A Randomized Controlled Trial to Determine the Effect of Depth of Anesthesia on Emergence Agitation in XXXX .

@entity1 @entity4094 @entity410 @entity3727 @entity1508 @entity146 @entity2614 @entity933 @entity1363 @entity3575
BACKGROUND: The cause of emergence agitation (EA) in @entity1 is unknown. Rapid emergence from inhaled anesthesia has been implicated because EA is more common with @entity2614 than with @entity1508 . A dose-dependent effect of @entity2614 , which increases @entity410 -like electroencephalogram activity, has also been proposed. METHODS: To determine whether depth of anesthesia as measured by bispectral index (BIS) affects EA, 40 ASA physical status I to II @entity1 aged 2 to 8 years undergoing ophthalmic surgery were enrolled in a blinded randomized controlled trial of low-normal (40-45, deep) versus high-normal (55-60, light) anesthesia. To distinguish transient @entity146 from severe EA, the primary outcome was first-stage postanesthesia care unit (PACU I) peak Pediatric Assessment of Emergence @entity933 (PAED) score, with secondary outcomes of PAED and Face, Legs, Activity, Cry, and Consolability scores at emergence, postoperative @entity3575 dose, emergence time, and discharge time. Subjects received a standard anesthesia protocol with oral @entity1363 followed by mask induction with @entity2614 8%, @entity3575 1 to 1.5  g/kg IV (then as needed), @entity4094 , and endotracheal intubation. Providers titrated expired @entity2614 (in @entity3727 67%) from 0.5% to 3% to maintain BIS range. PAED, Richmond Agitation Sedation Scale, and Face, Legs, Activity, Cry, and Consolability scores were measured at emergence, at PACU I arrival, and during PACU I stay. RESULTS: There was little difference between the groups in the primary outcome, peak PACU I PAED score (light: 7.7    4.6; deep: 8.6    5.3; mean difference, 0.9; 95% confidence interval, 4.1 to -2.3; effect size, 0.18). Discharge times were similar between groups. Treatment for severe EA was rare. CONCLUSIONS: There was no significant effect of BIS-guided deep versus light anesthesia on severe EA.
