الفهرس 
Physiological changes in pediatricsOnly 14 pages are availabe for public view
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Abstract
Emergence agitation is a clinical condition in which children experience a variety of behavioral disturbances, including crying, sobbing, thrashing, and disorientation, during early emergence from anesthesia. Although emergence agitation is not a new phenomenon in clinical practice, it is of growing interest because its incidence appears to be increasing with the widespread use of sevoflurane. It is defined as ”a disturbance in a child’s awareness of and attention to his/her environment with disorientation and perceptual alterations, including hypersensitivity to stimuli and hyperactive motor behavior in the immediate post-anesthesia period.” There is no definitive explanation for emergence agitation. Many different causes have been suggested, such as the child’s personality specially anxious personality, intense preoperative anxiety, both in children and their parents, stressful induction, rapid return of consciousness in an unfamiliar environment, the type of surgery and the duration of anesthesia, the presence of pain (wounds, sore throat, bladder distension, etc.), airway obstructions, a noisy environment, anesthetic premedication and the anesthetic technique used.
Many studies have used different measurement scales as PAED scale, Riker Sedation-Agitation Scale (SAS), Modified pain/discomfort scale, Co-operation on Induction Scale, and Hannallah et al.’s Objective Pain Scale (OPS), making it difficult to compare studies in terms of incidence rates, risk factors and techniques for the control and prevention of postoperative agitation.
Certain measures are recommendable in order to avoid or minimize the occurrence of postoperative agitation:
• Management of preoperative anxiety include some playful activities, clown doctors, parental presence at induction, children preparation book, and some medications as midazolam and melatonin.
• Induction of anesthesia using sevoflurane, desflurane or ketamine has a greater incidence of emergence agitation, while using propofol, dexmedetomidine or clonidine at induction reduces it.
• There are many scales to assess pain…and so the management of postoperative pain has an important role in reducing emergence agitation…fentanyl low dose, nalbuphine, NSAIDs, caudal anesthesia or other nerve block techniques are the most used….