Sevoflurane is used for pediatric
ambulatory surgery due to its low blood solubility, rapid emergence, non-pungency and low airway irritability. Nevertheless, its tendency to induce agitation during emergence may offset its benefits. The following study was designed to evaluate the effects of intravenous (i.v.)
tramadol (1 mg/kg) on the emergence from
sevoflurane anesthesia. Forty ASA I children, ranging from 1 to 8 years old, scheduled for inguinal surgery, were randomized into two groups (Group S--control group, Group ST--i.v.
tramadol, 20 in each group). The patients were first premedicated with oral
atropine (0.01 mg/kg), then
anesthesia was induced with i.v. application of
thiamylal (3-4 mg/kg) and maintained with mask
anesthesia with
sevoflurane. Topical infiltration with 2-3 ml of 1%
lidocaine was applied over skin incision area. I.v.
tramadol (1 mg/kg) was given before the end of operation in Group ST. The
emergence agitation was recorded on a visual analog scale (VAS, 0-10) by a blinded anesthesiologist in the PACU (postoperative
anesthesia care unit), as well as the length of other recovery stages and complications after
anesthesia. The age, weight, gender, and duration of surgery and
anesthesia were similar in the two groups. The
emergence agitation score (6.3 +/- 3.5 vs. 3.2 +/- 2.8, P < 0.05), incidences of agitation (VAS > 5, 55% vs 20%, P < 0.05), and
postoperative pain (65% vs 30%, P < 0.05) were higher for the control group. I.v.
Tramadol (1 mg/kg) before the end of operation reduced
postoperative pain and the incidence and degree of
emergence agitation from
sevoflurane anesthesia in pediatric
ambulatory surgery.