Paediatric emergence delirium: a comprehensive review and interpretation of the literature

Mason, Keira P.

doi:10.1093/bja/aew477

Cited by 185 publications

(230 citation statements)

References 79 publications

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“…Emergence Delirium (ED) is a common complication from anesthesia, especially for pediatric patients, with prevalence ranging from 2% to 80% . The occurrence of ED depends on, among other factors, the choice of anesthesia, with sevoflurane being associated with the highest occurrence of ED …”

Section: Introductionmentioning

confidence: 99%

“…ED has been described as a mental disturbance during recovery from general anesthesia that consists of hallucinations, crying, confusion, restlessness, and physical activity such as the child tossing and turning in bed . ED mainly occurs within the first 30 minutes after a procedure and is often limited to a period of 15 minutes .…”

Section: Introductionmentioning

confidence: 99%

“…In addition, ED can create dissatisfaction with hospital procedures for children, parents, and staff . In the hospital, ED often requires additional resources: staff, sedatives, and/or analgesics for the child, which may consequently lead to a prolonged hospital stay or maladaptive behavioral changes …”

Section: Introductionmentioning

confidence: 99%

“…2,5-7 ED has been described as a mental disturbance during recovery from general anesthesia that consists of hallucinations, crying, confusion, restlessness, and physical activity such as the child tossing and turning in bed. 1,2,8,9 ED mainly occurs within the first 30 minutes after a procedure and is often limited to a period of 15 minutes. 9 The early detection of ED is important as it may influence post-operative outcomes for the child and result in, eg, physical harm or dislocation of catheters.…”

mentioning

confidence: 99%

“…1,5,8,11 In the hospital, ED often requires additional resources: staff, sedatives, and/or analgesics for the child, which may consequently lead to a prolonged hospital stay or maladaptive behavioral changes. 2,9,12,13 The risk factors associated with ED are the child's age, temper, pre-operative anxiety, pain management, anesthesia method, and procedure length. 1,2,9,10,12,14 A few studies have found pain as a possible confounder for ED, and 1 study found difficulties in distinguishing between pain and ED when using different measurement tools.…”

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confidence: 99%

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An evaluation of the Danish version of the Pediatric Anesthesia Emergence Delirium scale

Simonsen

Skovby²,

Lisby

2020

Acta Anaesthesiol Scand

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Background Emergence Delirium (ED) is a common complication from anesthesia. Although ED has a short duration, detection is important due to the risk that ED poses for post‐operative complications in the child. The Pediatric Anesthesia Emergence Delirium (PAED) scale has been translated into Danish, but it has not yet been validated. The aim of this study was to investigate the inter‐rater reliability, criterion validity, and responsiveness of the Danish version of the PAED scale as well as to determine the prevalence of ED. Method A sample of 100 post‐operative children were enrolled and assessed with the PAED scale at pre‐specified time intervals. Inter‐rater reliability was assessed independently by 2 raters. For criterion validity, a clinical expert was chosen as the gold standard. Sensitivity and specificity were based on a comparison between the scoring of the raters and the gold standard. Responsiveness was assessed by comparing changes in scores. Prevalence was based on the PAED scale's cut‐off level of ≥10 points. Results A high level of agreement was found, with an intraclass correlation coefficient of 0.85‐0.94. Few outliers appeared in the Bland‐Altman plot. Sensitivity ranged from 70% to 86%, and the specificity of both raters against the gold standard was 100%. Changes in scores were indicative of responsiveness. Prevalence was 13.2%. Conclusion The Danish version of the PAED scale was found reliable and demonstrated high levels of sensitivity and specificity. In addition, it was possible to identify changes in scores over time. Prevalence was in line with existing literature.

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Section: Introductionmentioning

confidence: 99%

Section: Introductionmentioning

confidence: 99%

Section: Introductionmentioning

confidence: 99%

mentioning

confidence: 99%

mentioning

confidence: 99%

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An evaluation of the Danish version of the Pediatric Anesthesia Emergence Delirium scale

Simonsen

Skovby²,

Lisby

2020

Acta Anaesthesiol Scand

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Effect of Intranasal Dexmedetomidine or Midazolam for Premedication on the Occurrence of Respiratory Adverse Events in Children Undergoing Tonsillectomy and Adenoidectomy

Shen

Zhang

et al. 2022

JAMA Netw Open

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Effects of Intraoperative Auditory Stimulation on Pain and Agitation on Awakening After Pediatric Adenotonsillectomy

Muzzi

Ronfani

Bossini

et al. 2021

JAMA Otolaryngol Head Neck Surg

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IMPORTANCE Severe pain on awakening (POA) and emergence delirium (ED) are common following pediatric adenotonsillectomy. Effective preventive interventions are lacking. OBJECTIVE To determine the effects of intraoperative auditory stimulation on reduction of POA and ED after pediatric adenotonsillectomy. DESIGN, SETTING, AND PARTICIPANTS Single-center, double-blinded, 4-armed, randomized clinical trial of children undergoing adenotonsillectomy from March 2018 to May 2019 at a tertiary care pediatric referral center.INTERVENTIONS Children were randomized to 1 of the following groups: auditory stimulation with music, auditory stimulation with noise, ambient noise insulation with masking earplugs, and a control group receiving no intervention. Ear inserts were placed in the operating room once general anesthesia was administered. Stimulation parameters were based on the preoperative audiological evaluation and the appropriate fitting of the transduction system, including ambient noise level monitoring. MAIN OUTCOMES AND MEASURESThe primary outcome was POA levels measured on 10-point scales according to age-appropriate validated tools. The secondary outcome was ED levels assessed according to the Pediatric Anesthesia Emergence Delirium 20-point scale.RESULTS A total of 104 consecutive healthy children (median [interquartile range] age at surgery, 5.0 [3.8-6.4] years) were included in the analysis. Music had a large effect size on POA (0.63; 98% CI, 0.43-0.84) and a medium effect size on ED (0.47; 98% CI, 0.21-0.75), while noise had a medium effect size on POA (0.47; 98% CI, 0.22-0.73) and a large effect size on ED (0.63; 98% CI, 0.44-0.85) compared with controls. The earplugs group showed a small effect size on POA and ED. Considering a clinically meaningful threshold of greater than 4 for POA and 10 or greater for ED at dichotomized analysis, a large effect size was achieved by music (1.39; odds ratio [OR], 0.08; 98% CI, 0.02-0.29; and 0.84; OR, 0.22; 98% CI, 0.06-0.75, respectively) and noise (0.97; OR, 0.17; 98% CI, 0.05-0.6; and 1.48; OR, 0.07; 98% CI, 0.02-0.26, respectively), while earplugs resulted in a small effect size. CONCLUSIONS AND RELEVANCEIn this randomized clinical trial, children undergoing adenotonsillectomy who received intraoperative auditory stimulation demonstrated a clinically meaningful decrease in POA and ED in the immediate postoperative period. Further research is needed to assess whether intraoperative auditory stimulation may decrease POA and ED in children undergoing other types of surgical procedures.

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Paediatric emergence delirium: a comprehensive review and interpretation of the literature

Cited by 185 publications

References 79 publications

An evaluation of the Danish version of the Pediatric Anesthesia Emergence Delirium scale

An evaluation of the Danish version of the Pediatric Anesthesia Emergence Delirium scale

Effect of Intranasal Dexmedetomidine or Midazolam for Premedication on the Occurrence of Respiratory Adverse Events in Children Undergoing Tonsillectomy and Adenoidectomy

Effects of Intraoperative Auditory Stimulation on Pain and Agitation on Awakening After Pediatric Adenotonsillectomy

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