Incidence and associated factors of emergence agitation after general anesthesia and surgery among pediatric patients: A prospective follow-up study

Abstract

Introduction: Emergence agitation is one of the significant anesthetic and surgery-related complications. It is usually short-lived but causes self-injury during agitation and it led to parental anxiety. This study was aimed to assess incidence and factors associated with emergence agitation after general anesthesia and surgery among pediatric patients at University of Gondar specialized hospital. Methods: A prospective follow-up study conducted on 153 pediatric patients aged 2–9 years who were operated from first February to April 30, 2019. Emergence agitation was recorded by the pediatrics anesthesia emergence delirium scale. Descriptive statistics performed to determine the incidence. To identify the associated factors multi-variable binary logistic regression was held, and a p-value <0.05 was considered as significant. Results: Emergence agitation was experienced on eighty (52.3%) children with a mean and standard deviation of 12 ± 5.9 min of duration. Among agitated children, 8 (10%) of them developed adverse events related to agitation. Difficult parental separation behaviour (AOR = 2.688, 95% CI = 1.131–6.39), children aged 2–5 years (AOR = 2.688, 95% CI = 1.131–6.3925), isoflurane maintenance (AOR = 4.001, 95% CI = 1.733–9.234) and propofol administration after maintenance closure (AOR = 0.145, 95% CI = 0.030–0.695) were significantly associated with agitation. Conclusion: Being a preschool child, difficult parental separation and isoflurane maintenance were associated with emergence agitation. But propofol administration after maintenance closure was found to be protective. So, agitation should be assessed and detected in the postoperative period and efforts should apply to prevent emergence agitation. Highlights:

Correlation Between Sociocultural and Economic Factors in Pediatric Patients' Families and Emergence Delirium

“…In pediatric patients undergoing surgery, delirium rates can reach up to 66% [ 2 , 12 ]. Previous studies have indicated higher rates of recovery agitation following ophthalmic and ear, nose, and throat surgeries, suggesting the significance of these procedures as determinants of delirium [ 13 ]. Eshetie et al [ 13 ] reported a higher incidence of delirium in ophthalmic and ear-nose-throat surgeries (56.2%) compared to other surgical procedures (32.7%).…”

“…Previous studies have indicated higher rates of recovery agitation following ophthalmic and ear, nose, and throat surgeries, suggesting the significance of these procedures as determinants of delirium [ 13 ]. Eshetie et al [ 13 ] reported a higher incidence of delirium in ophthalmic and ear-nose-throat surgeries (56.2%) compared to other surgical procedures (32.7%). Ophthalmic surgeries, in particular, have a higher incidence of postoperative delirium due to changes in vision following the operation compared to other pediatric surgeries [ 14 ].…”

“…Age group is recognized as a factor that can influence postoperative delirium [ 7 , 12 , 16 ]. Many studies have highlighted a higher occurrence of delirium in preschoolers, particularly in patients aged 2-5 [ 7 , 13 , 16 ]. Similar to the literature, in our study, patients, being under six years of age, were a risk factor for delirium.…”

Incidence of emergence agitation in children undergoing sevoflurane anesthesia compared to isoflurane anesthesia: An updated systematic review and meta‐analysis

“…As might be expected, EA is also associated with parental and staff dissatisfaction 2 . EA has been associated with other complications like impaired functional recovery 3 . The exact mechanism of EA is still unknown despite identifying numerous risk factors.…”

“…2 EA has been associated with other complications like impaired functional recovery. 3 The exact mechanism of EA is still unknown despite identifying numerous risk factors. Potential risk factors for EA include patient age, temperament, preoperative anxiety, pain, type of surgery, and anesthetic strategy.…”