Objective. Desflurane, having the lowest blood-gas partition coefficient among the available halogenated agents, is known for its rapid recovery after discontinuation of anesthesia. This makes desflurane a suitable agent particularly for day care surgery. However, this very same property of desflurane is responsible for the high incidence of postoperative delirium especially in pediatric patients. The objective of this study was to determine if single technique or concurrent use of inguinal block or rectal paracetamol in children for herniotomy has an effect on the incidence of emergence agitation associated with desflurane Methodology. Sixty ASA 1-2 children ages 1-10 years old for unilateral herniotomy were randomly assigned into three groups: (i) inguinal block (0.25 percent bupivacaine, 1-2 mg/kg) (ii) rectal paracetamol (40 mg/kg) (iii) inguinal block with paracetamol. Treatments were administered after inhaled induction with sevoflurane. The patients received desflurane for maintenance of general anesthesia from incision to end of surgery. Emergence time and quality of emergence, using a four-point scale (1-asleep or calm; 2-mildly agitated, crying but consolable; 3-hysterical, crying inconsolably; 4-combative), was assessed by an observer blinded to the anesthetic technique. Results were analyzed using Pearsons Chi Square and Kruskal-Wallis One Way ANOVA Results. The group who received inguinal block with or without paracetamol had significantly lower incidence of emergence delirium than the group who received paracetamol only. The difference in emergence time between groups and the difference in demographic characteristics between groups were not significant Conclusion. Inguinal block, with or without paracetamol, decreases the incidence of post-operative delirium in children maintained on desflurane anesthesia. (Author)
Human ; Child ; Child Preschool ; ANESTHESIA ; CHILD ; ACETAMINOPHEN ; DELIRIUM