EFFECTS OF PROPOFOL ON THE LEVEL OF POSTOPERATIVE BEHAVIORAL CHANGES IN CHILDREN WHO UNDERWENT CATARACT SURGERY

Abstract

Introduction: The appearance of agitation and behavioral changes in children after sevoflurane anesthesia is common, especially in short-term interventions such as ophthalmic operations. Usage of sub-hypnotic doses of propofol before termination of sevoflurane has been reported that may provide effective sedation and reduce the incidence of severe agitation. The aim of this study was to determine if switching from sevoflurane to propofol (in subhypnotic doses) before the ending of surgery reduces the incidence of agitation-delirium in children after cataract surgery. Material and methods: 60 children aged 3-7 years, with ASA (American Society of Anesthesiologists physical status) I/II, undergoing cataract surgery were randomly divided into two groups. Group P (n=30) included children in whom 3-5 minutes before the ending the surgery sevoflurane was terminated and propofol 25μg/kg/h was started. The control group (n=30) were patients in whom sevoflurane anesthesia was maintained till the end of the surgery. In all children we evaluated the time of un-operated eye opening (on verbal command), the children’s behavior changes and pain. Behavior was assessed with the help of five degree Watch scale (score 1(awake), 2, 3,and 4 (agitation). The degree of pain was followed by visual analogue scale (VAS scale) during the first hour at 30 minutes period. We additionally recorded the need for additional interventions (additional midazolam) during this time. Results: Agitation occurred in significantly larger number of children in group S compared to group P. Percentage differences for the scores of the ED were significant between the groups for score 4 and score 1. Pain evaluation didn’t show any difference between the groups. In group S, 60% of the children had need for giving additional midazolam. Conclusion: Giving subanesthetic propofol doses 3-5 minutes before the ending of the surgery effectively reduces occurrence of agitation in children after cataract surgery.