Clarifying the Assessment of Emergence Agitation and Postoperative Recovery in Young Children Receiving Ciprofol or Propofol for Dental Surgery [Letter]
We read with interest the randomized controlled trial comparing ciprofol with propofol for general anesthesia in children undergoing dental surgery. 1 The study provides useful clinical data on emergence agitation (EA) and postoperative recovery in this population. We would like to comment on several aspects of the outcome assessment and interpretation. First, the timing of PAED assessment should be clarified. EA was assessed using the Pediatric Anesthesia Emergence Delirium (PAED) scale 5 minutes after awakening. However, the meaning of “awakening” is not clearly defined in relation to the other recovery endpoints. Deep anesthesia extubation was performed in the study, while emergence time was defined as the interval from discontinuation of anesthesia to the child being able to correctly answer simple questions. The PAED scale evaluates several behavioral features of emergence, including eye contact, purposeful actions, awareness of surroundings, restlessness, and inconsolability, so the child’s level of consciousness at the time of assessment is relevant to interpretation of the score. 2 It would therefore be helpful to clarify whether “awakening” referred to eye opening, purposeful interaction, response to verbal commands, or the predefined emergence criterion. It would also be useful to specify whether the PAED assessment was performed 5 minutes after extubation, 5 minutes after reaching the emergence criterion, or at another predefined time point. These details are important when interpreting the primary outcome. Second, the timing of QoR-15 assessment should also be clarified. Parent-proxy assessment of the QoR-15 has previously been used by the authors in younger children undergoing outpatient dental surgery under general anesthesia, with the questionnaire completed 24 hours after surgery. 3 In the present study, however, the QoR-15 was completed by guardians before discharge. Because discharge timing may vary between patients, assessment before discharge could result in different postoperative assessment