Emergence delirium after paediatric anaesthesia: new strategies in avoidance and treatment

Nair, Shrijit; Wolf, Andrew

doi:10.1016/j.bjae.2017.07.001

Cited by 31 publications

(51 citation statements)

References 18 publications

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“…The incidence of emergence agitation is two to three times more common in children than in adults. 26 Our meta-analysis showed that IV clonidine premedication produced an 11% lower incidence of emergence agitation than a placebo. Ydemann et al 27 conducted…”

Section: Ta B L E 3 Results Of Subgroup Analysesmentioning

confidence: 77%

Safety and efficacy of clonidine on postoperative vomiting and pain in pediatric ophthalmic surgery: A systematic review and meta‐analysis

Hsu

Chu

Bai

et al. 2019

Pediatric Anesthesia

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Background Postoperative vomiting and pain are common, unpleasant phenomena in pediatric patients undergoing ophthalmic surgery. Clonidine has antiemetic and analgesic properties and thus may be used as premedication to reduce postoperative vomiting and pain. Aim To assess whether clonidine premedication may safely decrease postoperative vomiting and postoperative pain in pediatric patients who received an ophthalmic surgery. Methods We systematically searched PubMed, EMBASE, Cochrane Library, and Scopus databases from their inception to September 2018. Randomized clinical trials comparing clonidine premedication with a placebo or an active comparator that investigated postoperative vomiting or postoperative pain in pediatric patients undergoing ophthalmic surgery were included. The primary outcome was postoperative vomiting. The secondary outcome was postoperative pain. We also evaluated the safety of clonidine premedication by tracking hemodynamic instability associated with its use. Results Ten studies with 979 patients were eligible for inclusion. Clonidine achieved a significantly lower incidence of postoperative vomiting within 6 hours postoperatively, 6‐24 hours postoperatively, and at the end of the study (risk difference: −0.15; 95% confidence interval: −0.32 to −0.05; risk difference: −0.15; 95% confidence interval: −0.29 to 0.01; and risk difference: −0.23; 95% confidence interval: −0.34 to −0.12, respectively) than placebo. For the subgroup of patients who received strabismus surgery, clonidine produced a lower incidence of postoperative vomiting than placebo (risk difference: −0.19; 95% confidence interval: −0.29 to −0.05). Compared to benzodiazepine, clonidine achieved a lower incidence of postoperative vomiting at the end of the study (risk difference: −0.19; 95% confidence interval: −0.31 to −0.07); the effect was only observed in patients receiving clonidine 4 μg/kg. Furthermore, children receiving clonidine had lower postoperative pain scores, lower analgesic requirements, and more of them were pain‐free compared to those who received a placebo. No patient using clonidine had any major hemodynamic instability. Conclusion Compared to placebo or benzodiazepine, clonidine premedication was effective in reducing postoperative vomiting in pediatric patients undergoing ophthalmic surgery. Clonidine premedication also provided more reduction in postoperative pain when compared to placebo. The use of clonidine premedication was not associated with adverse hemodynamic events.

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Section: Ta B L E 3 Results Of Subgroup Analysesmentioning

confidence: 77%

Safety and efficacy of clonidine on postoperative vomiting and pain in pediatric ophthalmic surgery: A systematic review and meta‐analysis

Hsu

Chu

Bai

et al. 2019

Pediatric Anesthesia

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“…This is higher than that quoted in the pediatric dental surgery population of between 13% and 29% 13,18,19 . Our entire study population comprised patients in the preschool group undergoing sevoflurane volatile anesthesia, both of which are established risk factors for ED 2,8,9 . The patients with ED in our study had a mean age of 3.8 years.…”

Section: Discussionmentioning

confidence: 76%

“…ED is a well‐described complication in pediatric anesthesia, more often occurring following short surgical procedures using volatile anesthetics with a rapid recovery profile 8 . The incidence of ED ranges from 10%‐80% 2 with most studies suggesting an incidence of 20% 9 . Inconsistent definitions, different scoring systems and different threshold values for ED contribute to the wide incidence 2 …”

Section: Introductionmentioning

confidence: 99%

“…Risk factors for the development of ED include preschoolers; volatile agents, particularly sevoflurane; otorhinolaryngology and ophthalmology procedures; child temperament; and preoperative child and parent anxiety 2,6,8‐10 . ED occurs soon after emergence and lasts on average between 5 and 15 minutes but may persist up to 45 minutes; it does not recur 2,3,8,9,11 and is associated with a longer recovery room stay 3 . Postoperative maladaptive behavior has been associated with ED 12,13 …”

Section: Introductionmentioning

confidence: 99%

“…While ED is self‐limiting, the experience is unpleasant. It causes distress to the child, parent, nursing staff, and anesthetist as well as causing parental dissatisfaction 9,14 . The child may also inflict self‐harm, disrupt the surgical site, and remove intravenous lines or catheters 14 …”

Section: Introductionmentioning

confidence: 99%

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Emergence delirium in children undergoing dental surgery under general anesthesia

Jooma

Perrie

Scribante

et al. 2020

Pediatric Anesthesia

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Background: Emergence delirium is a well-described complication in pediatric anesthesia, occurring more often following short surgical procedures using volatile anesthetics with a rapid recovery profile. Dental extractions and conservation dentistry are commonly performed in children and are not painful postoperatively. The use of nerve blocks and local anesthetic infiltration intraoperatively limits nociception and obviates the need for opioids, allowing for more objective assessment of emergence delirium. Aim: The purpose of this preliminary study was to describe the incidence of emergence delirium and the associated risk factors in children undergoing elective dental surgery under general anesthesia at a regional academic hospital in South Africa. Methods: A prospective, descriptive study of healthy children aged 2-6 years was undertaken. Patients were anesthetized using standardized protocols. Assessments included demographics of the child and caregiver, child anxiety at induction using the modified Yale Preoperative Anxiety Scale, intraoperative events, and Paediatric Anaesthesia Emergence Delirium score in the recovery room. Data were assessed for associations and correlations. Results: Ninety-one children with a mean age of 3.9 (SD = 0.9) years were included. Anxiety was present in 69.2% at induction and emergence delirium occurred in 51.6% of the patients. The mean (SD, range) Paediatric Anaesthesia Emergence Delirium score in the patients without emergence delirium was 7 (2.65, 0-9) and in patients with emergence delirium was 14 (2.52, 10-18). Children with emergence delirium required more interventions in the recovery room but few required pharmacological treatment. Conclusions: Emergence delirium occurs commonly after dental surgery, and the majority of the children presenting for dental surgery are anxious at induction. Children with emergence delirium require more interventions in the recovery room but few require pharmacological treatment.

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The Effect of Alfentanil on Emergence Delirium Following General Anesthesia in Children: A Randomized Clinical Trial

et al. 2022

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Background Emergence delirium can occur after general anesthesia in children. An intravenous infusion of alfentanil may reduce the incidence or severity of emergence delirium after sevoflurane anesthesia. Objective The study aimed to investigate the effects of alfentanil intravenous infusion on emergence delirium and other perioperative complications. Method This was a single-center, randomized, placebo-controlled, double-blind clinical trial. A total of 172 children undergoing ambulatory dental treatment were randomized into three groups. Alfentanil group Alf2 received 0.2 μg/kg/min of alfentanil for continuous infusion, alfentanil group Alf4 received 0.4 μg/kg/min alfentanil, and the saline group (group Sal) received a continuous infusion of normal saline, with the same volume as the two other groups, as a placebo. The incidence of emergence delirium (assessed by the Paediatric Anaesthesia Emergence Delirium [PAED] scale), hemodynamic parameters, and recovery characteristics were recorded during the recovery period. The Aono scale was also used to assess for emergence delirium. A WeChat applet was designed to facilitate a caregiver teleconsultation and to provide feedback on postoperative nausea and vomiting and any other complications after discharge. ResultsThe incidence of emergence delirium in group Alf2 (22.9%) and group Alf4 (21.1%) was significantly lower than that observed in the Sal group (48.3%). The PAED scores in group Alf2 (6.4 ± 3.5) and group Alf4 (5.8 ± 3.8) were significantly lower than those for group Sal (9.6 ± 5.1) (p < 0.01). Ten children in the Alf4 group needed manual ventilatory assistance to maintain end-tidal carbon dioxide (ETCO 2 ) < 55 mm; children in group Alf2 did not. There was no significant difference between the discharge time of groups Alf2 and Sal (31.2 ± 4.64 vs 30.5 ± 2.82 min; 0.659 [95% confidence interval {CI} −1.052 to 2.369], p = 0.643); the time to discharge of group Alf4 (35.16 ± 3.97 min) was significantly longer than that of groups Alf2 and Sal (p < 0.01). The incidence of nausea and vomiting was similar in the three groups. No other clinically relevant adverse events were observed. Conclusions Intravenous infusion of 0.2 μg/kg/min and 0.4 μg/kg/min alfentanil decreased the incidence of emergence delirium in the post-anesthesia care unit. The 0.2 μg/kg/min dose of alfentanil resulted in less respiratory depression and discharge delay than the 0.4 μg/kg/min alfentanil dose.

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Emergence delirium after paediatric anaesthesia: new strategies in avoidance and treatment

Cited by 31 publications

References 18 publications

Safety and efficacy of clonidine on postoperative vomiting and pain in pediatric ophthalmic surgery: A systematic review and meta‐analysis

Safety and efficacy of clonidine on postoperative vomiting and pain in pediatric ophthalmic surgery: A systematic review and meta‐analysis

Emergence delirium in children undergoing dental surgery under general anesthesia

The Effect of Alfentanil on Emergence Delirium Following General Anesthesia in Children: A Randomized Clinical Trial

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