Effect Meperidine on Agitation and Pain following Sevoflurane Anesthesia in Children

Emergence agitation (EA) is a frequent phenomenon especially in children recovering from sevoflurane-based general anesthesia. Its incidence is as high as 80%. It characterized by excitement, restlessness, disorientation, and other unusual behaviors, such as crying, shouting, kicking, disorientation and non-cooperation. It may lead to higher complication rates; increased bleeding from operative sites, pulling out a surgical drain or intravenous (iv) catheter, or surgical dressings, increase the risks of self-injury, unhappy parents, disturbances to the other recovering patients and prolonged PACU stay, in addition to maladaptive behavioral changes which can create another challenge to the postanesthetic care providers. Numerous medications have been suggested for either prophylaxis or treatment of EA with varying degrees of success; including ketamine, propofol, clonidine, midazolam, dexmedetomidine and opioids. However, some medications may show undesirable side effects or varying success. Among them, Meperidine, is a potent synthetic opioid analgesic agent with mu-opioid receptor agonist activity.The aim of the study is to evaluate the efficacy and the safety of intraoperative Meperidine used intravenously on the postoperative agitation and pain in pediatric patients recovering from sevoflurane anesthesia undergoing elective hypospadias surgery.