Effect of opioid-sparing anesthesia on emergence agitation after laparoscopic hernia repair in children
Objective To investigate the effect of opioid-sparing anesthesia on emergence agitation(EA)in children undergo-ing laparoscopic hernia repair.Methods A single-center randomized controlled trial was conducted.A total of 82 children,Ameri-can Society of Anesthesiologists(ASA)Ⅰ or Ⅱ,aged 6 to 36 months,who underwent elective laparoscopic hernia repair were selected.According to the random number table method,they were divided into two groups(n=41):a conventional group(group C)and an opioid-sparing group(group DS).Both groups underwent anesthesia induction with sevoflurane.Group C received sufentanil(0.3 μg/kg),and group DS received esketamine(1 mg/kg)combined with dexmedetomidine(0.5 μg/kg).Within 30 min after laryngeal mask remov-al,the incidence of EA was assessed with the Pediatric Anesthesia Emergence Delirium(PAED)scale every 5 min,and the highest PAED score was recorded.The mean arterial pressure(MAP)and heart rate were recorded at admission to the operating room(To),be-fore insertion of laryngeal mask(T,),5 min after insertion of laryngeal mask(T2),5 min after incision(T3),and at the end of operation(T4).Pain was assessed by the Face,Legs,Activity,Cry,Consolability(FLACC)scale every 5 min for 30 min after extubation,and the highest FLACC score was recorded.The use of rescue analgesia,the duration of operation,emergence time,the length of post-anesthesia care unit(PACU)stay,and the incidences of adverse reactions,such as nausea and vomiting,hypoxemia,and laryngeal spasms during the recovery period in the PACU were recorded.The use of remedial analgesia,operation time,recovery time,PACU res-idence time and the occurrence of adverse reactions such as nausea and vomiting,hypoxemia and laryngeal spasm during PACU resus-citation were recorded.Results Compared with group C,group DS showed decreases in the incidence of EA,the highest PAED score and the highest FLACC score(all P＜0.05).There were no statistical differences in the rate of rescue analgesia,the duration of op-eration,time to extubation,the length of PACU stay and the incidence of adverse reactions between the two groups(all P＞0.05).The dif-ference of time effect of heart rate between two groups was statistically significant(P＜0.05),but the difference of time and group interac-tion effect was not statistically significant(P＞0.05).The difference of time effect of MAP between two groups was statistically signifi-cant(P＜0.05),and the difference of time and group interaction effect was statistically significant(P＜0.05).There was no statistical dif-ference in heart rate and MAP between the two groups at each time point(all P＞0.05).Conclusions The opioid-sparing anesthesia strategy reduces the incidence of EA and postoperative pain score in children undergoing laparoscopic hernia repair,without increases in perioperative complications.
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