Date of Award

2015

Type of Degree

DMPNA

Document Type

Research Paper

First Advisor

Alberto Coustasse, Committee Chair, Graduate College of Business, Marshall University

Second Advisor

Cassy Taylor, Committee Member, CAMC School of Nurse Anesthesia

Third Advisor

Steve Lusk, Committee Member, CAMC Health System, Memorial Hospital

Abstract

Abstract: The purpose of this study was to compare inhalation anesthesia with sevoflurane versus Total Intra Venous Anesthesia (TIVA) with propofol infusion as it relates to the quality of recovery including postoperative pain, Post Operative Nausea and Vomiting (PONV), and Post Anesthesia Care Unit (PACU) Length Of Stay (LOS) in pediatric patients undergoing ambulatory dental surgery. Introduction: Pediatric dental procedures are increasingly performed in an outpatient setting under general anesthesia due to inadequate cooperation, circumstantial anxiety, and other behavioral and health issues. Commonly used inhalation anesthetics, such as sevoflurane, can induce hyperalgesia in children. While sevoflurane increases the risk PONV, the time spent in PACU is reduced compared to other methods of anesthesia. Maintenance of anesthesia via TIVA with propofol infusion has been shown to reduce postoperative pain and PONV in pediatric patients. The goal of the study was to determine if pediatric patients anesthetized with sevoflurane displayed more postoperative pain than those patients anesthetized via TIVA with propofol. The study evaluated the incidence of PONV and the duration of PACU length of stay in both groups.

Methodology: The research study used a retrospective, quantitative, randomized case control design at Charleston Area Medical Center in West Virginia. The chart review was conducted on pediatric patients undergoing general anesthesia for ambulatory dental surgery from January 1, 2006 through June 1, 2015. Two groups were developed for the study. The control group (Group S), which were pediatric patients documented as general anesthesia by inhalation with sevoflurane on the intraoperative record, and the case group (Group P), which were pediatric patients documented as general anesthesia via TIVA with propofol on the intraoperative record. These two groups were used for comparison of demographics and clinical characteristics such as postoperative pain, frequency of PONV measured by administration of an antiemetic drug, and PACU LOS.

Results: There was no statistical significance found with patient demographics between the two groups. Patients in Group P had a mean pain score of 0.24 (± 1.207) while Group S had a mean pain score of 1.11 (± 2.313) (p>.05). Results of a linear regression analysis from the collected data did suggest a decreased association between average postoperative pain score with the administration of propofol (p<.05). Results of the study showed type of anesthesia, gender, age, BMI, ASA, and length of surgery was not associated with the frequency of PONV within the groups. Patients in Group P had a mean PACU LOS of 39.32 (±15.843) minutes while Group S had a PACU LOS of 37.98 (±15.239) minutes (p<.05). Results from a linear regression analysis did not show a statistically significant decreased PACU LOS with propofol (p>.05). The BMI of the patient did indicate a statistical significance for PACU LOS in Group S where as BMI increased, PACU LOS decreased (p<.05).

Discussion: Inhalation with sevoflurane and TIVA via propofol are two methods of maintaining anesthesia with pediatric patients undergoing general anesthesia for ambulatory dental surgery. The results of this study were associated with higher postoperative pain scores with patients in Group S than patients in Group P. These results have been seen in previous studies. Although past research has shown a decreased incidence of PONV with the use propofol, the results of this study did not show the same association between the two methods of anesthesia. Previous research has shown a decreased PACU LOS with the administration of sevoflurane compared to propofol. However, results of this study did show a similar PACU LOS between the two groups.

Conclusion: The use of propofol for maintenance of general anesthesia in pediatric patients was associated with decreased postoperative pain scores compared to maintenance with sevoflurane. TIVA via propofol infusion is an effective method for maintenance of general anesthesia in pediatric dental surgery with an improved quality of recovery.

Implications/Recommendations: With the growing trend of general anesthesia for pediatric patients undergoing ambulatory dental surgery, results from this study suggest favorable outcomes with the use of TIVA via propofol infusion. This study found an association with a decreased postoperative pain score in pediatric patients who received TIVA via propofol infusion. Decreased pain scores not only result in improved patient and parental satisfaction, but less PACU nursing interventions and LOS.

Subject(s)

Anesthesiology -- Research.

Nursing -- Research.

Additional Files
Neal-Kristin-2015-pt2.pptx (318 kB)
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