Visual preconditioning reduces emergence delirium in children - PowerPoint PPT Presentation

Visual preconditioning reduces emergence delirium in children undergoing ophthalmic surgery Xiaoliang Gan, MD, PhD Department of Anesthesiology, Zhongshan Ophthalmic Center of Sun Yat-sen University Email: ganxl@mail.sysu.edu.cn

30 th annual meeting 2

Zhongshan Ophthalmic Center 3

Zhongshan Ophthalmic Center ◆ >70,000 surgeries per year ◆ >14,000 cases under GA per year 4 Nature. 2015;519(7543):276-8.

Emergence delirium ◆ A cluster of postoperative disturbing behaviors occurring in the early period of postanesthetic recovery ◆ Characterized by a variety of presentations, including crying, excitation, and agitation 5 J Anesth (2014) 28:4 – 11

Unfavorable results of ED ◆ Extra nursing staffs ◆ Accidental removal of cannulation ◆ Postoperative negative behavior ◆ Even surgery failure Eur J Anaesthesiol 2011; 28:640-645 Anaesthesia 2015, 70:393-399 6

Risk factors of ED ◆ Preschool children; ◆ Male; ◆ Preoperative anxiety; ◆ Sevoflurane or desflurane anesthesia; ◆ Eye, ear, nose and throat surgery 7 Curr Opin Anesthesiol 2014, 27:309 – 315

ED in ophthalmic surgery ◆ High incidences in ophthalmic surgery Anesthesiology 2014; 120:1354-61 8 Journal of Clinical Anesthesia (2016) 33, 289 – 295

Underlying mechanisms ---unclear ◆ Postoperative pain ◆ The psychological immaturity ◆ Lack of adaptation to the perioperative anxiety 9

Pharmacologic prevention 10

Pharmacologic prevention ◆ Prolong the PACU stay time ◆ Increase the risks of hypoxemia J Anesth (2016) 30:261 – 267 11

Nonpharmacologic prevention ◆ Parental presence ◆ Anxiety-reduction ◆ Distraction ◆ Video modeling and education ◆ Coaching ◆ Exposure/shaping J Anesth (2016) 30:261 – 267 Eur J Anaesthesiol 2017; 34:169 – 175 Pediatric Anesthesia 26 (2016) 207 – 212 12

Characterization of cataract surgery ◆ Cataract surgery characterized by minor trauma ◆ Visual disturbance may contribute to ED after eye surgery 13

Hypothesis ◆ Visual preconditioning 14

Inclusion criteria ◆ 3 to 7 years old ◆ ASA 1-2 ◆ Unilateral cataract surgery 15

Exclusion criteria ◆ Bilateral procedures ◆ Neurological illness ◆ Developmental delay ◆ Maladaptive behavior ◆ ADD ◆ Autism ◆ Parental refusal 16

Exclusion criteria ◆ Mild cold, or cough. ◆ Breathe holding or laryngospasm or severe cough with the treatment of propofol after removing the LMA 17

Intervention ◆ Group C: programmed explanation ◆ Group P: prophylactic treatment with eye patch 18

Anesthesia induction ◆ The preoperative anxiety was evaluated at the pre-operative holding room ◆ Intravenous access for anaesthesia obtained ◆ Propofol (1mg/kg i.v.) at the holding room with the parents accompanied 19

◆ Sevoflurane 8% (with oxygen 8L/ min) ◆ Fentanyl (1μg/kg, i.v.) ◆ LMA was inserted without neuromuscular blocking drugs. 20

Maintenance of anesthesia ◆ 2% to 3% sevoflurane ◆ synchronized intermittent mandatory ventilation (SIMV) ◆ P ET CO 2 35-45mmHg 21

To prevent postoperative pain ◆ Topical anesthesia at the beginning and completion of the surgery ◆ Nonsteroidal anti-inflammatory drugs (NSAIDs) during the induction 22

◆ On completion of the surgery, the operated eye was covered by ointment and patch. ◆ Sevoflurane was discontinued and the concentration of oxygen was increased to 100% with oxygen flow at 6 L min-1. 23

◆ The LMA was removed under anaesthesia state when spontaneous breath recovered with tidal volume above 5mL kg-1, then the patients were transferred to the PACU for further observation. 24

PAED score 25

Results 26

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Risk factors 30

Clinical perspective ◆ Postoperative application of eye ointment and an eyepatch may cause or exacerbate agitation ◆ Eyepatch application significantly reduced the incidence of emergence delirium 31

Thank you ！ 32