Anesthesia Progress – When a child is unable to stay calm during dental surgery, the dentist anesthesiologist typically uses an inhalant to deliver general anesthesia. Young children who receive such treatment often experience delirium and agitation when they “wake up.” These reactions increase risk of injury to the child and decrease the parents’ satisfaction with the care their child is receiving.
An article in the current issue of the journal Anesthesia Progress describes a new technique that may reduce the delirium and agitation common in pediatric dental patients upon emerging from general anesthesia. It also reviews past studies of six drugs, as well as acupuncture, as options to lessen delirious and agitated behavior following anesthesia.
Sevoflurane is the inhalant of choice for young patients, because the I.V. does not have to be started while the child is awake and uncooperative, and it is easy to regulate during dental surgery. But patients receiving it are more likely to be overly anxious and disoriented after anesthesia than they are with other inhalants. Preschool-age children have these reactions far more often than children who are 6 to 10 years old.
In every case, the alternative drug or technique reviewed in this article had some effect on delirium and agitation. However, each option had disadvantages that made it unpopular among anesthesiologists. The author argues that rather than replacing the popular inhalant sevoflurane, researchers and doctors should focus on a way to reduce its undesirable effects.
The author presents a technique known as Bispectral Index System (BIS)–guided anesthesia, combined with the drug propofol, as a potential solution. The dentist anesthesiologist still gives a child sevoflurane to induce anesthesia and then maintains it throughout the surgery. But 30 minutes before the dental surgeon expects to complete the operation, the anesthesiologist switches the anesthetic from sevoflurane to propofol. Recovery time is shortened by decreasing the concentration of the drug as the surgeon finishes.
With such a technique, the effects of the second drug are gone within 15 to 20 minutes, notes the author. The child may still cry but can ask for a drink of water or talk about going home, neither of which is possible when the patient is in the typical inconsolable condition.
The author has put the technique into practice, using it in more than 300 procedures. He reports that the children experienced less agitation and delirium after their surgery more than 90% of the time. With further study using large, double-blinded groups of patients, the method may prove to be an effective option for children facing dental surgery.
Full text of “Prevention of Sevoflurane Delirium and Agitation With Propofol,” and other articles, Anesthesia Progress, Vol. 60, No. 2, 2013, are available at https://www.anesthesiaprogress.org/doi/full/10.2344/0003-3006-60.3.67.