Incidence of Emergence Delirium in the Pediatric PACU: Prospective Observational Trial

Abstract

Emergence delirium (ED) is a postoperative complication in pediatric anesthesia characterized by perception and psychomotor disorder and has a negative impact on morbidity in the form of maladaptive behavior, which can last weeks after anesthesia. Patients with developed ED present with psychomotor anxiety, agitation, and are at higher risk of unintentional extraction of an intravenous cannula, self-harm and nausea and vomiting. The described incidence of ED varies between 25–80%, with a higher prevalence among children younger than 6 years of age. We aimed to determine the incidence of ED in pediatric patients (>1 month) after general anesthesia in the post-anesthesia care unit (PACU), using Paediatric Anaesthesia Emergence Delirium (PAED) score, Watcha score and Richmond agitation and sedation scale (RASS). The incidence of ED was the highest in the PAED score with cutoff ≥10 points (89.0%, n = 1088). When using PAED score >12 points, ED incidence was 19.3% (n = 236). The lowest incidence was described by Watcha and RASS scores, 18.8% (n = 230) vs. 18.1% (n = 221), respectively. The threshold for PAED ≥10 points seems to give false-positive results, whereas the threshold >12 points is more accurate. RASS scale, although intended primarily for estimation of the depth of sedation, seems to have a good predictive value for ED.

Effect of Preoperative Clear Liquid Consumption on Postoperative Recovery in Pediatric Patients Undergoing Minimally Invasive Repair of Pectus Excavatum: A Prospective Randomized Controlled Study

“…In our study, we utilized two ED evaluation scores—PAED and Watcha—with good sensitivity and specificity in diagnosing ED. Although the cut-off values for PAED have varied among studies, a PAED score of ≥12 more accurately identifies ED compared with a score of 10 [ 31 , 32 ]. A PAED score of ≥12 has demonstrated 100% sensitivity and 94.5% specificity in diagnosing ED [ 33 ].…”

Possible role of high calcium concentrations in rat neocortical neurons in inducing hyper excitatory behavior during emergence from sevoflurane: a proposed pathophysiology

“…Emergence delirium increases the risk of patient safety incidents, increases workload, and may prolong the patient’s length of stay, thereby increasing the overall healthcare cost. 2 3 The etiology of emergence delirium has yet to be understood, thus, an optimal course of action has not been determined yet.…”

Assessment of the Delirium Prevalence Among Pediatric Patients Admitted to the Pediatric Intensive Care Unit in West of Iran

“…On the other hand, the patients may be exposed to hypoactive delirium and be neglected by the treatment staff due to their calm appearance and, therefore, be susceptible to pressure ulcers or pneumonia more frequently. This group of patients, moreover, has symptoms of lethargy, impatience, and depression (9)(10)(11).…”