EVALUATION OF THE EMERGENCE AGITATION INCIDENCE IN CHILDREN WHO UNDERWENT DEEP SEDATION FOR TOOTH EXTRACTION.

Purpose: Emergence agitation (EA) is a condition where factors associated with patient, surgery and anesthesia play role in occurrence, and that may occur in any age groups–particularly well-defined in children and delay discharge. Emergence agitation has been investigated for medical interventions under general anesthesia in children, but not for dental treatment under deep sedation. The objective of this study was to investigate the incidence of EA in pediatric cases scheduled for tooth extraction under deep sedation and its relationship with drugs for sedation. Materials and Methods: 120 cases, less than 12 years old and in ASA I-II group according to “American Society of Anaesthesiologists (ASA)” risk classification were scheduled for elective tooth extraction under deep sedation without premedication. The patients were admitted in operating room just according to our anesthesia protocol. With the aim of achieving Richmond Agitation Sedation Scale (RASS)=(-4), In Group K who allowed IV (Intravenous) canulla insertion: 2-3 mg.kg-1 IV Ketamine was administrated. In Group KM who also allowed IV cannula insertion: 0.5 mg of Midazolam was added to 2-3 mg.kg-1 IV Ketamine. In Group S: 8% Sevofluranein 50% O2/N2O through face mask (connected to a Mapleson C circuit) was administrated to the Group S who did not allow inserting IV canulla. Detecting the RASS as -4 local infiltration anaesthesia was applied for the extraction of associated teeth. Following the procedure recovery was evaluated at T0, than 15 min. later (T15), 30 min. later (T30), 45 min later (T45), 60 min later (T60) with RASS. Results: The RASS values at T0 were statistically significantly higher in Group K than those of other groups. No significant differences were found between groups for RASS mean at T15 RASS values at T30, T45, T60 minutes were statistically significantly lower in Group S than Group K and Group KM. Conclusions: We concluded that use of ketamine alone or in combination with low dose of midazolam for short-time surgical procedures did not cause agitation compared to sevoflurane, increased quick recovery and child-parent satisfaction and efficiency of operating room.