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Postoperative Agitation im Kindesalter

Pediatric emergence agitation

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Zusammenfassung

Hintergrund

Die Genese der postoperativen Agitation im Kindesalter ist bisher nicht eindeutig geklärt. Der Zusammenhang zwischen der Inzidenz und dem operativem Eingriff, dem Alter des Patienten und dem verwendeten Anästhesieregime ist in der Literatur beschrieben.

Ziel der Arbeit

Im Rahmen dieser Umfrage zwischen Februar und April 2014 sollten Daten von erfahrenen Kinderanästhesisten hinsichtlich der üblichen Praxis von Dokumentation, Prämedikation, Narkoseführung und postoperativem Umgang bei pädiatrischen Patienten mit postoperativer Agitation erhoben werden.

Material und Methode

Es wurde ein Onlinefragebogen mit 33 Fragen entwickelt, der über den E-Mail-Verteiler des Wissenschaftlichen Arbeitskreises Kinderanästhesie der Deutschen Gesellschaft für Anästhesiologie und Intensivmedizin e. V. (DGAI) an alle 525 Mitglieder versendet wurde.

Ergebnisse

Den Fragebogen beantworteten 156 Mitglieder. Es waren 143 Fragebogen auswertbar (27 %). Von den Befragten wiesen 77 % eine über 6-jährige Berufserfahrung in der Kinderanästhesie auf, und 87  % der befragten Anästhesisten sahen die postoperative Agitation als relevantes klinisches Problem an. Die Inzidenz der postoperativen Agitation bei ihrem Patientenkollektiv gaben 56 % mit 1–10 % an, 20 % der Befragten sogar mit 11–20 %. Die schriftliche Dokumentation der postoperativen Agitation anhand von Scores fand nur bei 11 % der Befragten statt. Zur Prämedikation wird mit 89 % überwiegend Midazolam verwendet. Als präventive Maßnahme der 1. Wahl geben 56 % der Antwortenden die Durchführung einer totalen intravenösen Anästhesie (TIVA) an, während 30 % der Befragten die intraoperative Clonidingabe nennen. Zur medikamentösen Therapie der postoperativen Agitation im Aufwachraum verwenden 56 % der Anästhesisten Propofol und 26 % Clonidin. Die postoperative Anwesenheit der Eltern wurde von 82 % der befragten Anästhesisten befürwortet.

Schlussfolgerung

Die postoperative Agitation wird auch von Experten als klinisch relevantes Problem angesehen. Propofol hat den höchsten Stellenwert hinsichtlich Prävention und Therapie bei der postoperativen Agitation. Die postoperative Anwesenheit der Eltern wird von der Mehrzahl der befragten Anästhesisten befürwortet.

Abstract

Background

The origin of emergence agitation in children remains unclear; however, an association between surgical procedure, patient age and anesthetic regimen and the incidence of postoperative agitation has been described in the literature.

Aim

The aim of this survey performed between February and April 2014 was to collect data from the daily clinical practice by experienced pediatric anesthesiologists regarding documentation, premedication, anesthesia regimen and postoperative treatment with respect to children with emergence agitation.

Material and methods

An online questionnaire with 33 items was developed and sent to all 525 members of the scientific committee of pediatric anesthesia (WAKKA) of the German Society of Anesthesiology and Intensive Care (DGAI). Members were asked to respond within a time period of 1 month but no reminders were sent out via email or telephone.

Results

A total of 156 members participated in the survey and of these 143 questionnaires were fully completed and included in the final evaluation (27 %). Of the participants 77 % had more than 6 years professional experience in the field of pediatric anesthesia and for 87 % emergence agitation remains a relevant clinical problem. The estimated incidence of emergence agitation was given as 1–10 % and as high as 11–20 % by 56% and 20 % of the participants, respectively. The incidence of postoperative agitation is documented by only 11 % of the participants with a validated score, such as the pediatric anesthesia emergence delirium (PEAD) scale and 89 % of the participants use midazolam for premedication. As a preemptive intervention total intravenous anesthesia is performed by 56 % whereas clonidine is used as first line prevention by 30 %. Postoperative pharmacological treatment is performed by a bolus administration of propofol (56 %) and clonidine (26 %). Postoperative parental presence was considered beneficial by 82 %.

Conclusion

Emergence agitation is still seen as a relevant clinical problem by experienced pediatric anesthesiologists. Propofol is first choice when it comes to pharmacological prevention and treatment of emergence agitation. Postoperative parental presence was considered beneficial by the majority of anesthesiologists.

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Authors and Affiliations

  1. Klinik und Poliklinik für Anästhesiologie und Operative Intensivmedizin, Universitätsklinikum Bonn, Sigmund-Freud-Str. 25, 53105, Bonn, Deutschland

    V. Lehmann, C. Bode &  R. K. Ellerkmann DESA

  2. Klinik für Anästhesie, perioperative Medizin und Schmerztherapie, Helios Klinikum Berlin-Buch, Berlin, Deutschland

    J. Giest

  3. Klinik für Anaesthesiologie, Universität München, München, Deutschland

    J. Wermelt

  4. Anästhesie und Intensivmedizin, Cnopfʼsche Kinderklinik/Klinik Hallerwiese, Nürnberg, Deutschland

    K. Becke

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  1. V. Lehmann
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Correspondence to R. K. Ellerkmann DESA.

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Interessenkonflikt

V. Lehmann, J. Giest, J. Wermelt, C. Bode, K. Becke und R. K. Ellerkmann geben an, dass kein Interessenkonflikt besteht.

Ein Ethikantrag für die Durchführung dieser Onlineumfrage wurde nicht gestellt.

Dieser Beitrag beinhaltet keine Studien an Menschen oder Tieren.

Anhang

Anhang

Der in der Umfrage verwendete Fragebogen ist in Abb. 3 dargestellt.

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Lehmann, V., Giest, J., Wermelt, J. et al. Postoperative Agitation im Kindesalter. Anaesthesist 64, 373–380 (2015). https://doi.org/10.1007/s00101-015-0026-6

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