الفهرس 
INTRODUCTIONOnly 14 pages are availabe for public view
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Abstract
Inhalation general anaesthesia is frequently required in children undergoing surgical or diagnostic procedures. Sevoflurane has gained widespread acceptance in paediatric anaesthesia because of rapidity of induction and emergence from anaesthesia, hemodynamic stability and minor airway side effects. In spite of the clear usefulness of sevoflurane, increased incidence of emergence agitation or delirium has been documented following sevoflurane anaesthesia.
Several medications have been used in an attempt to decrease the incidence and severity of emergence agitation.
Propofol is a short acting sedative and hypnotic that produce dose dependent depression of cerebral cortex, ascending reticular activating system and medullary centre resulting in sedation, hypnosis, amnesia, anaesthesia, respiratory depression.
Fentanyl is a potent opioid agonist whose principal actions of therapeutic value are analgesia and sedation.
The current study aimed at studying the effectiveness of preventing sevoflurane induced emergence agitation in paediatrics undergoing adenotonsillectomy by using small dose of propofol or fentanyl administered just before discontinuation of anaesthesia.
This study was carried out in Alexandria University Hospital, on 105 pediatric patients with ASA physical status I-II. The patients were divided into three groups of 35 patients each, scheduled for adenotonsillectomy surgery under general anaesthesia with sevoflurane as the sole inhalation agent in induction and maintenance. Patients were randomly allocated into the three equal groups using the closed envelope technique.
After a written informed consent from parents and preoperative evaluation, each patient was attached to a standard multi-channel monitor upon arrival to operation room then induction of general anaesthesia using sevoflurane in 100% oxygen then application of ETT appropriate for age and weight. Just before discontinuation of anaesthesia patients randomly received saline, propofol or fentanyl. Sevoflurane administration was discontinued immediately after the study drug injection , the fresh gas flow was increased to 8L/min oxygen.
The following data were measured :age , weight , sex , vital signs , duration of anaesthesia in minutes , duration of surgery in minutes , duration of emergence in minutes , agitation according to the 5 step score , Aono’s and PAED emergence score , time to discharge from recovery unit in minutes.
The result of the present study showed that:
• No signicant difference as regards demograph data, vital signs, duration of anaesthesia and duration of surgery.
• As regards the emergence time there was highly significant difference between the 3 groups (p= < 0.001) where the shortest mean time was in S group and longest mean time in F group followed by P group .
• As regards the emergence agitation scores there was significant difference between the 3 groups in 5,10,15, 20,25 postoperative minutes but there was no significant difference at 30 minutes where more agitated patients in S group( 14 cases) while in F group (3cases) and in Pgroup (7 cases).