Dental Tribune America

New technique may reduce delirium and agitation following anesthesia

By Dental Tribune International
June 24, 2013

CHICAGO, Ill., USA: A considerable number of young children experience emergence delirium and agitation (EAD) when they wake up from anesthesia after dental surgery. However, Dr. Zakaria Messieha, a professor at the University of Illinois at Chicago, has recently described a technique that could reduce these undesirable effects significantly.

According to Messieha, the incidence of EAD following the administration of sevoflurane, an inhalational anesthetic often used for young patients instead of intravenous injection, is as high as 58 percent, with an increased prevalence in toddlers and preschool children. The condition often increases the risk of injury and decreases parents' satisfaction with the treatment administered.

In the study, Messieha reviewed the literature currently available on the subject and found that Bispectral Index-guided anesthesia combined with propofol, a short-acting drug, could be used to reduce anxious and agitated behavior following anesthesia. With this technique, the anesthesiologist induces and maintains anesthesia with sevoflurane but switches the anesthetic to propofol 30 minutes before the dentist completes the surgery. As describes by Messieha, the effects of the second drug wear off within 15 to 20 minutes. During this time, the child may still be crying but is able to communicate. In addition, the technique is cost-effective and easy to administer.

Messieha has tested the technique in more than 300 procedures already, reporting a significant limitation of EAD in over 90 percent of the cases. However, larger studies are needed to verify its effectiveness.

The study, titled "Prevention of Sevoflurane Delirium and Agitation With Propofol," was published in the summer issue of the Anesthesia Progress journal.

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