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

30th annual meeting

2

Zhongshan Ophthalmic Center

3

Zhongshan Ophthalmic Center

4

◆>70,000 surgeries per year ◆>14,000 cases under GA per year

• Nature. 2015;519(7543):276-8.

Emergence delirium

◆A cluster of postoperative disturbing behaviors

• ccurring in the early period
• f postanesthetic recovery

◆Characterized by a variety

• f 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

6

Eur J Anaesthesiol 2011; 28:640-645 Anaesthesia 2015, 70:393-399

Risk factors of ED

◆Preschool children; ◆Male; ◆Preoperative anxiety; ◆Sevoflurane or desflurane anesthesia; ◆Eye, ear, nose and throat surgery

7Curr Opin Anesthesiol 2014, 27:309–315

ED in ophthalmic surgery

◆High incidences in ophthalmic surgery

8

Anesthesiology 2014; 120:1354-61 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

11

J Anesth (2016) 30:261–267

Nonpharmacologic prevention

◆Parental presence ◆Anxiety-reduction ◆Distraction ◆Video modeling and education ◆Coaching ◆Exposure/shaping

12

J Anesth (2016) 30:261–267 Eur J Anaesthesiol 2017; 34:169–175 Pediatric Anesthesia 26 (2016) 207–212

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

• btained

◆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) ◆PETCO2 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

• xygen 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

• bservation.

24

PAED score

25

Results

26

27

28

29

Risk factors

30

Clinical perspective

31

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

32

Thank you！