Akgün Ebru SALMAN, Aynur CAMKIRAN, Sabiha OĞUZ, Aslı DÖNMEZ

Gabapentin premedication for postoperative analgesia and emergence agitation after sevoflurane anesthesia in pediatric patients

Amaç: Bu çalışmanın amacı gabapentin premedikasyonunun tonsillektomi ve adeneidektomiye giden pediyatrik hastalarda ameliyat sonrası 24 saatlik analjezik tüketimi ve sevofluran anerstezisinden sonra derlenme ajitasyonunun insidansı üzerindeki etkisini araştırmaktır. Gereç ve Yöntem: Yaşları 3-12 arasında değişen ASA I-II grubu sağlıklı 46 çocuk çalışmaya dahil edildi. Hastalar randomize olarak her biri 23 hastadan oluşan kontrol (Grup C) ve gabapentin (Grup G) olmak üzere iki gruba ayrıldı.Grup C 10 ml salin ve grup G ise 10 ml salin içinde çözünmüş 15ml.kg-1 gabapentini anestezi indüksiyonundan 30 dak. önce oral olarak aldı. %50 O2-N2O karışımı içinde %8 sevofluran ile anestezi indüksiyonunu takiben genel anestezi %50 O2-N2O karışımı içinde 1 MAC sevofluran ile idame edildi. Derlenme ajitasyonu beş noktalı skala ile değerlendirildi ve postoperatif ilk 30 dak. boyunca 10 dakika arayla kaydedildi. Cerrahiden 24 saat sonra ağrıyı, total analjezik tüketimi, ebeveyn memnuniyetini ve yan etkileri değerlendirmek için ebeveynlerle iletişime geçildi. Bulgular: Ajitasyon skorları grup G’de grup C’ye göre ameliyat sonrası 20. ve 30. dakikalarda anlamlı olarak düşüktü (p

Pediyatrik hastalarda ameliyat sonrası analjezi ve sevofluran anestezisi sonrası derlenme ajitasyonu için gabapentin premedikasyonu

Objectives: The aim of this study was to investigate the effect of gabapentin premedication on postoperative 24th hour total analgesic consumption and the incidence of emergence agitation after sevoflurane based anesthesia in pediatric patients un- dergoingtonsillectomyandadenoidectomy. Methods: 46 healthy, ASA class I or II, aged 3-12 year old children were included into the study. The patients were randomly assigned to one of the control (Group C) or gabapentin group (Group G) consisting of 23 patients in each. Group C received 10 ml of saline, Group G received gabapentin 15 mg.kg-1 dissolved in 10 ml of saline orally 30 min. before the induction of anesthesia. After anesthesia induction with 8% sevoflurane in 50% O2-N2O. General anesthesia was maintained with 1 MAC sevoflurane in 50% O2-N2O. Emergence agitation was assessed with a 5 point scale and recorded every 10 min. of first 30 min. of the postoperative period. Parents were contacted 24 hours after the surgery to evaluate pain, total analgesic consumption, parent satisfactionandanysideeffect. Results: Agitation scores were significantly lower in group G compared to group C in the postoperative 20th and 30th minutes (p<0.01, 0.05 respectively). Total analgesic requirement in postoperative 24 hour was significantly lower in group G (p<0.01). Satisfaction scores of parents was also higher in group G (p<0.05). Conclusion: Gabapentin premedication decreases postoperative 24th hour analgesic consumption and attenuates emergence agitation after sevoflurane anesthesia.

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1. Turan A, Memiş D, Karamanlioğlu B, Yağiz R, Pamukçu Z, Yavuz E. The analgesic effects of gabapentin in monitored anesthesia care for ear-nose-throat surgery. Anesth Analg 2004;99(2):375-8.
2. Fassoulaki A, Stamatakis E, Petropoulos G, Siafaka I, Hassia- kos D, Sarantopoulos C. Gabapentin attenuates late but not acute pain after abdominal hysterectomy. Eur J Anaesthesiol 2006;23(2):136-41.
3. Ménigaux C, Adam F, Guignard B, Sessler DI, Chauvin M. Preoperative gabapentin decreases anxiety and improves early functional recovery from knee surgery. Anesth Analg 2005;100(5):1394-9.
4. Uezono S, Goto T, Terui K, Ichinose F, Ishguro Y, Nakata Y, et al. Emergence agitation after sevoflurane versus propofol in pediatric patients. Anesth Analg 2000;91(3):563-6.
5. Kuratani N, Oi Y. Greater incidence of emergence agitation in children after sevoflurane anesthesia as compared with halothane: a meta-analysis of randomized controlled trials. Anesthesiology 2008;109(2):225-32.
6. Moos DD. Sevoflurane and emergence behavioral changes in pediatrics. J Perianesth Nurs 2005;20(1):13-8.
7. Cravero JP, Beach M, Dodge CP, Whalen K. Emergence characteristics of sevoflurane compared to halothane in pediatric patients undergoing bilateral pressure equalization tube insertion. J Clin Anesth 2000;12(5):397-401.
8. Mayer J, Boldt J, Röhm KD, Scheuermann K, Suttner SW. Desflurane anesthesia after sevoflurane inhaled induction reduces severity of emergence agitation in children undergoing minor ear-nose-throat surgery compared with sevoflurane induction and maintenance. Anesth Analg 2006;102(2):400-4.
9. Turan A, White PF, Karamanlioglu B, Memis D, Tasdogan M, Pamukçu Z, et al. Gabapentin: an alternative to the cyclo- oxygenase-2 inhibitors for perioperative pain management. Anesth Analg 2006;102(1):175-81.
10. Rusy LM, Hainsworth KR, Nelson TJ, Czarnecki ML, Tassone JC, Thometz JG, et al. Gabapentin use in pediatric spinal fusion patients: a randomized, double-blind, controlled trial. Anesth Analg 2010;110(5):1393-8.
11. Aldrete JA. Modifications to the postanesthesia score for use in ambulatory surgery. J Perianesth Nurs 1998;13(3):148-55.
12. Cole JW, Murray DJ, McAllister JD, Hirshberg GE. Emergence behaviour in children: defining the incidence of excite- ment and agitation following anaesthesia. Paediatr Anaesth 2002;12(5):442-7.
13. Norden J, Hannallah RS, Getson P, O’Donnell R, Kelliher G, Walker N. Concurrent validation of an objective pain scale for infants and children. Anesthesiology 1997;75:934.
14. Mikkelsen S, Hilsted KL, Andersen PJ, Hjortsø NC, Enggaard TP, Jørgensen DG, et al. The effect of gabapentin on post-op- erative pain following tonsillectomy in adults. Acta Anaes- thesiol Scand 2006;50(7):809-15.
15. Hurley RW, Cohen SP, Williams KA, Rowlingson AJ, Wu CL. The analgesic effects of perioperative gabapentin on post- operative pain: a meta-analysis. Reg Anesth Pain Med 2006;31(3):237-47.
16. Fassoulaki A, Patris K, Sarantopoulos C, Hogan Q. The analge- sic effect of gabapentin and mexiletine after breast surgery for cancer. Anesth Analg 2002;95(4):985-91.
17. Isik B, Arslan M, Tunga AD, Kurtipek O. Dexmedetomidine decreases emergence agitation in pediatric patients after sevoflurane anesthesia without surgery. Paediatr Anaesth 2006;16(7):748-53.
18. Aouad MT, Nasr VG. Emergence agitation in children: an up- date. Curr Opin Anaesthesiol 2005;18(6):614-9.
19. Cohen IT, Finkel JC, Hannallah RS, Hummer KA, Patel KM. Rapid emergence does not explain agitation following sevo- flurane anaesthesia in infants and children: a comparison with propofol. Paediatr Anaesth 2003;13(1):63-7.
20. Ibacache ME, Muñoz HR, Brandes V, Morales AL. Single-dose dexmedetomidine reduces agitation after sevoflurane anes- thesia in children. Anesth Analg 2004;98(1):60-3.
21. Ghosh SM, Agarwala RB, Pandey M, Vajifdar H. Efficacy of low- dose caudal clonidine in reduction of sevoflurane-induced agitation in children undergoing urogenital and lower limb surgery: a prospective randomised double-blind study. Eur J Anaesthesiol 2011;28(5):329-33.
22. Dong YX, Meng LX, Wang Y, Zhang JJ, Zhao GY, Ma CH. The effect of remifentanil on the incidence of agitation on emer- gence from sevoflurane anaesthesia in children undergoing adenotonsillectomy. Anaesth Intensive Care 2010;38(4):718- 22.
23. Patel A, Davidson M, Tran MC, Quraishi H, Schoenberg C, Sant M, et al. Dexmedetomidine infusion for analgesia and prevention of emergence agitation in children with obstruc- tive sleep apnea syndrome undergoing tonsillectomy and adenoidectomy. Anesth Analg 2010;111(4):1004-10.
24. Kulka PJ, Bressem M, Wiebalck A, Tryba M. Prevention of “post-sevoflurane delirium” with midazolam. [Article in Ger- man] Anaesthesist 2001;50(6):401-5. [Abstract]
25. Cravero JP, Beach M, Thyr B, Whalen K. The effect of small dose fentanyl on the emergence characteristics of pediatric patients after sevoflurane anesthesia without surgery. Anes- th Analg 2003;97(2):364-7.
26. Picard V, Dumont L, Pellegrini M. Quality of recovery in chil- dren: sevoflurane versus propofol. Acta Anaesthesiol Scand 2000;44(3):307-10.
27. Voepel-Lewis T, Malviya S, Tait AR. A prospective cohort study of emergence agitation in the pediatric postanesthesia care unit. Anesth Analg 2003;96(6):1625-30.