Visual preconditioning reduces emergence delirium in children undergoing ophthalmic surgery: a randomised controlled trial.
BACKGROUND
Emergence delirium is a common complication in children, especially in preschool children undergoing ophthalmic surgery. The aim of the study was to investigate the effects of visual preconditioning (application of an eyepatch over the eye to be operated for ≥3 h the day before surgery) on emergence delirium after ophthalmic surgery under sevoflurane anaesthesia.


METHODS
One hundred and seventy-nine children undergoing unilateral cataract surgery, aged 3-7 yr, were involved in this prospective, blinded, randomised study. Subjects were randomised to receive visual preconditioning (Group P, n=89) or to receive programmed explanation the day before surgery (Group C, n=90). The primary outcome was incidence of emergence delirium evaluated by the paediatric anaesthesia emergence delirium (PAED) scale. The secondary outcomes included emergence time and post-anaesthesia care unit (PACU) stay time.


RESULTS
Children in Group P had a significantly lower incidence of emergence delirium than those in Group C [16.9% vs 44.4%, odds ratio (OR) 4.0, 95% confidence interval (CI) 2.0 to 8.0]. The maximal PAED score was lower in Group P than in Group C [4 (0-20) vs 9 (0-20), median difference -3.0, 95% CI -5.0 to -1.0]. Visual preconditioning prolonged emergence time (P<0.001) and PACU stay time (P=0.002).


CONCLUSION
Visual disturbance contributes to emergence delirium in preschool children undergoing ophthalmic surgery with sevoflurane, and prophylactic eyepatch treatment can reduce emergence delirium.


CLINICAL TRIALS REGISTRATION
NCT02590744.
['Lin|Y|Y|', 'Shen|W|W|', 'Liu|Y|Y|', 'Wang|Q|Q|', 'Chen|Q|Q|', 'Fang|Z|Z|', 'Chi|W|W|', 'Gan|X|X|', 'Liu|Y Z|YZ|']
D000762:Anesthesia Recovery Period D000768:Anesthesia, General D018685:Anesthetics, Inhalation D002387:Cataract Extraction D002648:Child D002675:Child, Preschool D000071257:Emergence Delirium D005260:Female D006801:Humans D015994:Incidence D008297:Male D009483:Neuropsychological Tests D013508:Ophthalmologic Surgical Procedures D011300:Preoperative Care D011446:Prospective Studies D000077149:Sevoflurane
emergence delirium anaesthesia recovery period anaesthetics inhalation child lens diseases