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Postoperative emergence agitation and intraoperative sevoflurane sedation under caudal block in children: a randomized comparison of two sevoflurane doses
Anesth Pain Med 2019;14(4):434-40
Published online October 31, 2019
© 2019 Korean Society of Neuroscience in Anesthesiology and Critical Care.

Eun Kyung Choi1 , Suyong Park1 , Ki-bum Park2 , Kyung Hwa Kwak3 , and Sungsik Park3
Department of Anesthesiology and Pain Medicine, 1Yeungnam University College of Medicine, 2Dongsan Hospital, Keimyung University School of Medicine, 3School of Medicine, Kyungpook National University, Daegu, Korea
Correspondence to: Sungsik Park, M.D., Ph.D. Department of Anesthesiology and Pain Medicine, School of Medicine, Kyungpook National University, 130 Dongdeok-ro, Jung-gu, Daegu 41944, Korea Tel: 82-53-420-5877 Fax: 82-53-426-2760 E-mail:
Received October 12, 2018; Revised December 18, 2018; Accepted December 18, 2018.
cc This is an Open Access article distributed under the terms of the Creative Commons Attribution Non-Commercial License ( which permits unrestricted non-commercial use, distribution, and reproduction in any medium, provided the original work is properly cited.
Background: Sub-umbilical surgery under caudal block in conjunction with sevoflurane sedation may be safe in terms of maintaining spontaneous breathing and avoiding complications associated with general anesthesia. However, sevoflurane-induced emergence agitation (EA) continues to be a clinically important phenomenon in children. To compare the incidence of EA in children undergoing sub-umbilical surgery under caudal block with two different doses of sevoflurane.
Methods: Forty children (aged 1–5 years) scheduled to undergo inguinal hernia repair under caudal block with sevoflurane sedation via a face mask were randomized into either the low-dose (1.0%) end-tidal sevoflurane concentration group (Group LS) or the high-dose (2.5%) end-tidal sevoflurane concentration group (Group HS). We monitored EA episodes at 5 and 30 min in the post-anesthetic care unit (PACU) by using the fourpoint agitation scale and the Pediatric Anesthesia Emergence Delirium (PAED) scale.
Results: The four-point agitation scale scores and PAED scores were not different between the groups at 5 min. However, the agitation score was higher in Group HS than in Group LS at 30 min after arriving in the PACU. The time required to recover from sedation was longer in Group HS than in Group LS.
Conclusions: Face-mask sedation with 1.0% sevoflurane in conjunction with caudal block may be more effective than that with 2.5% sevoflurane in preventing EA.
Key Words : Caudal extradural; Child; Emergence delirium; Sevoflurane.

October 2019, 14 (4)
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