The Effect of Obesity on Emergence Agitation in Children Undergoing General Anesthesia

Year 2022, Volume: 10 Issue: 3, 113 - 117, 31.12.2022

Mehmet Sargın , Emine Aslanlar , Fatma Sargın

https://doi.org/10.21765/pprjournal.1222510

Abstract

Objective: Although the factors affecting emergence agitation (EA) have been examined in the literature, the literature evaluating the effect of obesity on postoperative EA in children is limited. In this study, we aimed to evaluate whether obesity has an effect on postoperative EA.
Material and method: The medical records of patients aged 2-14 years, with ASA I-II physical status and undergoing elective surgery were reviewed (November 2018 and November 2022). Patients who underwent emergency surgery or who used an anesthetic agent other than sevoflurane for the maintenance of anesthesia were excluded from the study. Patients will be divided into 3 groups according to their body mass index; Group 1; Normal (5th to 85% percentile), Group 2; Overweight (85-95% percentile), Group 3; Obese (95th percentile and above). Emergence agitation was assessed by anesthesiologists using the Watcha scale.
Results: 567 patients were included in the study and EA occurred in 115 (20.3%) of them. Of the patients, 428 were considered normal, 64 were overweight and 75 were obese. When demographic data were compared, there was no statistical difference between the groups. EA incidence was statistically higher in Group II (28.1%) and Group III (29.3%)compared to Group I (17.5%) (p=0.006).
Conclusion: In conclusion, we are of the opinion that both overweight and obesity increase the incidence of EA in children undergoing general anesthesia, but prospective further studies are also required.

Keywords

Emergence agitation, general anesthesia, pediatric, Derlenme ajitasyonu, genel anestezi, pediatrik

Çocuklarda Obezitenin Postoperatif Derlenme Ajitasyonuna Etkisi

Abstract

Amaç: Literatürde derlenme ajitasyonuna etki eden faktörler incelenmiş olmakla beraber çocuklarda obezitenin postoperatif derlenme ajitasyonuna etkisinin değerlendirildiği literatür bilgisi kısıtlıdır. Bu çalışmada obezitenin postoperatif derlenme ajitasyonuna etkisinin olup olmadığını değerlendirmeyi amaçladık.
Gereç ve Yöntem: 2-14 yaş arasında, ASA I-II fiziksel statusa sahip, Kasım 2018 ve Kasım 2022 tarihleri arasında elektif cerrahi geçiren hastaların kayıtları incelendi. Acil cerrahi geçiren veya anestezi idamesinde sevofluran dışında bir anestezik ajan kullanılan hastalar çalışma dışında bırakıldı. Hastalar vücut kitle indekslerine göre 3 gruba ayrıldı: Grup 1; Normal (%5 ila %85 persentil ), Grup 2; Fazla kilolu (%85-95 persentil ), Grup 3; Obez (95. persentil ve üzeri). Derlenme ajitasyonu bir anestezist tarafından Watcha skalası ile değerlendirildi.
Bulgular: Çalışmaya 567 hasta dahil oldu ve bunların 115'inde (%20.3) derlenme ajitasyonu meydana geldi. Hastaların 428'i normal, 64'ü fazla kilolu ve 75'i obez olarak değerlendirildi. Demografik veriler karşılaştırıldığında gruplar arasında istatistiksel oalrak herhangi bir fark yoktu. Derlenme ajitasyonu insidansı Grup II (%28,1) ve Grup III'te (%29,3) Grup I'e (%17.5) göre istatistiksel olarak daha yüksekti (p=0,006).
Sonuç: Sonuç olarak, genel anestezi uygulanan çocuklarda hem fazla kilolu olmanın hem de obezitenin derlenme ajitasyonu insidansını arttırdığı görülmüştür ancak prospektif çalışmalara da ihtiyaç vardır.

Keywords

Derlenme ajitasyonu, genel anestezi, pediatrik

References

• 1. Barriuso L, Miqueleiz E, Albaladejo R, Villanueva R, Santos JM, Regidor E. Socioeconomic position and childhood-adolescent weight status in rich countries: a systematic review, 1990-2013. BMC Pediatr. 2015;15:129.
• 2. Ng M, Fleming T, Robinson M, et al. Global, regional, and national prevalence of overweight and obesity in children and adults during 1980-2013: a systematic analysis for the Global Burden of Disease Study 2013. Lancet. 2014;384(9945):766-781.
• 3. WHO. Obesity and overweight. http://www.who.int/en/news-room/fact-sheets/ detail/obesity-and-overweight; 2018, Accessed date: 26 August 2018.
• 4. Sonntag D, Ali S, Lehnert T, Konnopka A, Riedel-Heller S, König HH. Estimating the lifetime cost of childhood obesity in Germany: Results of a Markov Model. Pediatr Obes. 2015;10(6):416-422.
• 5. Owen J, John R. Childhood obesity and the anaesthetist. Cont Educ Anaesth Crit Care Pain 2012; 12: 169e75 6. Tait AR, Voepel-Lewis T, Burke C, Kostrzewa A, Lewis I. Incidence and risk factors for perioperative adverse respiratory events in children who are obese. Anesthesiology. 2008;108(3):375-380.
• 7. Sinha R, Fisch G, Teague B, et al. Prevalence of impaired glucose tolerance among children and adolescents with marked obesity. N Engl J Med. 2002;346(11):802-810.
• 8. Edem P, Uzum O, Ince T, Arslan N, Gunay T, Aydın A. What are the important risk factors for the obesity in the children three to six years of age: A cross-sectional study. İzmir Dr. Behçet Uz Çocuk Hast. Dergisi. 2018;8(2):87-94.
• 9. Sari E, Yildiz FM, Inalhan M, Sari I, Sezer RG. The prevalence of insulin resistance and metabolic sendrome in obese and overweight children. ZEYNEP KAMİL TIP BÜLTENİ. 2012; 43 (3):114-119.
• 10. Onder A, Kavurma C, Celmeli G, Surer Adanir A, Ozatalay E. Assessment of psychopathology, quality of life and parental behaviours of children and adolescents with obesity. İzmir Dr. Behçet Uz Çocuk Hast. Dergisi. 2018;8(1):51-58.
• 11. Ulutas AP, Atla P, Say ZA, Sarı E. Investigation of the Factors Affecting the Formation of 6-18 Years School-Age Children Obesity. ZEYNEP KAMİL TIP BÜLTENİ. 2014; 45 (4):192-196.
• 12. Lloret-Linares C, Lopes A, Declèves X, et al. Challenges in the optimisation of post-operative pain management with opioids in obese patients: a literature review. Obes Surg. 2013;23(9):1458-1475.
• 13. Cravero J, Surgenor S, Whalen K. Emergence agitation in paediatric patients after sevoflurane anaesthesia and no surgery: a comparison with halothane. Paediatr Anaesth. 2000;10(4):419-424.
• 14. Sikich N, Lerman J. Development and psychometric evaluation of the pediatric anesthesia emergence delirium scale. Anesthesiology. 2004;100(5):1138-1145.
• 15. Dahmani S, Mantz J, Veyckemans F. Case scenario: severe emergence agitation after myringotomy in a 3-yr-old child. Anesthesiology. 2012;117(2):399-406.
• 16. Costi D, Cyna AM, Ahmed S, et al. Effects of sevoflurane versus other general anaesthesia on emergence agitation in children. Cochrane Database Syst Rev. 2014;(9):CD007084.
• 17. Kuratani N, Oi Y. Greater incidence of emergence agitation in children after sevoflurane anesthesia as compared with halothane: a meta-analysis of randomized controlled trials. Anesthesiology. 2008;109(2):225-232.
• 18. Merkel SI, Voepel-Lewis T, Shayevitz JR, Malviya S. The FLACC: a behavioral scale for scoring postoperative pain in young children. Pediatr Nurs. 1997;23(3):293-297.
• 19. Redline S, Tishler PV, Schluchter M, Aylor J, Clark K, Graham G. Risk factors for sleep-disordered breathing in children. Associations with obesity, race, and respiratory problems. Am J Respir Crit Care Med. 1999;159(5 Pt 1):1527-1532.
• 20. Wills M. Orthopedic complications of childhood obesity. Pediatr Phys Ther 2004; 16: 230–235.
• 21. El-Metainy S, Ghoneim T, Aridae E, Abdel Wahab M. Incidence of perioperative adverse events in obese children undergoing elective general surgery. Br J Anaesth. 2011;106(3):359-363.
• 22. Tait AR, Voepel-Lewis T, Burke C, Kostrzewa A, Lewis I. Incidence and risk factors for perioperative adverse respiratory events in children who are obese. Anesthesiology. 2008;108(3):375-380.
• 23. Scherrer PD, Mallory MD, Cravero JP, et al. The impact of obesity on pediatric procedural sedation-related outcomes: results from the Pediatric Sedation Research Consortium. Paediatr Anaesth. 2015;25(7):689-697.
• 24. Walia H, Balaban O, Jacklen M, Tumin D, Raman V, Tobias JD. Pilot study comparing post-anesthesia care unit length of stay in moderately and severely obese children. J Anesth. 2017;31(4):510-516.
• 25. Viitanen H, Annila P, Viitanen M, Yli-Hankala A. Midazolam premedication delays recovery from propofol-induced sevoflurane anesthesia in children 1-3 yr. Can J Anaesth. 1999;46(8):766-771.
• 26. van Hoff SL, O'Neill ES, Cohen LC, Collins BA. Does a prophylactic dose of propofol reduce emergence agitation in children receiving anesthesia? A systematic review and meta-analysis. Paediatr Anaesth. 2015;25(7):668-676.
• 27. Kim N, Park JH, Lee JS, Choi T, Kim MS. Effects of intravenous fentanyl around the end of surgery on emergence agitation in children: Systematic review and meta-analysis. Paediatr Anaesth. 2017;27(9):885-892.
• 28. Kunigo T, Nawa Y, Yoshikawa Y, Yamakage M. Tracheal extubation of anesthetized pediatric patients with heart disease decreases the incidence of emergence agitation: A retrospective study. Ann Card Anaesth. 2020;23(4):433-438.
• 29. Wu YM, Su YH, Huang SY, et al. Recovery Profiles of Sevoflurane and Desflurane with or without M-Entropy Guidance in Obese Patients: A Randomized Controlled Trial. J Clin Med. 2021;11(1):162.
• 30. Fields A, Huang J, Schroeder D, Sprung J, Weingarten T. Agitation in adults in the post-anaesthesia care unit after general anaesthesia. Br J Anaesth. 2018;121(5):1052-1058.