Emergence agitation in paediatric day case surgery: A randomised, single-blinded study comparing narcotrend and heart rate variability with standard monitoring.

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• Study type: Randomised single-blinded study in paediatric patients (1–6 year-olds; ASA 1-2) undergoing minor general surgery.
• Methods: Evaluated emergence agitation using the RASS 15-minutely in three groups:
  • Intraoperative use of standard monitoring (STD)
  • Intraoperative use of standard monitoring + Mdoloris Anaesthesia Nociception Index (ANI)
  • Intraoperative use of standard monitoring + Narcotrend EEG (NCT)

Interestingly, cases where supraglottic airways and bag-mask ventilation were used were included whereas cases where endotracheal tubes (ETTs) were used were excluded. By the same token, cases under total intravenous anaesthesia (TIVA) were also excluded.

• Findings:
  • During the entire PACU stay, a total of 49% of patients developed agitation
    • 48% STD group
    • 30% ANI group
    • 65% NCT group
  • A significant statistical difference was discovered between ANI and NCT groups with ANI outperforming NCT. However, paired evaluations comparing STD with the two interventions did not demonstrate statistical differences. The ANI group received higher doses of fentanyl.

Take Home Message / Commentary

Interesting and relevant study where the null hypothesis was unsuccessfully rejected (when comparing additional monitoring with STD). The higher dosing of fentanyl and lower RASS in ANI may be a small signal to indicate relative underdosing of opioids in this demographic. Nil explanation for exclusion of ETTs and TIVA.

Reviewed by Dr Philip Cheung