Abstract: PURPOSE: To investigate the risk factors associated with postoperative emergence agitation(EA) in children with nevus flammeus in the maxillofacial region undergoing photodynamic therapy, and to identify optimal anesthetic interventions for efficacy. METHODS: A total of 270 children aged 2-12 years old who underwent photodynamic therapy under general anesthesia for the treatment of nevus flammeus were included. Preoperative anxiety scores of the patient and their parents, the use of anesthetics, and the degree of pain and Pediatric Anesthesia Emergence Delirium(PAED) scale during the recovery period were recorded. Based on PAED score in the recovery room, children were categorized into EA group(PAED score≥12) and non-EA group(PAED score<12). Differences between the groups were then compared. Logistic regression analysis, adjusted regression analysis were performed to identify effective anesthetics intervention measures with SPSS 25.0 software package. RESULTS: Significant differences were observed between EA group and non-EA group in terms of age, opioid anesthesia induction, dexmedetomidine administration, extubation time, preoperative anxiety of the children and their parents, and postoperative pain(P<0.05). After adjusting for preoperative baseline factors, logistic regression analysis showed that the induction opioid fentanyl/sufentanil(OR: 0.03, 95%CI: 0-0.16), dexmedetomidine（OR=0.56, 95%CI: 0.33-0.95）,esketamine 0.5 mg/kg(OR=0.16, 95%CI: 0.04-0.50), and 1 mg/kg(OR=0.07, 95%CI: 0.00-0.41) were the significant influencing factors for EA(P<0.05). CONCLUSIONS: Postoperative emergence agitation during photodynamic therapy for nevus flammeus is related to age, pain, anxiety, extubation time, dexmedetomidine. The use of sufentanil for induction and esketamine(0.5-1 mg/kg) during the recovery period can effectively reduce the occurrence of EA.

Key words: Postoperative emergence agitation, Pediatrics, Photodynamic therapy, Nevus flammeus, Maxillofacial region