Sevo psychosis

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    I've noticed some of our peds patients wake up like wildcats and are totally uncooperative and screaming for about half an hour. I asked one of the docs and she said Sevo could be to blame. If we can get them to calm down (morphine, demerol, or versed), the second time they wake up they're generally fine. Has anyone else noticed this and what do the anesthesiologists do differently for the ones who wake up fine the first time?
    Thanks.
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  3. 10 Comments so far...

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    some of the nurses here are doing a study that links the psychosis to versed...we have had to use ketamine to knock them down before.
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    I would like to know if this is due to Sevo.
    I do find that kids wake up with emergence delerium at times but for the most part it may have to do with their personality and how prepared they were for surgery etc. The kids whose parents spoil them and let them rule the house often are difficult when awakening. The young toddlers and the older teens also tend to be the wildest. Teen boys , forget about it, just keep out of fist and foot range uz they are nutso(all that testosterone?)
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    Yes I've seen it, usually called emergence delirium, happens more frequently in peds. It occurs when the patient is brought out of anesthesia too quickly. They are incosolabe, confused and agitated. Our docs just put them back down with propofol and they wake up nicer. I dont see a type of patient that it happens to more. Sometimes a pt will have it after a case and the next time they wont, no real rhyme or reason to it. Luckily it doesnt happen much, probably <5% of pts we anesthesize.
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    I remember doing a clinical rotation in a recovery room and every single one of the children (younger and older) woke up enraged. They were screaming and flaling (sp) their arms. One little girl had a T&A and she ended up with major bronchospams and had to have a respiratory therapist called to help her with her breathing. It was scary, she sounded just like she had croup and her sats kept going down. After a few minutes which seemed like an eternity, she came around and relaxed. I did ask my instructor about it, because of the repeated events, and she said that it was very common. I was scared thinking what if something really happens to this little one just having an outpatient procedure that is so minor, but I guess it's a common reaction.
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    I work in a high volume peds PACU and see emergence due mostly to the use of sevo as both the induction and maintenance anesthetic for shorter cases. Our anesthesiologists will often give a small bolus of propofol or fentanyl at the end of the case to keep them asleep for 10 or 15 min following extubation. I find that patients who sleep for about 15 to 20 min following extubation wake up better, assuming their pain is under control.

    I have also read that pain can sometimes contribute to emergence, so we do also give some form of analgesic along with a sedative as treatment. I agree that patients who are delirious but then "knocked" back out for a short nap, usually wake up more socially appropriate.
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    I attended a conference today led by nurses from CHOP and one of them said the biggest cause of delirium is a full bladder...
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    A full bladder and usage of Sevo or simply a full bladder irregardless of anesthesia technique?
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    Quote from mark2climb
    A full bladder and usage of Sevo or simply a full bladder irregardless of anesthesia technique?
    JUST A FULL BLADDER
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    Interesting...

    So do they routinely cath their patients before arrival to the PACU?

    How did they assess for full bladder?

    Is that evidence based? We are doing some studies on emergence delirium now but it's focused more on anesthesia technique and BIS numbers. I would think if it was so closely tied to fullness of the bladder they would have looked at that already.

    Still, very interesting...


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