This study investigated whether intraoperative infusion of magnesium sulphate reduces the incidence of emergence agitation (EA) in paediatric patients who undergo ambulatory ophthalmic surgery using the Paediatric Anaesthesia Emergence Delirium (PAED) scale. Ninety-two paediatric patients who were scheduled for elective ophthalmic surgery were randomly allocated to two groups: control or magnesium. In the magnesium group, patients received an initial intravenous loading dose of 30 mg/kg of 10% solution of magnesium sulphate over 10 min and then a continuous infusion of 10 mg/kg×h during the surgery. In the control group, an equal volume of 0.9% isotonic saline was administered in the same way as in the magnesium group. The PAED scale was assessed at 15-min intervals until the PAED score reached below 10 at the postanaesthetic care unit. EA was defined as a PAED score of 10 or higher. Of the 86 patients recruited, 44 and 42 were allocated to the control and magnesium groups, respectively. The incidence of EA was 77.3% in the control group and 57.1% in the magnesium group (odds ratio, 0.392; 95% confidence interval, 0.154 to 0.997; p = 0.046). The intraoperative infusion of magnesium sulphate significantly reduced the incidence of EA.

Background/Objectives: Emergence delirium (ED) is one of the most frequent postoperative complications in pediatric patients after general anesthesia. In adults, a deeper intraoperative level of anesthesia has been reported as an independent predictor of postoperative delirium. However, the effect of anesthetic depth on ED has rarely been demonstrated in the pediatric population. We evaluated whether the depth of general anesthesia could affect the occurrence of emergence delirium (ED). Methods: Patients aged 3–5 years, scheduled for strabismus surgery were enrolled in this prospective observational study. Intraoperative bispectral index (BIS) was monitored, and the pediatric anesthesia emergence delirium (PAED) scale was evaluated. When the PAED scale was 10 or more, it was designated as an ED case. Results: According to the intraoperative mean BIS range, enrolled patients were divided into two groups: the low BIS (BIS < 40; n = 28) and the normal BIS (BIS 40–60; n = 34) group. The incidence of ED was comparable between the two groups (67.6% vs. 67.9%, odds ratio = 0.99, 95% CI = 0.34–2.89, p = 0.986). Conclusions: The intraoperative anesthetic depth did not seem to affect the occurrence of ED in pediatric patients undergoing strabismus surgery under general anesthesia. Future studies with a larger sample size are necessary for more authentic results.

Background/Objectives: Strabismus surgery in pediatric patients is associated with a high incidence of postoperative nausea and vomiting (PONV). Patients showing pain are more prone to develop PONV. As the infratrochlear nerve (ITN) block can ameliorate perioperative pain following strabismus surgery, we hypothesized that ITN block may influence PONV in pediatric patients undergoing strabismus surgery. Methods: The medical charts of pediatric patients older than 2 years with exotropia who underwent strabismus surgery under general anesthesia, with or without ITN block, were reviewed retrospectively. The incidence of PONV, intraoperative surgical pleth index (SPI), state entropy (SE), response entropy (RE), the changes in hemodynamics, and perioperative use of metoclopramide and ketoprofen were investigated. Results: The study population comprised 116 patients (58 for the No-block group vs. 58 for the ITN group). The incidence of PONV was significantly lower in the ITN block group compared to the No-block group (5.2% vs. 22.4%, respectively; p = 0.015). The SPI at conjunctiva incision, muscle dissection and traction were significantly lower in the ITN block group than in the No-block group. SE was comparable between the two groups, but RE at muscle dissection and traction was significantly lower in the ITN block group than in the No-block group. The use of metoclopramide and ketoprofen was also lower in the ITN block group than in the No-block group. Conclusions: ITN block reduced PONV as well as perioperative pain in pediatric patients undergoing strabismus surgery.

Background: Emergence delirium (ED) is a common complication in pediatric patients following general anesthesia. Reduced cholinergic neurotransmission is closely associated with cognitive impairment and an increased risk of delirium. This study aimed to compare the effects of a cholinesterase inhibitor versus sugammadex–used as neuromuscular blockade reversal agents–on the incidence of ED following pediatric strabismus surgery. Methods: Seventy-six patients, aged 4–7 years, were enrolled and randomly allocated to either the pyridostigmine group (Group P) or the sugammadex group (Group S). The dose of each agent was determined according to the train-of-four count or ratio. The Pediatric Anesthesia Emergence Delirium (PAED) scale was assessed at 15-min intervals in the post-anesthesia care unit until the score fell below 10. ED was defined as a PAED score ≥ 10. Results: Of the 73 patients who completed the study, 36 were in Group P, and 37 were in Group S. The incidence of ED was 50.0% in Group P and 40.5% in Group S (odds ratio = 0.682; 95% confidence interval = 0.270–1.721; p = 0.417). The peak PAED scores were 10.0 (7.0, 15.5) in Group P and 9.0 (7.5, 11.5) in Group S (median [interquartile range]; p = 0.277). Conclusions: The choice of neuromuscular reversal agent did not significantly affect the incidence of ED in pediatric patients undergoing strabismus surgery.

Background and Objectives: Hip surgery is increasingly performed among elderly patients. Oral antithrombotics, which are taken for patients’ underlying diseases, are a main concern regarding perioperative bleeding. Postoperative venous thromboembolism (VTE) is a leading cause of mortality after hip surgery. Therefore, administration of preoperative oral antithrombotics is a double-edged sword in hip surgery. In this study, we examined the correlation between the occurrence of postoperative VTE and the type of oral antithrombotics administered preoperatively. Materials and Methods: We analyzed the medical records of 601 patients aged 19 and over who underwent hip surgery from January 2021 to June 2023. The patients were assigned to two groups as follows: Groups VTE+ (patients who developed postoperative VTE) and VTE- (patients who did not develop postoperative VTE), respectively. Results: Of the 139 patients who had been taking oral antithrombotics for 6 months or more, 24 were allocated to group VTE+ and 115 to group VTE-, respectively. The number of patients who took clopidogrel and cilostazol was significantly higher in groups VTE- and VTE+, respectively (12.5 vs. 33.9%, p = 0.038, odds ratio (OR) = 0.278, 95% confidence interval (CI) = 0.078–0.991; 20.8 vs. 5.2%, p = 0.010, 95% CI = 1.325–17.245; group VTE+ vs. group VTE-). Preoperative albumin levels were significantly lower in group VTE+ (3.4 ± 0.6 g/dL vs. 3.7 ± 0.4 g/dL, p = 0.004, OR = 0.285, 95% CI = 0.115–0.702). In multivariate regression analysis, the results were statistically significant for clopidogrel, cilostazol, and preoperative albumin levels (p = 0.035, OR = 0.237, 95% CI = 0.062–0.901; p = 0.011, OR = 6.479, 95% CI = 1.542–27.226; p = 0.002, OR = 0.211, 95% CI = 0.080–0.558). Conclusions: Among the patients who had been taking oral antithrombotics for ≥6 months, clopidogrel had a prophylactic effect, but cilostazol showed an aggravating effect on postoperative VTE in hip surgery. Preoperative hypoalbuminemia increases the risk of postoperative VTE in hip surgery.