain. | Within the duration of PACU stay of 0-8 hours |
| PONV | Postoperative nausea and vomiting (PONV). A score from 0-2 where 2 represents worst nausea and vomiting. | Within the duration of PACU stay of 0-8 hours |
| Other medications | Other drugs, such as NSAIDs, given | During the first 24 postoperative hours |
| ID | Term |
|---|---|
| D000071257 | Emergence Delirium |
| ID | Term |
|---|---|
| D003693 | Delirium |
| D003221 | Confusion |
| D019954 | Neurobehavioral Manifestations |
| D009461 | Neurologic Manifestations |
| D009422 | Nervous System Diseases |
| D011183 | Postoperative Complications |
| D010335 | Pathologic Processes |
| D013568 | Pathological Conditions, Signs and Symptoms |
| D012816 | Signs and Symptoms |
| D019965 | Neurocognitive Disorders |
| D001523 | Mental Disorders |
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