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Korean J Anesthesiol > Epub ahead of print
DOI: https://doi.org/10.4097/kja.d.18.00345    [Epub ahead of print]
Published online March 6, 2019.
Three minutes propofol after sevoflurane anesthesia to prevent emergence agitation in genito-urinary pediatric surgeries: a randomized controlled trial
Mostafa Samy Abbas, Essam Ezzat Abd El-Hakeem, Hossam Esmat Kamel
Faculty of Medicine, Assiut University, Assiut, Egypt
Corresponding author:  Mostafa Samy Abbas, Tel: +201003060187, Fax: +2088-2335520, 
Email: mostafasamy@aun.edu.eg
Received: 5 December 2018   • Revised: 24 January 2019   • Accepted: 21 February 2019
Abstract
Background
emergence agitation (ED) is a common problem after sevoflurane anesthesia in pediatrics. Confusing results are there when propofol is administered as a 1 mg/kg bolus at the end of sevoflurane anesthesia. Infusion of propofol 3 mg/kg over 3 min at the end of sevoflurane anesthesia was found to be promising in children undergoing magnetic resonance imaging (MRI) scans. While no trials in surgical settings were found, we therefore, aimed to examine the same regimen in children undergoing inguinal hernia repair surgeries.
Methods
In this prospective randomized controlled trial, 64 children aged 1 - 12 years, scheduled for inguinal hernia repair surgeries using sevoflurane as an anesthetic were randomized to receive either propofol 3 mg/ kg over 3 min (propofol group) or no propofol (control group), after cessation of sevoflurane anesthesia. ED was assessed by using the Paediatric Emergence Anesthesia Delirium (PAED) scale and the Watcha scale. Emergence time and postanesthesia care unit (PACU) stay were also recorded.
Results
The incidence of ED was lower in the intervention group on both PAED (81.250% vs. 15.625%, p <0.001) and Watcha (78.125% vs. 15.625%, p <0.001) scales. The mean emergence time was 6.37 minutes longer in the active group, but with no significant difference in PACU times.
Conclusions
Transition to propofol 3 mg/ kg over 3 min after sevoflurane anesthesia reduces the incidence of emergence agitation and improves the quality of emergence. Despite the increase in emergence time, but no delay in PACU stays.
Key Words: Propofol; Sevoflurane; Emergence; Delirium; Agitation; Pediatrics


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