The content of dissociative hexafluoroisopropanol metabolized from different concentration of sevoflurane and its association with emergence agitation in school-aged children: a systematic, double-blind, randomized study. for their dedication to supporting perioperative childhood research

Abstract

Abstract Backgroud Unknown at this time is the mechanism underlying restlessness in recovery period. The risk of emergence agitation (EA) referring sevoflurane (SEV) anaesthesia compared with other ordinary anaesthetic is higher in paediatric practices. The hexafluoroisopropanol (HFIP) concentration has been linked to usage of the SEV. HFIP could play a significant role in the formation of EA. To explore the relationship between free HFIP density gradient and the rate of emergence EA which recorded by the Richmond agitation-sedation scale (RASS) in children from anaesthesia. The primary endpoint were score of RASS in relation to dissociative HIFP concentration, and an analysis of the association between the concentration of HIFP and SEV. The secondary outcomes included the extubation indicates, the postoperative vital signs at different time points, the postoperative complication, as well as the Visual Analogue Scale (VAS). Methods In this single-center, double-blind, randomized study, sixty-six school-age children without liver dysfunction were chosen, divided into three groups, with twenty-two patients in each group. Every group had inhaling SEV at a predetermined concentration. Every three milliliter (ml) of the bloods was taken from every 30 minutes(min) intervals after inhalation and inhalation ceased, and delivered it to the lab for analysis. One-stage headspace equilibration was used to determine the real free HFIP and SEV concentrations in the bloods of patients who had undergone inhalation anesthesia. Results The HIFP concentrations showed a trend of increasing and then decreasing comparing the three groups (P < 0.05) together with a rise in the end-expiratory SEV concentrations. And the concentrations of HIFP peaked in Group N2 at all time points. Group N2 also had the highest RASS score at extubation(P < 0.05). However, the concentrations of free-HIFP increased constantly as the inhalation time increased in three groups, and declined following the end of inhalation. But the Group N3 did so more slowly than the other two groups. Conclusions The incidence of emergence agitation was higher with the moderate concentrations of SEV (1.71%) at three concentrations of SEV inhalation anesthesia which produced the higher concentration of free-HIFP in the pediatric patients. The duration of 1.5 hours of the SEV anesthesia had a tendency to raise the blood levels of free-HFIP, and when the concentrations of SEV inhaled reached a point, the free-HFIP productions in children was repressed.