Y Lin1, W Shen1, Y Liu2, Q Wang1, Q Chen1, Z Fang3, W Chi4, X Gan5, Y Z Liu4. 1. Department of Anaesthesiology, State Key Laboratory of Ophthalmology, Zhongshan Ophthalmic Center, Sun Yat-sen University, Guangzhou, Guangdong, China. 2. Department of Anaesthesiology, First Affiliated Hospital, Sun Yat-sen University, Guangzhou, Guangdong, China. 3. Department of Anaesthesiology and Perioperative Medicine, David Geffen School of Medicine at UCLA, Los Angeles, CA, USA. 4. Department of Cataract, State Key Laboratory of Ophthalmology, Zhongshan Ophthalmic Center, Sun Yat-sen University, Guangzhou, Guangdong, China. 5. Department of Anaesthesiology, State Key Laboratory of Ophthalmology, Zhongshan Ophthalmic Center, Sun Yat-sen University, Guangzhou, Guangdong, China. Electronic address: ganxl@mail.sysu.edu.cn.
Abstract
BACKGROUND:Emergence delirium is a common complication in children, especially in preschool children undergoing ophthalmic surgery. The aim of the study was to investigate the effects of visual preconditioning (application of an eyepatch over the eye to be operated for ≥3 h the day before surgery) on emergence delirium after ophthalmic surgery under sevoflurane anaesthesia. METHODS:One hundred and seventy-nine children undergoing unilateral cataract surgery, aged 3-7 yr, were involved in this prospective, blinded, randomised study. Subjects were randomised to receive visual preconditioning (Group P, n=89) or to receive programmed explanation the day before surgery (Group C, n=90). The primary outcome was incidence of emergence delirium evaluated by the paediatric anaesthesia emergence delirium (PAED) scale. The secondary outcomes included emergence time and post-anaesthesia care unit (PACU) stay time. RESULTS: Children in Group P had a significantly lower incidence of emergence delirium than those in Group C [16.9% vs 44.4%, odds ratio (OR) 4.0, 95% confidence interval (CI) 2.0 to 8.0]. The maximal PAED score was lower in Group P than in Group C [4 (0-20) vs 9 (0-20), median difference -3.0, 95% CI -5.0 to -1.0]. Visual preconditioning prolonged emergence time (P<0.001) and PACU stay time (P=0.002). CONCLUSION: Visual disturbance contributes to emergence delirium in preschool children undergoing ophthalmic surgery withsevoflurane, and prophylactic eyepatch treatment can reduce emergence delirium. CLINICAL TRIALS REGISTRATION: NCT02590744.
RCT Entities:
BACKGROUND:Emergence delirium is a common complication in children, especially in preschool children undergoing ophthalmic surgery. The aim of the study was to investigate the effects of visual preconditioning (application of an eyepatch over the eye to be operated for ≥3 h the day before surgery) on emergence delirium after ophthalmic surgery under sevoflurane anaesthesia. METHODS: One hundred and seventy-nine children undergoing unilateral cataract surgery, aged 3-7 yr, were involved in this prospective, blinded, randomised study. Subjects were randomised to receive visual preconditioning (Group P, n=89) or to receive programmed explanation the day before surgery (Group C, n=90). The primary outcome was incidence of emergence delirium evaluated by the paediatric anaesthesia emergence delirium (PAED) scale. The secondary outcomes included emergence time and post-anaesthesia care unit (PACU) stay time. RESULTS:Children in Group P had a significantly lower incidence of emergence delirium than those in Group C [16.9% vs 44.4%, odds ratio (OR) 4.0, 95% confidence interval (CI) 2.0 to 8.0]. The maximal PAED score was lower in Group P than in Group C [4 (0-20) vs 9 (0-20), median difference -3.0, 95% CI -5.0 to -1.0]. Visual preconditioning prolonged emergence time (P<0.001) and PACU stay time (P=0.002). CONCLUSION:Visual disturbance contributes to emergence delirium in preschool children undergoing ophthalmic surgery with sevoflurane, and prophylactic eyepatch treatment can reduce emergence delirium. CLINICAL TRIALS REGISTRATION: NCT02590744.
Authors: Ivan Urits; Jacquelin Peck; Stephen Giacomazzi; Riki Patel; John Wolf; Denzil Mathew; Ruben Schwartz; Hisham Kassem; Richard D Urman; Alan D Kaye; Omar Viswanath Journal: Adv Ther Date: 2020-04-09 Impact factor: 3.845