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Effects of intravenous and mask induction on post-operative emergence delirium in pediatric patients undergoing tonsillectomy with or without adenoidectomy

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Abstract

Background

Emergence delirium occurs in children during recovery from general anesthesia. The aim of the study was to examine the effects of mask and intravenous sevoflurane anesthesia induction on emergence delirium in children undergoing tonsillectomy with or without adenoidectomy.

Methods

This single-blinded, prospective, randomized clinical trial was conducted in the operating room and the post-operative recovery area at a university hospital. Sixty-seven children (aged 3–12 years) were randomly assigned to receive either mask induction (group M) or intravenous induction (group IV). Vascular access was provided in group M after 8% sevoflurane and 60% nitrous oxide in oxygen were given through a mask. In the IV cohort, an intravenous cannula was inserted prior to induction. The incidence of emergence delirium was assessed using the Pediatric Anesthesia Emergence Delirium (PAED) scale after arrival in the post-anesthesia care unit. Post-operative pain was assessed using the Face, Legs, Activity, Cry, and Consolability (FLACC) scale.

Results

PAED scores were significantly higher in group M at 5 min (group M = 12.2 ± 4.215, group IV = 9.1 ± 4.0; mean difference = 3.094, 95% CI [1.108; 5.081]; P = 0.003), at 15 min (group M = 8.0 ± 2.6, group IV = 5.1 ± 2.3; mean difference = 2.942, 95% CI [1.586–4.301]; P < 0.001), and at 30 min (group M = 5.1 ± 2.8, group IV = 2.5 ± 1.8; mean difference = 2.620, 95% CI [1.457; 3.783]; P < 0.001) than in group IV. The FLACC scale scores were similar between the two groups.

Conclusion

Mask induction for pediatric patients undergoing tonsillectomy with or without adenoidectomy increased Pediatric Anesthesia Emergence Delirium scores more than intravenous induction.

Trial registration

NCT03252405

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Authors and Affiliations

  1. Department of Anesthesiology and Critical Care, Kırıkkale University School of Medicine, Kırıkkale, Turkey

    Kevser Peker

  2. Department of Anesthesiology and Critical Care, Diskapi Yildirim Beyazit Training and Research Hospital, Ankara, Turkey

    Reyhan Polat

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  1. Kevser Peker
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Correspondence to Kevser Peker.

Ethics declarations

Ethical approval for this study (2017-11/105) was provided by the Ethics Committee of the university’s Faculty of Medicine on June 20, 2017. Written consent was obtained from all the parents of the patients.

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The authors declare that they have no conflict of interest.

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Peker, K., Polat, R. Effects of intravenous and mask induction on post-operative emergence delirium in pediatric patients undergoing tonsillectomy with or without adenoidectomy. Ir J Med Sci 189, 1061–1068 (2020). https://doi.org/10.1007/s11845-020-02197-4

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  • DOI: https://doi.org/10.1007/s11845-020-02197-4

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