Drama im Aufwachraum: pädiatrisches Emergence-Delir

Krämer, Sarah; Krebs, Michaël; Spies, Claudia; Ghamari, Shahab; Höhne, Claudia; Becke, Karin; Eich, Christoph; Hoeft, Andreas; Wermelt, Julius Z.; Ellerkmann, Richard K.

doi:10.1055/a-0575-0473

Cited by 6 publications

(4 citation statements)

References 19 publications

(15 reference statements)

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“…However, all interviews were performed by the same investigator. Furthermore, some authors take the view that the parents’ assessment with regard to delirium symptoms is a helpful contribution in practice [ 61 ].…”

Section: Discussionmentioning

confidence: 99%

Depth of anesthesia, temperature, and postoperative delirium in children and adolescents undergoing cardiac surgery

et al. 2023

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Background After pediatric cardiosurgical interventions, postoperative delirium can occur, which can be associated with undesirable consequences during and after the hospital stay. It is therefore important to avoid any factors causing delirium as far as possible. Electroencephalogram (EEG) monitoring can be used during anesthesia to individually adjust dosages of hypnotically acting drugs. It is necessary to gain knowledge about the relationship between intraoperative EEG and postoperative delirium in children. Methods In a dataset comprising 89 children (53 male, 36 female; median age: 0.99 (interquartile range: 0.51, 4.89) years) undergoing cardiac surgery involving use of a heart–lung machine, relationships between depth of anesthesia as measured by EEG (EEG index: Narcotrend Index (NI)), sevoflurane dosage, and body temperature were analyzed. A Cornell Assessment of Pediatric Delirium (CAP-D) score ≥ 9 indicated delirium. Results The EEG could be used in patients of all age groups for patient monitoring during anesthesia. In the context of induced hypothermia, EEG monitoring supported individually adjusted sevoflurane dosing. The NI was significantly correlated with the body temperature; decreasing temperature was accompanied by a decreasing NI. A CAP-D score ≥ 9 was documented in 61 patients (68.5%); 28 patients (31.5%) had a CAP-D < 9. Delirious patients with an intubation time ≤ 24 h showed a moderate negative correlation between minimum NI (NImin) and CAP-D (rho = -0.41, 95% CI: -0.70 – -0.01, p = 0.046), i.e., CAP-D decreased with increasing NImin. In the analysis of all patients’ data, NImin and CAP-D showed a weak negative correlation (rho = -0.21, 95% CI: -0.40 – 0.01, p = 0.064). On average, the youngest patients had the highest CAP-D scores (p = 0.002). Patients with burst suppression / suppression EEG had a longer median intubation time in the intensive care unit than patients without such EEG (p = 0.023). There was no relationship between minimum temperature and CAP-D score. Conclusions The EEG can be used to individually adjust sevoflurane dosing during hypothermia. Of the patients extubated within 24 h and classified as delirious, patients with deeper levels of anesthesia had more severe delirium symptoms than patients with lighter levels of anesthesia.

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Section: Discussionmentioning

confidence: 99%

Depth of anesthesia, temperature, and postoperative delirium in children and adolescents undergoing cardiac surgery

et al. 2023

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“…The PAED scale, used for the assessment of EA, is a known tool for evaluating EA, the reliability and validity of which has been previously proved (22)(23)(24)(25). While some recent studies (26) propose the use of age-adjusted PAED scores, no such score was used in this study. Using the PAED scale, midazolam and propofol showed comparable effectiveness in preventing EA.…”

Section: Discussionmentioning

confidence: 99%

Comparison Between Administration of Midazolam and Propofol at the End of Anesthesia for Prevention of Emergence Agitation in Children

et al. 2019

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Background: Comparison of midazolam and propofol has been done hoping to reduce the incidence rates of emergence agitation (EA) after anesthesia. Both drugs however, are still under inspection as for their effect on EA after using Isoflurane for maintenance of anesthesia. Objectives: This study was designed for measuring the effect of either propofol or midazolam near the end of tonsillectomy operation on incidence of EA during the recovery phase. Methods: In this randomized, double-blind study, 90 children, aged 5 to 15, undergoing anesthesia with Isoflurane were randomly assigned to three groups receiving either propofol (group P), midazolam (group M) or saline (group S) near the end of anesthesia. Severity and incidence of EA were then calculated using the pediatric anesthesia emergence delirium (PAED) scale. Results: The mean PAED score in group P was (2.87 ± 2.69) and (1.90 ± 2.55) in group M. Both were significantly lower than group S (7.60 ± 3.78) (P < 0.05). However, there was no statistical difference in the duration of post-anesthesia care unit (PACU) stay between groups P (42.50 ± 12.58) and M (48.33 ± 24.26), groups P and S (52.00 ± 10.64) and between groups M and S (P > 0.05). No significant difference was found between all groups for apnea and laryngospasm (P > 0.05). Conclusions: Administration of either midazolam or propofol near the end of operation may result in reduction of EA in children undergoing tonsillectomy after Isoflurane anesthesia.

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“…Weitere, typische Komplikationen im AWR sind Schmerzen und postoperative Unruhe oder das sog. Aufwachdelir ("emergence delirium", [26]).…”

Section: Wichtigunclassified

Präoperative Vorbereitung in der Kinderanästhesie

Becke‐Jakob

Eich

Röher

2020

Monatsschr Kinderheilkd

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Tab. 1 Risikofaktoren für perioperative Komplikationen. (Nach Becke [3]) Patientenbezogen Alter <1 Jahr, im Speziellen <1 Monat Ehemalige Frühgeborene Schwerwiegende Komorbiditäten Kinder mit hyperreagiblem Atemweg Kinder mit Herzerkrankungen und/oder pulmonaler Hypertension Eingriffsbezogen Atemwegsnahe Eingriffe (Hals-, Nasen-, Ohren-, Augen-, Zahn-, Mundund Kieferoperationen) Abdominal-, Thorax-oder Kardiochirurgie Notfalleingriffe Anlage eines zentralen Venenkatheters Anästhesie-/ Teambezogen Individuelle und institutionelle Kompetenz

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Drama im Aufwachraum: pädiatrisches Emergence-Delir

Cited by 6 publications

References 19 publications

Depth of anesthesia, temperature, and postoperative delirium in children and adolescents undergoing cardiac surgery

Depth of anesthesia, temperature, and postoperative delirium in children and adolescents undergoing cardiac surgery

Comparison Between Administration of Midazolam and Propofol at the End of Anesthesia for Prevention of Emergence Agitation in Children

Präoperative Vorbereitung in der Kinderanästhesie

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