RESUMEN
BACKGROUND/PURPOSE: This prospective, randomized, and observer-blinded study was performed to evaluate the effects of oral chloral hydrate on perioperative psychological and behavioral phenomena in children. METHODS: In total, 100 boys (age, 1-5 years) scheduled for day-case unilateral orchiopexy were randomly allocated into 2 groups and orally administered either 40 mg/kg of chloral hydrate (CH group) or placebo (control group) 30 minutes before surgery, followed by assessment of anxiety, induction compliance, emergence delirium, postoperative pain, and maladaptive behavioral changes. RESULTS: Anxiety scores were significantly lower in the CH group compared with the control group (45.7 vs 28.8). The induction compliance of the CH group was better than that of the control group (3.2 vs 4.8). Postoperative sedation was more frequent (62.7% vs 20.4%); however, the incidence of vomiting was lower (2.0% vs 14.3%) in the CH group than in the control group. Postoperative emergence delirium and maladaptive behavior changes were similar between the 2 groups. CONCLUSION: Decreasing preoperative anxiety with oral chloral hydrate improves induction compliance and reduces postoperative pain intensity without delaying recovery in young boys. However, chloral hydrate had little impact on emergence delirium and postoperative maladaptive behavior.
Asunto(s)
Procedimientos Quirúrgicos Ambulatorios , Ansiolíticos/farmacología , Conducta Infantil/efectos de los fármacos , Hidrato de Cloral/farmacología , Hipnóticos y Sedantes/farmacología , Dolor Postoperatorio/prevención & control , Complicaciones Posoperatorias/prevención & control , Anestésicos Generales/efectos adversos , Ansiolíticos/administración & dosificación , Ansiolíticos/efectos adversos , Ansiolíticos/uso terapéutico , Ansiedad/epidemiología , Ansiedad/prevención & control , Preescolar , Hidrato de Cloral/administración & dosificación , Hidrato de Cloral/efectos adversos , Hidrato de Cloral/uso terapéutico , Delirio/inducido químicamente , Delirio/epidemiología , Humanos , Hipnóticos y Sedantes/administración & dosificación , Hipnóticos y Sedantes/efectos adversos , Hipnóticos y Sedantes/uso terapéutico , Lactante , Masculino , Orquidopexia , Dolor Postoperatorio/epidemiología , Cooperación del Paciente , Complicaciones Posoperatorias/epidemiología , Estudios Prospectivos , Agitación Psicomotora/prevención & control , Método Simple CiegoRESUMEN
BACKGROUND: Intraoperative cerebral oxygen desaturation was reported to be associated with postoperative cognitive dysfunction in elderly patients. The effect of the anesthesia method on regional cerebral oxygen saturation (rSO(2)) is still a question under debate. The purpose of this study was to compare the effects of three common anesthesia methods on intraoperative rSO(2) changes in elderly patients. METHODS: In this prospective randomized clinical trial, 87 patients scheduled for elective transurethral prostatectomy were allocated to receive general inhalational anesthesia (GA group, n = 30), spinal anesthesia (SA group, n = 28), or spinal anesthesia plus sedation with midazolam (SA+S group, n = 29). RESULTS: The numbers of patients showing a decrease in rSO(2) below the baseline value were higher in the SA (92.9 %) and SA+S (100 %) groups than in the GA group (33.3 %). The number of patients with a ≥ 50 % decrease in rSO(2) below baseline was greater in the SA+S (31.0 %) group than in the GA (0 %) or SA (3.6 %) group. During surgery, patients subjected to general anesthesia had higher rSO(2) than those with spinal anesthesia. Blood pressures and heart rates were similar in three groups except 5 and 10 min after anesthesia. Intraoperative SpO(2) was higher in the GA group than in the two spinal anesthesia groups. CONCLUSIONS: Spinal anesthesia is associated with more frequent cerebral desaturation than general anesthesia; and it was aggravated when combined with midazolam sedation. The cerebral effects of anesthesia should be considered when managing high-risk elderly patients.