Emergence Delirium in Pediatric Age Group: Comparison between Sevoflurane and Intravenous Anesthesia in Hypospadias Repair: A Randomized Clinical Trial | ||||
| Ain Shams Medical Journal | ||||
| Volume 76, Issue 2, June 2025, Page 311-320 PDF (442.06 K) | ||||
| Document Type: Original Article | ||||
| DOI: 10.21608/asmj.2025.332734.1332 | ||||
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| Authors | ||||
Amany Nagah Fekry; Mona Sobhy Emara; Ramy Mousa Saleh 
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| Anesthesia and Surgical ICU Department, Faculty of Medicine, Benha University, Benha, Egypt | ||||
| Abstract | ||||
| Background: Emergence delirium (ED), also known as emergence agitation (EA), is a phenomenon that occurs during the post-anesthesia recovery phase. A dissociative state of consciousness is its defining feature, which induces behavioral disturbances. Aim of the Work: Our aim was to compare sevoflurane and intravenous anesthesia during hypospadias repair with regard to the severity and incidence of ED in children. Methods: We conducted this parallel, double-anonymized, randomized trial on 90 pediatric cases with American Society of Anesthesiologists I and II (ASA physical status I and II) aged 1 to 8 years who underwent hypospadias repair. The children were randomly allocated into two equivalent groups: group S (sevoflurane) and group P (propofol). All patients were sedated 30 minutes preoperatively by intranasal dexmedetomidine 1 ug/kg. Inhalational induction was started in all patients. Group S was maintained under sevoflurane anesthesia ( 2 MAC), and group P was maintained under continuous infusion of 100-400 mcg/kg/min propofol and 0.1 ug/kg/min fentanyl with an oxygen-to-air ratio of 1:1in both groups. Evaluation of the recovery characteristics, such as the duration between the cessation of anesthesia and the removal of the laryngeal mask (LMA), FLACC, PACU discharge, adverse effects, and parental satisfaction, constituted the secondary outcomes. Results: Group S (71.11%) had a greater incidence of ED (PAED maximal ≥ 10) than group P (35.56%) (P = 0.001). In comparison to group P, group S exhibited higher maximal PAED and FLACC scores (P= 0.016 and < 0.001, respectively). In relation to the recovery outcome, group P exhibited extended durations until LMA removal, PACU stay, and eye opening in comparison to group S (P<0.001, <0.001, <0.001, respectively). Group P had significantly greater parental satisfaction than group S (P=0.021). Conclusions: In this patient population, anesthesia maintained using total intravenous anesthesia utilizing propofol–fentanyl reduced ED incidence in comparison to sevoflurane. | ||||
| Keywords | ||||
| Emergence delirium; hypospadias repair; intravenous anesthesia; pediatric; propofol; sevoflurane | ||||
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