Prevention and Therapy of Pediatric Emergence Delirium: A National Survey

Huett, Christopher; Baehner, Torsten; Erdfelder, Felix; Hoehne, Claudia; Bode, Christian; Hoeft, Andreas; Ellerkmann, Richard K.

doi:10.1007/s40272-017-0212-x

Cited by 24 publications

(32 citation statements)

References 35 publications

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“…Our survey confirms that the diagnosis of ED remains difficult, especially the distinction between unrelieved pain and ED. Moreover, as in the German and Canadian studies, diagnostic scores were rarely used by the respondents . Lack of eye contact and the ineffectiveness of a trial analgesic treatment appeared to be the two main diagnostic elements, confirming the decision tree proposed by Somaini et al.…”

Section: Figuresupporting

confidence: 75%

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Current practice regarding pediatric emergence delirium in France: A survey of the ADARPEF

Sintzel

Bourdaud

Evain

2020

Pediatric Anesthesia

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Section: Figuresupporting

confidence: 75%

“…Practices for the management of ED appear to be heterogeneous and depend more on individuals' experience than on guidelines. Three recent surveys have reported practices regarding pediatric ED in Canada, Germany, Italy, and the United Kingdom . Such work had not yet been done among French pediatric anesthesiologists.…”

Section: Figurementioning

confidence: 99%

Current practice regarding pediatric emergence delirium in France: A survey of the ADARPEF

Sintzel

Bourdaud

Evain

2020

Pediatric Anesthesia

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“…Potential risk factors for EA in children are as follows: preschool age (2 -5 years), no previous surgery, hospitalization or high number of previous interventions, poor adaptability, attention-deficit hyperactivity disorder, patient pre-existing behavior, psychological immaturity, preoperative anxiety, parental anxiety, patient and parent interaction with healthcare providers, lack of premedication (with midazolam), paradoxical reaction to midazolam stated in child's medical history, type of surgery, use of inhalational anesthetics with low blood-gas partition coefficients (e.g., sevoflurane and desflurane), excessively rapid awakening (in a hostile environment), and pain [6,12,17,29,[34][35][36].…”

Section: Proposed Risk Factors For Emergence Agitationmentioning

confidence: 99%

Emergence agitation: current knowledge and unresolved questions

Lee

Sung

2020

Korean J Anesthesiol

115

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This article is protected by copyright of Korean Journal of Anesthesiology. All rights reserved. Emergence agitation (EA), which is also referred to as emergence delirium, can lead to clinically significant consequences. The mechanism of EA remains unclear. Proposed contributors to EA include age, male sex, type of surgery, emergency operation, use of inhalational anesthetics with low blood-gas partition coefficients, long duration of surgery, anticholinergics, premedication with benzodiazepines, voiding urgency, postoperative pain, and the presence of invasive devices. If preor intraoperative objective monitoring could predict the occurrence of agitation during emergence, this would help to reduce the adverse consequences of EA. Several tools are available for assessing EA; however, its incidence varies considerably according to the assessment tool and definition of EA used, due to the absence of standardized clinical research practice guidelines. Total intravenous anesthesia, propofol, μ-opioid agonists, N-methyl-D-aspartate receptor antagonists, nefopam, α2adrenoreceptor agonists, regional analgesia, multimodal analgesia, parent-present induction, and preoperative education for surgery may contribute to prevention of EA. However, it is difficult to identify patients at high risk for EA and to properly apply EA prevention methods in various clinical situations, because both risk factors and preventive strategies often show inconsistent results depending on the methodology of the study and the patients assessed. This review discusses the most important research topics related to EA and directions for future research.

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“…Emergence agitation occurs frequently in children during recovery from sevoflurane anesthesia, which may accompany with the risk of self‐injury, lead to an increased length of stay in PACU and result in patient discomfort . Although the etiology of emergence agitation remains unclear, several pharmacological agents have been proposed to reduce the incidence of emergence agitation, including sedative agents, opioids, and α 2 adrenergic receptor agonists . Our data indicated that dexmedetomidine prolonged the time of emergence from anesthesia but did not delay PACU discharge.…”

Section: Discussionmentioning

confidence: 70%

Caudal and intravenous dexmedetomidine similarly prolong the duration of caudal analgesia in children: A randomized controlled trial

Yao

Zhang

et al. 2018

Pediatric Anesthesia

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Summary Background Dexmedetomidine can prolong the duration of action of a local anesthetic agent, but the route of administration that is the most beneficial remains unclear. The purpose of this study was to compare the clinical effectiveness of caudal or intravenous dexmedetomidine administration on postoperative analgesia in children undergoing inguinal hernia repair given caudal levobupivacaine. Methods This was a prospective, randomized, double‐blinded, placebo‐controlled trial. Ninety ASA I subjects, aged 2‐5 year, undergoing unilateral inguinal hernia repair were enrolled. The children were randomized in a double‐blind fashion to three groups. The L‐Dcau group received 1 mL/kg of caudal 0.25% levobupivacaine plus 1 μg/kg dexmedetomidine and IV 20 mL saline. The L‐Div group received 1 mL/kg of caudal 0.25% levobupivacaine and IV 1 μg/kg dexmedetomidine in 20 mL saline. The L group received 1 mL/kg of caudal 0.25% levobupivacaine and IV 20 mL saline. The primary outcome was the duration of analgesia, which was defined as the time from the caudal block to a Postoperative Pain Scale (CHIPPS) score ≥4. Secondary outcomes were the number of patients requiring rescue analgesia, pain intensity, the incidence of emergence agitation, intraoperative hemodynamic variations, residual motor block, and adverse effects. Results The median duration of analgesia in the L‐Dcau group was 14.2 hour compared to 6 hour in the L group with a median difference of 8.5 hour [95% CI (6.5, 10.5), P < 0.001]. The median duration of analgesia in the L‐Div group was 12.4 hour compared to 6 hour in the L group with a median difference of 6.4 hour [95% CI (4, 8.5), P < 0.001]. Fewer patients in the L‐Dcau and L‐Div groups required rescue analgesia in the first 24 hour postoperatively compared to the L group, although there was no significant difference between the L‐Dcau and L‐Div groups for these outcomes. Both dexmedetomidine routes reduced the pain and the incidence of emergence agitation. No bradycardia, hypotension, or motor block was observed in any of the three groups. Conclusion Caudal and IV dexmedetomidine similarly prolong the duration of analgesia produced by caudal levobupivacaine.

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Prevention and Therapy of Pediatric Emergence Delirium: A National Survey

Abstract: Propofol is the preferred choice for pharmacological prevention and treatment of ED among German anesthesiologists. Further therapy options as well as alternatives to a midazolam-centered premedication procedure are underrepresented.

Cited by 24 publications

References 35 publications

Current practice regarding pediatric emergence delirium in France: A survey of the ADARPEF

Current practice regarding pediatric emergence delirium in France: A survey of the ADARPEF

Emergence agitation: current knowledge and unresolved questions

Caudal and intravenous dexmedetomidine similarly prolong the duration of caudal analgesia in children: A randomized controlled trial

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