Emergence Delirium After Paediatric Anaesthesia: New Strategies in Avoidance and Treatment
Highlights
- Emergence delirium (ED) was first described by Eckenhoff and colleagues1 in the1960s, and is defined in paediatric anaesthesia as ‘a disturbance in a child’s awareness or attention to his/her environment with disorientation and perceptual alterations including hypersensitivity to stimuli and hyperactive motor behaviour in the immediate post anaesthesia period’ (View Highlight)
- The incidence of ED is two to three times more common in children than in adults. Current data would suggest that the incidence of ED varies from 20% to 80% of all paediatric anaesthetics with most of the literature suggesting it to be close to 20% (View Highlight)
- There are defined risk factors, and usually symptoms occur within 30 min of termination of anaesthesia and last for 15–30 min. However, ED can be persistent and has been reported to continue for up to 2 days (View Highlight)
- Sevoflurane and desflurane with their low blood–gas solubility coefficients are associated with rapid washout and emergence from anaesthesia (View Highlight)
- It remains unclear as to whether rapid emergence per se causes ED, or whether emergence in the presence of surgical pain and before the onset of effective analgesia, is a major factor. Both of these theories have flaws: propofol anaesthesia, which is associated with rapid emergence, has a much lower incidence of ED than volatile agents, and slower emergence from volatile anaesthesia per se does not change the incidence of ED (View Highlight)
- Added to this is the effect of preoperative demeanour and anxiety (View Highlight)
- ED can be described with neurological symptoms and terms that amount to a discreet postoperative neurological state, characterised by core neurological and behavioural symptoms: motor agitation, confusion, and lack of recognition or appropriate interaction with their surrounding environment. It usually begins at the start of emergence, but the onset can be as long as 45 min after the termination of anaesthesia (View Highlight)