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Adenotonsillektomi ve Tonsillektomi operasyonlarında preemptif analjezinin derlenme deliryumu üzerine etkisi

Yıl 2024, Cilt: 15 Sayı: 1, 84 - 90, 28.03.2024
https://doi.org/10.18663/tjcl.1414090

Öz

Amaç: Derlenme deliryumu etiyolojisi tam olarak bilinmeyen, çoğunlukla küçük çocuklarda görülen, agresif davranışlar, göz teması eksikliği ve çevrenin farkında olmamakla karakterize bir fenomendir. Birçok sebepten kaynaklanabileceği gösterilmiş ancak en çok baş-boyun cerrahisi, inhaler ajanlar ve postoperatif ağrı suçlanmaktadır. Değerlendirmek için bazı skalalar kullanılır. Duyarlılığı en yüksek olan Pediyatrik Anestezi Deliryum Skalası olan "PAED" (Pediatric Anesthesia Delirium Scale)'dir. Preemptif analjezi, ağrı yolaklarının henüz ağrılı uyaran oluşmadan kesilerek engellenmesidir ve postoperatif analjezi için etkinliği birçok çalışma ile doğrulanmıştır. Bu çalışma: preemptif analjezi yöntemi ile azaltılan postoperatif ağrının derlenme deliryumunu azaltacağı hipotez edilerek planlanmıştır.
Gereç ve Yöntemler: Etik kurul onayı alındıktan sonra adenotonsillektomi ve tonsillektomi operasyonu geçirecek, 2-7 yaş arası 96 hasta iki gruba randomize edildi. Analjezikler preemptif gruba indüksiyondan önce, intraoperatif gruba ise operasyonun başlamasından 15 dakika sonra uygulandı. Derlenme ünitesinde derlenme deliryumu PAED skalası ile, ağrı skorları çocuğun yüz ifadesi, bacakların pozisyonu, hareketleri, ağlaması ve avutulabilmesi değerlendirilerek yapılan “FLACC” (Face, Legs, Activity, Cry, Consolability) ağrı değerlendirme skalası ile değerlendirildi. FLACC>7 ağrı ve PAED> 10 derlenme deliryumu kabul edildi.
Bulgular: Preemptif grupta PAED ve FLACC skorları istatistiksel olarak anlamlı düşük bulundu ancak derlenme deliryum gelişme insidansı açısından iki grup arasında sadece 5.dakikada anlamlı fark saptandı (p<0.01). Premptif grubun intraoperatif tüm ölçüm zamanlarında nabız değerleri anlamlı düşük saptandı (p<0.01).
Sonuç: Adenotonsilektomi ve tonsillektomi operasyonu geçiren çocuklarda uygulanan preemptif analjezi, postoperatif ağrı skorlarını ve deliryum skorlarını azaltmış ancak derlenme deliryum gelişme insidansını azaltmamıştır.

Kaynakça

  • Somaini M, Sahillioğlu E, Marzorati C, Lovisari F, Engelhardt T, Ingelmo PM. Emergence delirium, pain or both? A challenge for clinicians. Paediatr Anaesth. 2015 May;25(5):524-529.
  • Somaini M., Astuto M., Lonnqvist P.A. Early negative behavior in the pediatric postoperative anesthesia care unit. Interference between frequently used observational tools. Int. J. Dev. Res. 2016;6: 8473–8477.
  • Locatelli BG, Ingelmo PM, Emre S. et al. Emergence delirium in children: a comparison of sevoflurane and desflurane anesthesia using the Paediatric Anesthesia Emergence Delirium scale. Paediatr Anaesth. 2013 Apr;23(4):301-308.
  • Özaltun F, Ülgen Zengin S, Orhon Ergün et al.Determination of The Relationship Between Postoperative Delirium Development and Analgesia Nociception Index Values in Pediatric Patients. İKSSTD 2022;14(2):113-119.
  • Russell PSS, Mammen PM, Shankar SR. et al. Pediatric Anesthesia Emergence Delirium Scale: A diagnostic meta-analysis. World J Clin Pediatr. 2022 Mar 9;11(2):196-205.
  • Urits I, Peck J, Giacomazzi S. et al. Emergence Delirium in Perioperative Pediatric Care: A Review of Current Evidence and New Directions. Adv Ther. 2020 May;37(5):1897-1909.
  • Nancy Sikich, Jerrold Lerman; Development and Psychometric Evaluation of the Pediatric Anesthesia Emergence Delirium Scale. Anesthesiology 2004;100:1138–1145
  • McQuay HJ. Pre-emptive analgesia. Br J Anaesth. 1992 Jul;69(1):1-3.
  • Bedirli N, Akçabay M, Emik U. Tramadol vs dexmedetomidine for emergence agitation control in pediatric patients undergoing adenotonsillectomy with sevoflurane anesthesia: prospective randomized controlled clinical study. BMC Anesthesiol. 2017 Mar 11;17(1):41.
  • Filiz Alkaya Solmaz, Ali Abbas Yılmaz, Menekşe Hasdoğan, Oya Özatamer, Neslihan Alkış. Comparison of efficiency of preemptive tramadol and paracetamol in postoperative pain therapy in pediatrics undergoing adenotonsillectomy and tonsillectomy. S.D.Ü. Tıp Fak. Derg. 2014:21(1)/11-15
  • Xuan C, Yan W, Wang D. et al. Efficacy of preemptive analgesia treatments for the management of postoperative pain: a network meta-analysis. Br J Anaesth. 2022 Dec;129(6):946-958.
  • Zieliński J, Morawska-Kochman M, Dudek K, Czapla M, Zatoński T. The Effect of Pre-Emptive Analgesia on the Postoperative Pain in Pediatric Otolaryngology: A Randomized, Controlled Trial. J Clin Med. 2022 May 11;11(10):2713.
  • Merkel SI, Voepel-Lewis T, Shayevitz JR, Malviya S. The FLACC: a behavioral scale for scoring postoperative pain in young children. Pediatr Nurs. 1997 May-Jun;23(3):293-297.
  • Yang X, Lin C, Chen S, Huang Y, Cheng Q, Yao Y. Remimazolam for the Prevention of Emergence Delirium in Children Following Tonsillectomy and Adenoidectomy Under Sevoflurane Anesthesia: A Randomized Controlled Study. Drug Des Devel Ther. 2022 Sep 30;16: 3413-3420.
  • Mitchell RB, Archer SM, Ishman SL. et al. Clinical Practice Guideline: Tonsillectomy in Children (Update). Otolaryngol Head Neck Surg. 2019 Feb;160(1_suppl):S1-S42.
  • Turgut Karlıdağ. Tonsillectomy and adenoidectomy: Traditional and new technıques.Turkiye Klinikleri J E.N.T.-Special Topics 2012;5(4):53-62
  • Liu K, Liu C, Ulualp SO. Prevalence of Emergence Delirium in Children Undergoing Tonsillectomy and Adenoidectomy. Anesthesiol Res Pract. 2022 Sep 28;2022:1465999.
  • Driscoll JN, Bender BM, Archilla CA. et al. Comparing incidence of emergence delirium between sevoflurane and desflurane in children following routine otolaryngology procedures. Minerva Anestesiol. 2017 Apr;83(4):383-391.
  • Yu H, Simpao AF, Ruiz VM. et al. Predicting pediatric emergence delirium using data-driven machine learning applied to electronic health record dataset at a quaternary care pediatric hospital. JAMIA Open. 2023 Dec 13;6(4):ooad106.
  • Somaini M, Engelhardt T, Ingelmo P. Emergence from General Anaesthesia: Can We Discriminate between Emergence Delirium and Postoperative Pain? J Pers Med. 2023 Feb 28;13(3):435.
  • Shi M, Miao S, Gu T, Wang D, Zhang H, Liu J. Dexmedetomidine for the prevention of emergence delirium and postoperative behavioral changes in pediatric patients with sevoflurane anesthesia: a double-blind, randomized trial. Drug Des Devel Ther. 2019 Mar 15;13:897-905.
  • Zieliński J., Morawska-Kochman M., Zatoński T. Pain assessment and management in children in the postoperative period: A review of the most commonly used postoperative pain assessment tools, new diagnostic methods and the latest guidelines for postoperative pain therapy in children. Adv. Clin. Exp. Med. 2020;29:365–374.
  • El-Fattah AM, Ramzy E. Pre-emptive triple analgesia protocol for tonsillectomy pain control in children: double-blind, randomised, controlled, clinical trial. J Laryngol Otol. 2013 Apr;127(4):383-391.
  • McHale B, Badenhorst CD, Low C, Blundell D. Do children undergoing bilateral myringotomy with placement of ventilating tubes benefit from pre-operative analgesia? A double-blinded, randomised, placebo-controlled trial. The Journal of Laryngology & Otology. 2018;132(8):685-692.
  • Jørgen B. Dahl, Steen Møiniche, Pre-emptive analgesia, British Medical Bulletin, Volume 71, Issue 1, 2005, Pages 13–27, https://doi.org/10.1093/bmb/ldh030Ingelmo PM, Somaini M, Engelhardt T. Emergence delirium may not just be a recovery room problem. Paediatr Anaesth. 2021 Oct;31(10):1022-1024.
  • Stewart B., Cazzell M.A., Pearcy T. Single-blinded randomized controlled study on use of interactive distraction versus oral midazolam to reduce pediatric preoperative anxiety, emergence delirium, and postanesthesia length of stay. J. PeriAnesth. Nurs. 2019;34:567–575.
  • Ringblom J, Proczkowska M, Korhonen L, Wåhlin I. Experiences of paediatric emergence delirium - from parents' and a child's perspective. Scand J Caring Sci. 2022 Dec;36(4):1104-1112.
  • Purcell M, Longard J, Chorney J, Hong P. Parents' experiences managing their child's complicated postoperative recovery. Int J Pediatr Otorhinolaryngol. 2018 Mar;106:50-54.
  • Balkaya AN, Yılmaz C, Baytar Ç. et al.Relationship between Fasting Times and Emergence Delirium in Children Undergoing Magnetic Resonance Imaging under Sedation. Medicina (Kaunas). 2022 Dec 16;58(12):1861
  • Özdemir S., Dolgun E. The effect of preoperative fasting to postoperative agitation, nausea, and vomiting in children with tonsillectomy: The effect of preoperative fasting. Med. Sci. Discov. 2021;8:394-400.

The effect of preemptive analgesia on emergence delirium in tonsillectomy and adenotonsillectomy operations

Yıl 2024, Cilt: 15 Sayı: 1, 84 - 90, 28.03.2024
https://doi.org/10.18663/tjcl.1414090

Öz

Aim: Emergency delirium (ED) is a phenomenon of unknown etiology, mostly seen in young children, characterised by aggressive behaviour, lack of eye contact and lack of awareness of the environment. It has been shown to have many causes, but head and neck surgery, inhaled agents and post-operative pain are the most common. The most sensitive scale available is the Paediatric Anaesthesia Emergency Delirium (PAED) scale.
Preemptive analgesia is the interruption of pain pathways before the painful stimulus occurs, and its effectiveness in post-operative analgesia has been confirmed by many studies. This study was designed with the hypothesis that post- operative pain reduced by preemptive analgesia would reduce ED.
Material and Methods: After ethics committee approval, 96 patients aged 2-7 years undergoing adenotonsillectomy and tonsillectomy were randomised into two groups. Analgesics were administered to the preemptive group before induction and to the intra-operative group 15 min after the start of operation. In the recovery room, ED was assessed using the PAED scale and pain scores were assessed using the Face, Legs, Activity, Cry, Consolability (FLACC) scales. FLACC>7 was pain and PAED>10 was considered emergence delirium.
Results: PAED and FLACC scores were significantly lower in the preemptive group. There was a significant difference in the incidence of ED between the two groups only at 5 minutes (p<0.01). Heart rate was significantly lower in the preemptive group intraoperatively (p<0.01).
Conclusions: In children undergoing adenotonsillectomy and tonsillectomy, preemptive analgesia reduced postoperative pain scores and delirium scores, but did not reduce the incidence of recovery delirium.

Teşekkür

Dr.Öğr.Üyesi İskender Aksoy'a istatistik konusunda yardımlarından dolayı teşekkür ediyoruz.

Kaynakça

  • Somaini M, Sahillioğlu E, Marzorati C, Lovisari F, Engelhardt T, Ingelmo PM. Emergence delirium, pain or both? A challenge for clinicians. Paediatr Anaesth. 2015 May;25(5):524-529.
  • Somaini M., Astuto M., Lonnqvist P.A. Early negative behavior in the pediatric postoperative anesthesia care unit. Interference between frequently used observational tools. Int. J. Dev. Res. 2016;6: 8473–8477.
  • Locatelli BG, Ingelmo PM, Emre S. et al. Emergence delirium in children: a comparison of sevoflurane and desflurane anesthesia using the Paediatric Anesthesia Emergence Delirium scale. Paediatr Anaesth. 2013 Apr;23(4):301-308.
  • Özaltun F, Ülgen Zengin S, Orhon Ergün et al.Determination of The Relationship Between Postoperative Delirium Development and Analgesia Nociception Index Values in Pediatric Patients. İKSSTD 2022;14(2):113-119.
  • Russell PSS, Mammen PM, Shankar SR. et al. Pediatric Anesthesia Emergence Delirium Scale: A diagnostic meta-analysis. World J Clin Pediatr. 2022 Mar 9;11(2):196-205.
  • Urits I, Peck J, Giacomazzi S. et al. Emergence Delirium in Perioperative Pediatric Care: A Review of Current Evidence and New Directions. Adv Ther. 2020 May;37(5):1897-1909.
  • Nancy Sikich, Jerrold Lerman; Development and Psychometric Evaluation of the Pediatric Anesthesia Emergence Delirium Scale. Anesthesiology 2004;100:1138–1145
  • McQuay HJ. Pre-emptive analgesia. Br J Anaesth. 1992 Jul;69(1):1-3.
  • Bedirli N, Akçabay M, Emik U. Tramadol vs dexmedetomidine for emergence agitation control in pediatric patients undergoing adenotonsillectomy with sevoflurane anesthesia: prospective randomized controlled clinical study. BMC Anesthesiol. 2017 Mar 11;17(1):41.
  • Filiz Alkaya Solmaz, Ali Abbas Yılmaz, Menekşe Hasdoğan, Oya Özatamer, Neslihan Alkış. Comparison of efficiency of preemptive tramadol and paracetamol in postoperative pain therapy in pediatrics undergoing adenotonsillectomy and tonsillectomy. S.D.Ü. Tıp Fak. Derg. 2014:21(1)/11-15
  • Xuan C, Yan W, Wang D. et al. Efficacy of preemptive analgesia treatments for the management of postoperative pain: a network meta-analysis. Br J Anaesth. 2022 Dec;129(6):946-958.
  • Zieliński J, Morawska-Kochman M, Dudek K, Czapla M, Zatoński T. The Effect of Pre-Emptive Analgesia on the Postoperative Pain in Pediatric Otolaryngology: A Randomized, Controlled Trial. J Clin Med. 2022 May 11;11(10):2713.
  • Merkel SI, Voepel-Lewis T, Shayevitz JR, Malviya S. The FLACC: a behavioral scale for scoring postoperative pain in young children. Pediatr Nurs. 1997 May-Jun;23(3):293-297.
  • Yang X, Lin C, Chen S, Huang Y, Cheng Q, Yao Y. Remimazolam for the Prevention of Emergence Delirium in Children Following Tonsillectomy and Adenoidectomy Under Sevoflurane Anesthesia: A Randomized Controlled Study. Drug Des Devel Ther. 2022 Sep 30;16: 3413-3420.
  • Mitchell RB, Archer SM, Ishman SL. et al. Clinical Practice Guideline: Tonsillectomy in Children (Update). Otolaryngol Head Neck Surg. 2019 Feb;160(1_suppl):S1-S42.
  • Turgut Karlıdağ. Tonsillectomy and adenoidectomy: Traditional and new technıques.Turkiye Klinikleri J E.N.T.-Special Topics 2012;5(4):53-62
  • Liu K, Liu C, Ulualp SO. Prevalence of Emergence Delirium in Children Undergoing Tonsillectomy and Adenoidectomy. Anesthesiol Res Pract. 2022 Sep 28;2022:1465999.
  • Driscoll JN, Bender BM, Archilla CA. et al. Comparing incidence of emergence delirium between sevoflurane and desflurane in children following routine otolaryngology procedures. Minerva Anestesiol. 2017 Apr;83(4):383-391.
  • Yu H, Simpao AF, Ruiz VM. et al. Predicting pediatric emergence delirium using data-driven machine learning applied to electronic health record dataset at a quaternary care pediatric hospital. JAMIA Open. 2023 Dec 13;6(4):ooad106.
  • Somaini M, Engelhardt T, Ingelmo P. Emergence from General Anaesthesia: Can We Discriminate between Emergence Delirium and Postoperative Pain? J Pers Med. 2023 Feb 28;13(3):435.
  • Shi M, Miao S, Gu T, Wang D, Zhang H, Liu J. Dexmedetomidine for the prevention of emergence delirium and postoperative behavioral changes in pediatric patients with sevoflurane anesthesia: a double-blind, randomized trial. Drug Des Devel Ther. 2019 Mar 15;13:897-905.
  • Zieliński J., Morawska-Kochman M., Zatoński T. Pain assessment and management in children in the postoperative period: A review of the most commonly used postoperative pain assessment tools, new diagnostic methods and the latest guidelines for postoperative pain therapy in children. Adv. Clin. Exp. Med. 2020;29:365–374.
  • El-Fattah AM, Ramzy E. Pre-emptive triple analgesia protocol for tonsillectomy pain control in children: double-blind, randomised, controlled, clinical trial. J Laryngol Otol. 2013 Apr;127(4):383-391.
  • McHale B, Badenhorst CD, Low C, Blundell D. Do children undergoing bilateral myringotomy with placement of ventilating tubes benefit from pre-operative analgesia? A double-blinded, randomised, placebo-controlled trial. The Journal of Laryngology & Otology. 2018;132(8):685-692.
  • Jørgen B. Dahl, Steen Møiniche, Pre-emptive analgesia, British Medical Bulletin, Volume 71, Issue 1, 2005, Pages 13–27, https://doi.org/10.1093/bmb/ldh030Ingelmo PM, Somaini M, Engelhardt T. Emergence delirium may not just be a recovery room problem. Paediatr Anaesth. 2021 Oct;31(10):1022-1024.
  • Stewart B., Cazzell M.A., Pearcy T. Single-blinded randomized controlled study on use of interactive distraction versus oral midazolam to reduce pediatric preoperative anxiety, emergence delirium, and postanesthesia length of stay. J. PeriAnesth. Nurs. 2019;34:567–575.
  • Ringblom J, Proczkowska M, Korhonen L, Wåhlin I. Experiences of paediatric emergence delirium - from parents' and a child's perspective. Scand J Caring Sci. 2022 Dec;36(4):1104-1112.
  • Purcell M, Longard J, Chorney J, Hong P. Parents' experiences managing their child's complicated postoperative recovery. Int J Pediatr Otorhinolaryngol. 2018 Mar;106:50-54.
  • Balkaya AN, Yılmaz C, Baytar Ç. et al.Relationship between Fasting Times and Emergence Delirium in Children Undergoing Magnetic Resonance Imaging under Sedation. Medicina (Kaunas). 2022 Dec 16;58(12):1861
  • Özdemir S., Dolgun E. The effect of preoperative fasting to postoperative agitation, nausea, and vomiting in children with tonsillectomy: The effect of preoperative fasting. Med. Sci. Discov. 2021;8:394-400.
Toplam 30 adet kaynakça vardır.

Ayrıntılar

Birincil Dil İngilizce
Konular Anesteziyoloji
Bölüm Araştırma Makalesi
Yazarlar

Bilge Olgun Keles 0000-0002-8912-6317

Elvan Tekir Yılmaz 0000-0001-8631-2520

Yayımlanma Tarihi 28 Mart 2024
Gönderilme Tarihi 5 Ocak 2024
Kabul Tarihi 26 Şubat 2024
Yayımlandığı Sayı Yıl 2024 Cilt: 15 Sayı: 1

Kaynak Göster

APA Olgun Keles, B., & Tekir Yılmaz, E. (2024). Adenotonsillektomi ve Tonsillektomi operasyonlarında preemptif analjezinin derlenme deliryumu üzerine etkisi. Turkish Journal of Clinics and Laboratory, 15(1), 84-90. https://doi.org/10.18663/tjcl.1414090
AMA Olgun Keles B, Tekir Yılmaz E. Adenotonsillektomi ve Tonsillektomi operasyonlarında preemptif analjezinin derlenme deliryumu üzerine etkisi. TJCL. Mart 2024;15(1):84-90. doi:10.18663/tjcl.1414090
Chicago Olgun Keles, Bilge, ve Elvan Tekir Yılmaz. “Adenotonsillektomi Ve Tonsillektomi operasyonlarında Preemptif Analjezinin Derlenme Deliryumu üzerine Etkisi”. Turkish Journal of Clinics and Laboratory 15, sy. 1 (Mart 2024): 84-90. https://doi.org/10.18663/tjcl.1414090.
EndNote Olgun Keles B, Tekir Yılmaz E (01 Mart 2024) Adenotonsillektomi ve Tonsillektomi operasyonlarında preemptif analjezinin derlenme deliryumu üzerine etkisi. Turkish Journal of Clinics and Laboratory 15 1 84–90.
IEEE B. Olgun Keles ve E. Tekir Yılmaz, “Adenotonsillektomi ve Tonsillektomi operasyonlarında preemptif analjezinin derlenme deliryumu üzerine etkisi”, TJCL, c. 15, sy. 1, ss. 84–90, 2024, doi: 10.18663/tjcl.1414090.
ISNAD Olgun Keles, Bilge - Tekir Yılmaz, Elvan. “Adenotonsillektomi Ve Tonsillektomi operasyonlarında Preemptif Analjezinin Derlenme Deliryumu üzerine Etkisi”. Turkish Journal of Clinics and Laboratory 15/1 (Mart 2024), 84-90. https://doi.org/10.18663/tjcl.1414090.
JAMA Olgun Keles B, Tekir Yılmaz E. Adenotonsillektomi ve Tonsillektomi operasyonlarında preemptif analjezinin derlenme deliryumu üzerine etkisi. TJCL. 2024;15:84–90.
MLA Olgun Keles, Bilge ve Elvan Tekir Yılmaz. “Adenotonsillektomi Ve Tonsillektomi operasyonlarında Preemptif Analjezinin Derlenme Deliryumu üzerine Etkisi”. Turkish Journal of Clinics and Laboratory, c. 15, sy. 1, 2024, ss. 84-90, doi:10.18663/tjcl.1414090.
Vancouver Olgun Keles B, Tekir Yılmaz E. Adenotonsillektomi ve Tonsillektomi operasyonlarında preemptif analjezinin derlenme deliryumu üzerine etkisi. TJCL. 2024;15(1):84-90.


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