Emergence Delirium in Paediatric Anaesthesia

Abstract

Emergence delirium(ED) in children is a well-documented clinical phenomenon with incidence rangingfrom 25 to 80%. It is characterized by confusion, mental irritability, disorientation, inconsolable crying,and thrashing. No single factor can identified as the cause of postoperative agitation, which shouldtherefore be considered a syndrome made up of biological, pharmacological, psychological and socialcomponents. Possible causes and risk factors include child’s personality, inhalation anaesthetics,surgery of head and neck, rapid awakening and pain. Many scales have been proposed to evaluate theincidence and severity of ED and a variety of scales are used in clinical practice and for researchpurposes in children. Preventive measures include the co-administration of propofol, midazolam, orfentanyl, but the risks associated with their use must be weighed against the self-limiting nature of ED.Once ED is established, the most common interventions are pharmacological. Treatment options areclam environment in recovery and with agents having sedative and analgesic effect,such as propofol,fentanyl, ketamine andalpha-2 receptor agonists (clonidine and dexmedetomidine). ED may increasethe incidence of new-onset postoperative maladaptive behavior changes such as general anxiety,night-time crying, bed wetting, general anxiety and loss of appetite for up to 14 days after surgery. Astandard diagnostic, preventable and treatable guideline should be required for adverse outcomes in thepaediatric populations.

JBSA 2021; 34 (2) : 16-23