Emergence Delirium in Children: Many Questions, Few Answers

Abstract

The introduction of a new generation of inhaled anesthetics into pediatric clinical practice has been associated with a greater incidence of ED, a short-lived, but troublesome clinical phenomenon of uncertain etiology. A variety of anesthesia-, surgery-, patient-, and adjunct medication-related factors have been suggested to play a potential role in the development of such an event. Restless behavior upon emergence causes not only discomfort to the child, but also makes the caregivers and parents feel unhappy with the quality of recovery from anesthesia. Although the severity of agitation varies, it often requires additional nursing care, as well as treatment with analgesics or sedatives, which may delay discharge from hospital. To reduce the incidence of this adverse event, it is advisable to identify children at risk and take preventive measures, such as reducing preoperative anxiety, removing postoperative pain, and providing a quiet, stress-free environment for postanesthesia recovery. More clinical trials are needed to elucidate the cause as well as provide effective treatment.

The agitated child in recovery

“…5 Some studies have an incidence as high as 80%. 1 This variation is also a reflection of the difficulty in determining what ED is.…”

“…These include emotional children, those who are very impulsive and those who do not adapt easily to strange environments. 1 …”

“…Desflurane in some studies caused more ED than sevoflurane. 1 Analgesic/sedative agents The use of opiates such as fentanyl (1-2.5 µg/kg) and alfentanil (10 µg/kg) 10 reduced the incidence of ED. The effect was seen in non-or minimally painful procedures as well, such as imaging, and myringotomy and grommets.…”

Agitação no despertar da anestesia em crianças: aspectos atuais

“…29 furthermore, there are no scientific data confirming neurotoxic effects from the degradation products of sevoflurane and its interaction with other types of anesthetic medication in the emergence agitation phenomenon. 1 On the other hand, sevoflurane, isoflurane and desflurane all induce similar electroencephalographic changes during anesthesia, which are different to those provoked by halothane. This fact might explain the low incidence of agitation when patients are anesthetized with halothane.…”

“…However, prolonged episodes of agitation lasting for up to 2 days have been described. 1 There is no definitive explanation for emergence agitation. Many different causes have been suggested, such as rapid return of consciousness in an unfamiliar environment, the presence of pain (wounds, sore throat, bladder distension, etc.…”