<p>Emergence Agitation and Delirium: Considerations for Epidemiology and Routine Monitoring in Pediatric Patients</p>

Abstract

Emergence from anesthesia can be associated with a wide spectrum of cognitive and behavioral dysregulation in children, including delirium or acute brain dysfunction. This period of neurobehavioral recovery can be further confounded by pain, anxiety, and fear. The implementation of monitoring for level of consciousness, pain, and delirium using valid pediatric tools is necessary to avoid misdiagnosis due to overlapping symptomatology and support appropriate management. Understanding the epidemiology of delirium in the postoperative setting will require consistent use of accurate terminology in the medical literature. The current interchangeable use of the terms “emergence agitation” and “emergence delirium” needs to be highlighted and awareness of differences in patient conditions and assessment tools is essential. We discuss epidemiology of emergence agitation and delirium in the pediatric population, and the challenges for future delineation of monitoring and management. Furthermore, we describe the possible impact of long-term consequences of emergence delirium among infants and children, and the necessary areas of future research.

Predictive Value of Preoperative Profiling of Serum Metabolites for Emergence Agitation After General Anesthesia in Adult Patients

“…Accumulating evidence has shown that EA/delirium has a strong relationship with POD ( Sharma et al, 2005 ; Neufeld et al, 2013 ; Card et al, 2015 ). However, distinguishing EA from emergence delirium is still challenging ( Kwak, 2010 ; Lee and Sung, 2020 ; Menser and Smith, 2020 ). Pediatric EA appears to be an asynchronism of different brain regions during the washout of volatile anesthetics and tends toward anxiety due to immature psychology ( Dahmani et al, 2014 ).…”

“…Pediatric EA has attracted widespread attention due to its high incidence ( Voepel-Lewis et al, 2003 ; Silva et al, 2008 ; Kanaya, 2016 ; Menser and Smith, 2020 ). In recent years, adult EA has been the top priority of perioperative management ( Lepousé et al, 2006 ; Lee and Sung, 2020 ).…”

The effects of intraoperative magnesium sulfate administration on emergence agitation and delirium in pediatric patients: A systematic review and meta‐analysis of randomized controlled trials

“…This dissociated state of consciousness has been referred to by various terms since it was first described, including emergence agitation (EA), emergence delirium (ED), and emergence excitation. Although these terms are not synonymous with each other, they have been used interchangeably to describe behavioral dysregulation in the post‐anesthesia period, particularly in pediatric patients 2 …”

“…Currently, the mechanism behind EA/ED remains unclear. As there are no validated methods for the prevention or treatment of EA/ED, various efforts are ongoing to identify the risk factors for and reduce the incidence and severity of EA/ED 2 . One suggested pharmacologic intervention for the prevention of EA/ED is the intraoperative administration of magnesium sulfate 5 …”

Effects of Dexmedetomidine on Inflammatory Factors and Mitogen Activated Protein Kinase-Related Signaling Pathways of Alveolar Lavage Fluid in Mice with Lipopolysaccharide-Induced Acute Lung Injury

“…Dexmedetomidine (Dex) is currently widely used in critically ill patients, with ideal sedative and analgesic effects, and can be used as one of the adjuvant clinical anesthesia drugs [6] . Clinical studies have confirmed that dexmedetomidine plays an important role in resisting inflammatory response and protecting organs [7] . However, the mechanism of the anti-inflammatory effect of dex and sepsis induced acute lung injury is not clear, so the purpose of this study is to explore the effect of DEX on alveolar lavage fluid inflammatory factor and MAPK-related signaling pathway in mice with acute lung injury induced by lipopolysaccharide (LPS).…”