Medical Journal of The Islamic Republic of Iran (MJIRI)
Iran University of Medical Sciences
Sun, Jun 14, 2026
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Volume 40, Issue 1 (1-2026)
Med J Islam Repub Iran 2026 |
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Amiraslani T, Sehat Kashani S, Ghaemi M, Sorbi T, Sabouri M. Effect of Controlled versus Spontaneous Ventilation on Postoperative Emergence Agitation in 2–4-Year-Old Children Undergoing Adenotonsillectomy: A Double-Blind Randomized Clinical Trial. Med J Islam Repub Iran 2026; 40 (1) :328-334
URL: http://mjiri.iums.ac.ir/article-1-10035-en.html
URL: http://mjiri.iums.ac.ir/article-1-10035-en.html
Department of Anesthesiology and Pain Medicine, School of Medicine, Iran University of Medical Sciences, Tehran, Iran , Salume.sehat@gmail.com
Abstract: (93 Views)
Background: Emergence agitation (EA), characterized by restlessness and inconsolable behavior, is a common postoperative complication in children after sevoflurane anesthesia, potentially causing secondary injuries and prolonged PACU stays. While its etiology is multifactorial, the mode of ventilation during anesthesia may be a contributing yet under-investigated factor. This study aimed to compare the effects of controlled mechanical ventilation (CMV) versus spontaneous ventilation (SV) on EA, pain, recovery time, and related outcomes in children aged 2–4 years undergoing adenotonsillectomy.
Methods: This randomized double-blind trial enrolled 79 children (2–4 years, ASA I) undergoing adenotonsillectomy. Patients were randomized to controlled mechanical ventilation (CMV) or spontaneous ventilation (SV) during emergence. Anesthesia was standardized with sevoflurane and reversal with neostigmine/atropine. The primary outcome was emergence agitation assessed via the Richmond Agitation-Sedation Scale (RASS). Statistical analysis involved Analysis of covariance (ANCOVA), independent t-tests, and Chi-square or Fisher’s exact tests. The P<0.05 was considered a statistically significant level.
Results: The mean age was significantly higher in the controlled ventilation group compared to the spontaneous breathing group (40.75 ± 4.73 vs. 37.31 ± 5.80 months, P=0.005). EA incidence and agitation scores were significantly lower in the CMV group (0.60 ± 0.63 vs. 1.21 ± 0.61, P=0.001). Postoperative pain was reduced (VAS 2.80 ± 1.18 vs. 5.15 ± 1.69, P=0.001), recovery duration was shorter (38.98 ± 6.96 min vs. 44.72 ± 6.57 min, P=0.001), and EtCO₂ levels were lower (34.43 ± 2.52 mmHg vs. 36.82 ± 1.83 mmHg, P=0.001) in the CMV group. Oxygen saturation, neuromuscular monitoring, and postoperative nausea were comparable between groups. No delirium cases were observed.
Conclusion: CMV significantly reduces EA, postoperative pain, and PACU stay duration compared with SV in children undergoing adenotonsillectomy, likely by preventing hypercapnia and stabilizing physiological parameters. CMV is recommended as the preferred ventilation strategy in this population, while the absence of delirium confirms the low inherent neurological risk in children less than 5 years.
Methods: This randomized double-blind trial enrolled 79 children (2–4 years, ASA I) undergoing adenotonsillectomy. Patients were randomized to controlled mechanical ventilation (CMV) or spontaneous ventilation (SV) during emergence. Anesthesia was standardized with sevoflurane and reversal with neostigmine/atropine. The primary outcome was emergence agitation assessed via the Richmond Agitation-Sedation Scale (RASS). Statistical analysis involved Analysis of covariance (ANCOVA), independent t-tests, and Chi-square or Fisher’s exact tests. The P<0.05 was considered a statistically significant level.
Results: The mean age was significantly higher in the controlled ventilation group compared to the spontaneous breathing group (40.75 ± 4.73 vs. 37.31 ± 5.80 months, P=0.005). EA incidence and agitation scores were significantly lower in the CMV group (0.60 ± 0.63 vs. 1.21 ± 0.61, P=0.001). Postoperative pain was reduced (VAS 2.80 ± 1.18 vs. 5.15 ± 1.69, P=0.001), recovery duration was shorter (38.98 ± 6.96 min vs. 44.72 ± 6.57 min, P=0.001), and EtCO₂ levels were lower (34.43 ± 2.52 mmHg vs. 36.82 ± 1.83 mmHg, P=0.001) in the CMV group. Oxygen saturation, neuromuscular monitoring, and postoperative nausea were comparable between groups. No delirium cases were observed.
Conclusion: CMV significantly reduces EA, postoperative pain, and PACU stay duration compared with SV in children undergoing adenotonsillectomy, likely by preventing hypercapnia and stabilizing physiological parameters. CMV is recommended as the preferred ventilation strategy in this population, while the absence of delirium confirms the low inherent neurological risk in children less than 5 years.
Keywords: Adenotonsillectomy, Emergence agitation, Controlled ventilation, Spontaneous ventilation, Pediatrics
Policy Review: Original Research |
Subject:
Anesthesia
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