Development and Psychometric Evaluation of the Pediatric Anesthesia Emergence Delirium Scale

Sikich, Nancy; Lerman, Jerrold

doi:10.1097/00000542-200405000-00015

Cited by 687 publications

(715 citation statements)

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“…8 Finally, emergence from anesthesia in children may often be associated with inappropriate motor behaviour, disorientation, and emotional lability. 9 This condition lacks the fluctuating course that is characteristic of delirium and would be considered more appropriately as a drug effect. While it is tempting to view delirium, dementia, POCD, and emergence agitation as related conditions, there is little empirical evidence to suggest they share a common mechanism.…”

Section: Definitionmentioning

confidence: 99%

“…8 Enfin, l'émergence de l'anesthésie chez les enfants peut être souvent associée à un comportement moteur inapproprié, une désorientation et une labilité émotionnelle. 9 Cette maladie ne présente pas l'évolution fluctuante qui est caractéristique du delirium et serait considérée, de façon plus logique, comme un effet secondaire des médicaments. Bien qu'il soit tentant de penser que le delirium, la démence, les troubles cognitifs dysfonctionnels postopératoires et l'agitation du réveil sont des troubles apparentés, il existe peu de preuves empiriques pour suggérer qu'ils partagent un mécanisme commun.…”

Section: Définitionunclassified

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Postoperative delirium: risk factors and management: Continuing Professional Development

Chaput

Bryson

2012

Can J Anesth/J Can Anesth

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Purpose Postoperative delirium often remains undiagnosed and therefore untreated. The purpose of this continuing professional development module is to identify patients at high risk of developing delirium following noncardiac surgery and to provide tools to aid in the diagnosis of delirium at the bedside. Optimal prevention and treatment strategies are recommended. Principal findings Delirium is characterized by an acute onset and a fluctuating course, inattention, disorganized thinking and an altered level of consciousness, and occurs in up to 40% of patients in the perioperative period. The pathophysiology of delirium is multifactorial, but it is believed to be related to inflammation, altered neurotransmission, and stress in the patient who has had surgery. Acetylcholine and dopamine appear to play a significant role. There is an increased risk of a poor outcome in patients who develop delirium, including a longer hospital stay and death. Surgical and patient factors play a significant role in predicting who will subsequently develop delirium. Prevention is much more effective than treatment in the management of delirium. The most effective prevention strategies include proactive geriatric assessment and care of the patient on a geriatrics surgical ward as well as prophylactic low-dose antipsychotic agents. From an anesthetic perspective, evidence in some surgical populations would support the use of regional techniques and minimal sedation. If delirium develops, treatment with lowdose oral antipsychotics appears to be most effective.Conclusions Delirium is a serious condition that must be recognized early and treated promptly to minimize deleterious outcomes. In order to institute prevention strategies and treat the condition effectively when it occurs, the anesthesiologist must be vigilant in identifying patients at risk and in screening for this condition. Objectives of this Continuing Professional Development (CPD) module:After reading this module, the reader should be able to:1. Define delirium in the context of other cognitive changes following non-cardiac surgery. 2. Understand the incidence and adverse outcomes associated with delirium. 3. List predisposing and precipitating factors of postoperative delirium and identify the patient at risk. 4. Explain the underlying pathophysiologic mechanisms believed to be implicated in causing delirium. 5. Formulate an anesthetic plan that minimizes the risk of developing postoperative delirium. 6. Devise a management plan to treat postoperative delirium most effectively while minimizing the adverse effects of treatment.Like other Western nations, Canada's population is aging rapidly. Over the past 50 years, the proportion of Canadians over the age of 65 has risen from 7.7% to 13.7%. A Statistics Canada estimates that the proportion of seniors will double 123Can J Anesth/J Can Anesth (2012) 59:304-320 DOI 10.1007 yet again by 2036 and will represent 23-25% of Canada's population. B This rapid demographic shift will impact anesthesiologists and hospitals ...

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Section: Definitionmentioning

confidence: 99%

Section: Définitionunclassified

Postoperative delirium: risk factors and management: Continuing Professional Development

Chaput

Bryson

2012

Can J Anesth/J Can Anesth

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“…However, the implications of pediatric delirium in the Japanese context are not well clarified because of the lack of an adequate screening tool. Currently, there are a number of validated and reliable screening tools for delirium used in pediatric ICUs, including the Pediatric Anesthesia Emergence Delirium (PAED) scale,5 the Pediatric Confusion Assessment Method for the Intensive Care Unit (pCAM‐ICU),6 and the Cornell Assessment of Pediatric Delirium (CAPD) 7. The pCAM‐ICU can be used only in children over 5 years old, and the PAED scale does not evaluate hypoactive delirium.…”

Section: Introductionmentioning

confidence: 99%

Development of the Japanese version of the Cornell Assessment of Pediatric Delirium

Hoshino

Matsuishi

Shimojo

et al. 2017

Acute Medicine & Surgery

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AimDelirium is a form of acute cerebral dysfunction and is associated with increased length of hospital stay, mortality, and health‐care costs for adult patients in intensive care. However, in Japan, there are currently no reliable criteria or tools for diagnosing delirium in critically ill pediatric patients. The purpose of this study was to translate the Cornell Assessment of Pediatric Delirium (CAPD)—a screening tool for pediatric delirium—from English to Japanese for use in the diagnosis of delirium for pediatric patients in pediatric intensive care units.MethodsThe back‐translation method was used to ensure equivalence in the Japanese version of the CAPD and its accompanying developmental anchor points. The translation process was repeated by a multidisciplinary committee of medical researchers and clinicians.ResultsThe final back‐translated version of the CAPD was submitted to the original author, who gave her approval.ConclusionThe Japanese CAPD was developed and its effectiveness tested using a standardized procedure. Further study is required to test the validity and reliability of the Japanese version of the CAPD.

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“…6 As a response to this, the Pediatric Anesthesia Emergence Delirium (PAED) scale was developed with the objective of minimizing errors in the clinical assessment of agitation in children. 7 This scale is made up of five items: 1) the child makes eye contact with the caregiver;…”

Section: Introductionmentioning

confidence: 99%

“…7,8 Nevertheless, there is agreement that the use of the PAED scale is useful for improving the methodology of investigations into this area, particularly when postoperative pain has been ruled out as the cause of postoperative agitation. Challenges remain, related to the basic definitions and the need for accurate clinical instruments in order to diagnose and assess emergence agitation.…”

Section: Introductionmentioning

confidence: 99%

Agitação no despertar da anestesia em crianças: aspectos atuais

Silva¹,

Braz²,

Módolo³

2008

J. Pediatr. (Rio J.)

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Objective: Postoperative agitation in children is a well-documented clinical phenomenon with incidence ranging from 10% to 67%. There is no definitive explanation for this agitation. Possible causes include rapid awakening in unfamiliar settings, pain (wounds, sore throat, bladder distension, etc.), stress during induction, hypoxemia, airway obstruction, noisy environment, anesthesia duration, child's personality, premedication and type of anesthesia. The purpose of this paper is to discuss the possible causes of postoperative agitation in children, providing a foundation for better methods of identifying and preventing this problem.Sources: MEDLINE and PubMed were searched using the following words: emergence, agitation, incidence, etiology, diagnosis, treatment, children, pediatric, anesthesia. Summary of the findings:This study includes a review of potential agitation trigger factors and a proposal for a standardized diagnostic score system, in addition to measures to improve prevention and treatment. Conclusion:No single factor can identified as the cause of postoperative agitation, which should therefore be considered a syndrome made up of biological, pharmacological, psychological and social components, and which anesthesiologists and pediatric intensive care specialists should be prepared to identify, prevent and intervene appropriately as necessary.

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Development and Psychometric Evaluation of the Pediatric Anesthesia Emergence Delirium Scale

Abstract: These results support the reliability and validity of the PAED scale.

Cited by 687 publications

References 45 publications

Postoperative delirium: risk factors and management: Continuing Professional Development

Postoperative delirium: risk factors and management: Continuing Professional Development

Development of the Japanese version of the Cornell Assessment of Pediatric Delirium

Agitação no despertar da anestesia em crianças: aspectos atuais

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