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Emergence Delirium (Derlenme Deliryumu)NCT07826559

Brain Monitors to Reduce Child Confusion After Anesthesia

A study testing BIS-Guided Anesthesia in people with Emergence Delirium (Derlenme Deliryumu), run by Baskent University at 1 site in Turkey (Türkiye).

Completed

Finished. The study has ended and is not enrolling. Results may be posted on the official record.

Official record
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Trial summary

The goal of this clinical trial was to learn if using a brain monitor to adjust anesthesia (sleep medicine) during surgery could prevent emergence delirium (severe confusion and agitation upon waking) in children aged 2 to 12 years having their tonsils or adenoids removed. Read more about this study

Who is it for?
Ages 2 to 12 yearsHealthy volunteers can take part
Conditions the study is for
Emergence Delirium (Derlenme Deliryumu)
What is being tested?
BIS-Guided Anesthesia
Could I receive a placebo?
No, everyone receives an active treatment
How many people
125 participants
Where
1 siteTurkey (Türkiye)
Study dates
8 Aug 2025to 21 Nov 2025
Phase
Interventional
Are there results?
None posted in the registry

Key requirements

Who can take part, as listed by the sponsor. Only the study team can confirm whether you are eligible, so take this list to your doctor.

  • Ages 2 to 12 years
  • All sexes
  • Healthy volunteers accepted
  • Child

Who may be able to join

  • Children between the ages of 2 and 12 years
  • Scheduled for a planned surgery to remove adenoids, tonsils, or both
  • Generally healthy or having only mild medical conditions (American Society of Anesthesiologists class I or II)
  • Expected to have a surgery that lasts less than 4 hours
  • Having the procedure as an outpatient and expected to go home the same day

Who cannot join

  • Having severe medical conditions (American Society of Anesthesiologists class III or IV)
  • Having a known history of neurological or psychiatric diseases
  • Diagnosed with a developmental delay
  • Having severe heart, lung, or metabolic conditions
  • Having a known allergy to any of the medications used in the study
  • Parents or legal guardians refuse to provide written consent to participate

Trial locations and contacts

1 site in 1 country.

Turkey (Türkiye)1 site
  • Baskent University

    Ankara

Other trials in Turkey (Türkiye)

About this study

Official title: The Role of BIS-Guided Anesthesia in Reducing Emergence Delirium in Children (Çocuklarda Derlenme Deliryumunun Azaltılmasında BİS Kılavuzluğunda Anestezi)

The goal of this clinical trial was to learn if using a brain monitor to adjust anesthesia (sleep medicine) during surgery could prevent emergence delirium (severe confusion and agitation upon waking) in children aged 2 to 12 years having their tonsils or adenoids removed. The main questions it aimed to answer were:

Did using a brain monitor lower the chance of children waking up confused and upset?

Read more

Did using the brain monitor reduce the amount of anesthesia gas (sevoflurane) needed during surgery, and did it affect recovery time or pain levels?

Researchers compared anesthesia adjusted using a bispectral index (BIS) brain monitor to anesthesia adjusted using standard care to see if the brain monitor lowered the chance of emergence delirium.

Participants in the study:

Received general anesthesia (a standardized mix of inhaled and intravenous medicines, including sevoflurane and fentanyl) to safely sleep through surgery to remove their tonsils or adenoids

Had the dose of their main anesthesia gas (sevoflurane) adjusted during surgery based on either brain monitor readings (targeting a specific sleep depth of 40-60) or standard physical responses (like heart rate and blood pressure)

Were checked by the research team immediately after waking up to measure their confusion, agitation, and pain using standard clinical rating scales

Read the detailed description

Emergence delirium (ED) represents a significant neurobehavioral complication that frequently occurs during the immediate postoperative period in pediatric populations, particularly following otorhinolaryngological procedures such as adenoidectomy and tonsillectomy. Characterized by severe agitation, altered awareness, disturbed psychomotor behavior, and inconsolability, ED poses safety risks to the recovering patient and increases the burden on healthcare providers and caregivers. While the etiology of ED is multifactorial, the intraoperative depth of anesthesia and the cumulative exposure to specific volatile anesthetics, such as sevoflurane, are known modifiable risk factors. Both excessively deep and inadequately light anesthesia can contribute to poor recovery profiles. The Bispectral Index (BIS) is an electroencephalogram (EEG)-based monitor that provides an objective measurement of a patient's level of consciousness, allowing anesthesiologists to precisely titrate anesthetic agents to an optimal depth.

This prospective, randomized controlled study was designed to investigate the role of BIS-guided anesthetic titration in mitigating the risk of ED. Upon enrollment, pediatric patients undergoing adenoidectomy and/or tonsillectomy were randomized into one of two clinical care pathways: a BIS-guided anesthesia group or a standard-care group.

To ensure baseline consistency across the study, all participants followed a standardized anesthetic induction protocol. Following routine premedication, general anesthesia was induced using inhaled sevoflurane combined with intravenous lidocaine, rocuronium (for muscle relaxation), and fentanyl (for analgesia). For the maintenance phase of anesthesia, patients in both arms received a combination of inhaled sevoflurane and continuous remifentanil infusions.

The critical divergence in the study protocol occurred during the intraoperative maintenance phase:

BIS-Guided Pathway: Anesthesiologists continuously monitored the patient's EEG activity using the BIS monitor. The concentration of the sevoflurane gas was deliberately titrated to maintain a BIS value between 40 and 60, which represents an optimal and safe depth for surgical anesthesia. By keeping patients within this precise target range, the protocol systematically avoided periods of excessively deep (BIS < 40) or overly light (BIS > 60) anesthesia.

Standard-Care Pathway: Anesthesiologists adjusted the sevoflurane concentrations based entirely on traditional clinical signs and autonomic responses, specifically monitoring hemodynamic fluctuations such as heart rate and blood pressure, without the use of EEG-guided depth parameters.

Following the completion of the surgical procedure, patients were transferred to the post-anesthesia care unit (PACU) for close observation. The clinical team systematically evaluated the patients' transition from unconsciousness to wakefulness. To ensure a robust, multi-faceted assessment of neurobehavioral status, the clinical staff utilized three validated behavioral assessment tools: the Pediatric Anesthesia Emergence Delirium (PAED) scale, the Watcha scale, and the Cravero scale. Simultaneously, postoperative physical pain was managed and tracked using the Face, Legs, Activity, Cry, Consolability (FLACC) behavioral scale.

If a patient exhibited signs meeting predetermined thresholds for severe emergence delirium (specifically, a PAED score of 10 or higher, a Watcha score of 3 to 4, or a Cravero score of 4 or higher), the clinical protocol dictated the administration of intravenous fentanyl as a rescue pharmacological intervention to safely manage the agitation.

Through this methodology, the study sought to define the relationship between strict, brain-monitored anesthetic titration and postoperative behavior. It comprehensively evaluated how preventing fluctuations in anesthetic depth impacts overall volatile anesthetic consumption, the necessity for rescue opioids in the recovery room, and the overall quality and speed of pediatric recovery following airway surgery.

Being tested
BIS-Guided Anesthesia, Standard Care Anesthesia
Keywords
emergence delirium, pediatric anesthesia, bispectral index, anesthetic depth, adenoidectomy, tonsillectomy
Medical subject headings
Emergence Delirium

What participants receive

What participants receive. In a randomised study each person is assigned to one group by chance.

  • BIS-Guided AnesthesiaDevice

    Anesthetic depth was continuously guided by the Bispectral Index (BIS) monitor. A single-use BIS sensor was placed on the patient's forehead before anesthesia induction to record real-time EEG activity. The primary inhaled anesthetic (sevoflurane) was continuously titrated throughout the surgery to strictly maintain a BIS value within the target range of 40 to 60. If the BIS value dropped below 40, the sevoflurane concentration was decreased. If the BIS value exceeded 60, the continuous remifentanil infusion (0.02-0.1 mcg/kg/min) was increased first, followed by an increase in sevoflurane if necessary. Intervention

  • Standard Care AnesthesiaDrug

    Anesthetic depth was guided solely by traditional clinical signs and autonomic responses. The primary inhaled anesthetic (sevoflurane) was initiated at a 1% end-tidal concentration and adjusted in 0.25% increments (range 0.50% to 1.5%) to maintain the patient's heart rate and blood pressure within ±25% of their baseline pre-anesthesia values. Remifentanil was also infused continuously (0.02-0.1 mcg/kg/min) and adjusted based on clinical requirements. A BIS sensor was attached to the patient to record data, but the monitor screen was completely blinded to the anesthesia care provider, ensuring titration relied exclusively on standard hemodynamic metrics.

Study groups in NCT07826559
Study groupRoleWhat they receive
BIS-Guided AnesthesiaExperimentalThis group received the specific intervention (the BIS monitor to guide anesthesia depth) that is the main focus of your research study.
Receives: Device: BIS-Guided Anesthesia
Standard Care AnesthesiaActive comparatorThis group received the standard, established method of care (titrating anesthesia based on heart rate and blood pressure).
Receives: Drug: Standard Care Anesthesia

What is being measured

The primary outcome is the main question the study is designed to answer.

  1. Primary Outcome Measure 1: Incidence of Emergence Delirium Assessed by the PAED Scale

    Evaluated postoperatively using the Pediatric Anesthesia Emergence Delirium (PAED) scale. The scale ranges from a minimum of 0 to a maximum of 20. Higher scores mean a worse outcome (more severe delirium). Scores of 10 or higher were classified as a positive diagnosis for emergence delirium.

    Measured: Postoperative minutes 5, 10, 15, 30, 45, and 60 following extubation.

  2. Primary Outcome Measure 2: Incidence of Emergence Delirium Assessed by the Watcha Scale

    Evaluated postoperatively using the Watcha behavioral scale. The scale ranges from a minimum of 1 to a maximum of 4. Higher scores mean a worse outcome (greater agitation and delirium). Scores of 3 to 4 were classified as a positive diagnosis for emergence delirium.

    Measured: Postoperative minutes 5, 10, 15, 30, 45, and 60 following extubation.

  3. Primary Outcome Measure 3: Incidence of Emergence Delirium Assessed by the Cravero Scale

    Evaluated postoperatively using the Cravero behavioral scale. The scale ranges from a minimum of 1 to a maximum of 5. Higher scores mean a worse outcome (greater agitation). Scores of 4 or higher were classified as a positive diagnosis for emergence delirium.

    Measured: Postoperative minutes 5, 10, 15, 30, 45, and 60 following extubation.

Secondary outcomes (4)
  1. Total Sevoflurane Consumption

    The total volume of sevoflurane anesthetic gas consumed during the surgical procedure was measured in milliliters (mL).

    Measured: Intraoperative (From anesthesia induction until the completion of surgery).

  2. Postoperative Pain Assessed by the FLACC Scale

    Assessed using the Face, Legs, Activity, Cry, Consolability (FLACC) behavioral scale. The scale ranges from a minimum of 0 to a maximum of 10. Higher scores mean a worse outcome (more severe pain). Scores of 4 or higher indicated the presence of pain.

    Measured: Postoperative minutes 5, 10, 15, 30, 45, and 60 following extubation.

  3. Rescue Opioid Usage

    Administration of intravenous rescue fentanyl (administered at a dose of 1-2 mcg/kg) as an intervention for severe emergence delirium or inadequate pain control.

    Measured: Up to 60 minutes during the post-anesthesia recovery period.

  4. Recovery Time

    Time required to meet safe discharge criteria from the post-anesthesia care unit, determined by the Modified Aldrete Score. The scale ranges from 0 to 10; higher scores mean a better outcome. A score of 9 or higher indicates readiness for discharge.

    Measured: Up to 4 hours (From transfer to the recovery unit until discharge criteria were successfully met).

Timeline

From the start of the study to its completion; the mark is today. Estimated dates are the sponsor’s plan.

  1. First posted17 Sep 2026
  2. Study start8 Aug 2025
  3. Primary completion21 Nov 2025
  4. Study completion21 Nov 2025

Resources

More details

For doctors and researchers: how the study is designed, who runs it, and its registry IDs.

Study design
Study type
Interventional
Phase
Phase N/A
Primary purpose
Prevention
Allocation
Randomised
Intervention model
Parallel groups
Model description
This study utilized a parallel assignment model. A total of 125 pediatric patients (aged 2 to 12 years) undergoing adenoidectomy and/or tonsillectomy were randomized in a 1:1 ratio into two distinct, simultaneous arms: the intervention group (BIS-guided anesthesia) and the active comparator group (standard care). During the intraoperative phase, both groups received identical anesthetic agents (sevoflurane and remifentanil). The fundamental difference between the parallel arms was the titration strategy. In the BIS arm, sevoflurane was titrated continuously to maintain a strict Bispectral Index target of 40-60. In the standard-care arm, anesthesiologists adjusted the sevoflurane dosage based entirely on traditional clinical and hemodynamic responses, such as heart rate and blood pressure. Participants remained in their initially assigned arms for the entire duration of the surgery and the postoperative recovery observation period. No crossover design was utilized.
Masking
Single blind
Who is masked
Participant
Enrolment
125 participants (actual)
IDs, dates and publications
ClinicalTrials.gov ID
NCT07826559
Sponsor's protocol ID
KA24/328
Status last verified
Sep 2026
First submitted
4 Aug 2026
Last updated
17 Sep 2026
Results posted
No
Data monitoring committee
No
FDA-regulated drug
No
FDA-regulated device
No
Individual data sharing
Undecided

Questions about this trial

What is this clinical trial studying?

A study testing BIS-Guided Anesthesia in people with Emergence Delirium (Derlenme Deliryumu), run by Baskent University at 1 site in Turkey (Türkiye).

The full registered description is in the About this study section and the official record.

Who may be eligible to take part?

The sponsor lists 5 inclusion and 6 exclusion criteria. Eligibility is decided by the study team after screening, so read the full criteria and contact a listed site.

Is this clinical trial currently recruiting?

The record says: finished, as of the sponsor's last update on 17 Sep 2026. Status can change between updates, so confirm with the study contact before making plans.

Where is the study taking place?

The record lists 1 site in Turkey (Türkiye). Whether a site is taking part right now should be confirmed with that site. See every site.

What are the possible benefits and risks?

They depend on the study and the treatment, and no study can promise a benefit. The study team explains the known risks during informed consent, before anyone joins; the record itself does not list them.

Are results available for this study?

The study is completed, but results are not available in the source record. That does not mean the treatment did or did not work.

How can a doctor refer a patient or contact the research team?

The record lists no contact. The official record names the sponsor, who can be asked directly. AzTrials does not enrol participants or take referrals.

What does the primary outcome measure?

Primary Outcome Measure 1: Incidence of Emergence Delirium Assessed by the PAED Scale (time frame: Postoperative minutes 5, 10, 15, 30, 45, and 60 following extubation.). The study lists 3 primary outcomes in all. It is what the study was designed to measure, not a finding.

Where can I read the original study information?
Does a listing mean the treatment is approved or proven to work?

No. A listing means the study is registered. It does not show that the treatment is safe, works, or is approved by a regulator.

How often is this information updated?

AzTrials copies changed records from ClinicalTrials.gov every night and reloads the whole registry every week. The sponsor last updated this record on 17 Sep 2026.

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