서혜부탈장 환아에서 Sevoflurane 마취후 발생하는 각성흥분에 대한 Alfentanil의 효과 = The Effect of Alfentanil on the Emergence Agitation after Sevoflurane Anesthesia in Children Undergoing Inguinal Herniorraphy

다국어 초록 (Multilingual Abstract)

Background: Sevoflurane anesthesia is associated with emergence agitation in children. In this study, we compared the emergence and recovery profiles of children who received sevoflurane with fentanyl or alfentanil for inguinal herniorrhaphy.
Methods: Forty-five children receiving sevoflurane anesthesia for inguinal herniorraphy were assigned to three groups. Saline 0.1 ml/kg (group S), alfentanil 10μg/kg (group A) or fentanyl 1μg/kg (group F) was administered intravenously at the beginning of fascia closure. Duration of operation and anesthesia and emergence time were evaluated at the operating room. Agitation score, a degree of pain, the time of stay in PACU (postanesthetic care unit) and postoperative side effects were evaluated by a blinded observer at the PACU.
Results: The emergence time was prolonged in the group F compared to the other groups. The time of stay in PACU was prolonged in the group F compared to the group S. Group A and F had lower agitation score and pain score in comparison with that of the group S at the 0, 5, 10, 15 min in the PACU. Agitation score was also significantly lower in the group F compared to the group A at 30 min.
Conclusions: We suggest that intravenous administration of alfentanil 10μg/kg or fentanyl 1μg/kg at the closure of fascia could effectively reduce the agitation score. Alfentanil also does not delay from emergence and the time of stay in the PACU.

참고문헌 (Reference)

1 "and safety characteristics of sevoflurane in children undergoing ambulatory surgery A comparison with halothane" 1332-40, 1996

2 "The use of alfentanil for short duration surgery in pediatric anesthesia" 66 : 123-9, 2000

3 "The post-anesthesia recovery score revisited" 7 : 89-91, 1995

4 "The pharmacokinetics of alfentanil in man" 2-64, brjanaesth1983

5 "The effect of small dose fentanyl on the emergence characteristics of pediatric patients after sevoflurane anesthesia without surgery" 97 : 364-7, 2003

6 "The effect of intranasal fentanyl on the emergence characteristics after sevoflurane anesthesia in children undergoing surgery for bilateral myringotomy tube placement" 92 : 1164-8, 2001

7 "The effect of fentanyl on the emergence characteristics after desflurane or sevoflurane anesthesia in children" 94 : 1178-81, 2002

8 "The effect of fentanyl and midazolam on the incidence of emergence agitation in children following sevoflurane anesthesia for tonsillectomy" 46 : 524-7, 2004

9 "The effect of caudal analgesia on emergence agitation in children after sevoflurane versus halothane anesthesia" 98 : 321-6, 2004

10 "The comparison of incidence of postoperative agitation in children after enflurane or sevoflurane inhalational anesthesia" 6 : 647-51, 2004

11 "The comparative effects of caudal block and IV ketorolac on emergence delirium after sevoflurane anesthesia in children" 47 : 233-7, 2004

12 "Sevoflurane for ENT- surgery in children.A comparison with halothane" 39 : 546-50, 1995

13 "Sevoflurane causes more postoperative agitation in children than does halothane" 43 : 536-41, 1999

14 "Recovery characteristics of sevoflurane and halothane in preschool-aged children undergoing bilateral myringotomy and pressure equalization tube insertion" 88 : 34-8, 1999

15 "Rapid emergence does not explain agitation following sevoflurane anaesthesia in infants and children:a comparison with propofol" 13 : 63-7, 2003

16 "New inhalation agents in paediatric anaesthesia" 83 : 42-9, 1999

17 "Management of pediatric pain with opoid analgesics" 113 : 421-9, 1988

18 "Induction and recovery characteristics and hemodynamic responses to sevoflurane and halothane in children" 79 : 840-4, 1994

19 "Greater incidence of delirium during recovery from sevoflurane anesthesia in preschool boys" 87 : 1298-300, 1997

20 "Excitation and delirium during sevoflurane anesthesia in pediatric patients" 68 : 402-5, 2002

21 "Emergence behavior in children:defining the incidence of excitement and agitation following anaesthesia" 12 : 442-7, 2002

22 "Emergence agitation after sevoflurane versus propofol in pediatric patients" 91 : 563-6, 2000

23 "Effects of fentanyl on the incidence of emergence agitation in children receiving desflurane or sevoflurane anaesthesia" 21 : 538-42, 2004

24 "Decreased fentanyl and alfentanil dose requirements with age.A simultaneous pharmacokinetic and pharmacodynamic evaluation" 240 : 159-66, 1987

25 "Control of postinguinal herniorrhaphy pain in children" 47 : 373-8, 2004

26 "Comparison of emergence and recovery characteristics of sevoflurane,desflurane,and halothane in pediatric ambulatory patients" 83 : 917-20, 1996

27 "Comparison of effects of remifentanil,alfentanil and fentanyl on cardiovascular responses to tracheal intubation in morbidity obese patients" 19 : 125-8, 2002

28 "Comparison of caudal and ilioinguinal/iliohypogastric nerve blocks for control of post-orchiopexy pain in pediatric ambulatory surgery" 66 : 832-4, 1987

29 "Clinical uses of fentanyl,sufentanil,and alfentanil" 10 : 58-93, 1991

30 "Clinical characteristics of sevoflurane in children.A comparison with halothane" 82 : 38-46, 1995

31 "Appropriate dose of fentanyl for the prevention of emergence agitation after sevoflurane in pediatric patients undergoing tonsillectomy" 47 : 317-20, 2004

32 "Analgesia for appendectomy:comparison of fentanyl and alfentanil in children" 34 : 30-4, 1990

33 "Alfentanil suppresses coughing and agitation during emergence from isoflurane anesthesia" 7 : 114-8, 1995

34 "A comparison of ketorolac and meperidine for reducing postoperative excitement after VIMA with sevoflurane in pediatrics" 7 : 32-6, 2003

35 "A comparison of alfentanil pharmacokinetics in children and adults" 66 : 13-6, 1987