Epigenetics in PostOperative Pediatric Emergence Delirium
Status:
Recruiting
Trial end date:
2021-12-01
Target enrollment:
Participant gender:
Summary
Emergence delirium (ED) infers the occurrence of behavior and cognition changes during the
early postoperative period. Main signs and symptoms of ED are the disturbances of
consciousness and awareness of the environment, with disorientation and perceptual
alterations, including hypersensitivity to external stimuli and hyperactive motor behaviors.
The incidence may be higher than 80%. Risk factors include pre-school age, use of
sevoflurane, ophthalmologic and otorhinolaryngologic surgeries, child anxiety, parental or
caregiver anxiety. The recurrence of ED is controversial. The only validated scale for
diagnosis of ED is the PAED (Pediatric Anesthesia Emergence Delirium). Prevention is the best
approach, as well as the use of alpha-2 agonists, propofol and total intravenous anesthesia.
There are still no clear markers for postoperative delirium, especially ED. Cognitive
alterations may be related to epigenetic modifications. Anesthesia-induced epigenetic changes
may be the key to understanding perioperative complications and outcomes and is a field of
future research in anesthesia. The study aims to analyze the DNA methylation profile in
children with ED. A prospective, randomized study will be carried out in up to 322 children
undergoing general anesthesia (inhalation group or intravenous group) to perform endoscopic
procedures at the Instituto da Criança, Hospital das Clinicas, Faculdade de Medicina,
Universidade de Sao Paulo, Brazil. Patients will have blood samples drawn, and analysis of
the DNA methylation profile through the array technique will be performed in 40 children (20
of each group ) who presented ED as well as in 08 control cases. Also, the occurrence of ED
will be correlated with the degree of anxiety of the child, parents and during anesthetic
induction, in addition to comparing the two anesthetic techniques with the occurrence of ED
and late postoperative cognitive alterations.