Postoperative emergence delirium in children: a narrative review of recent publications

Abstract

Background: Emergence delirium is a challenge in pediatric anesthesiology, with important unanswered questions concerning incidence, causation, diagnosis, treatment, and sequelae. In this review, we will present the recent research with a particular focus placed on treatment and prevention options. Methods: A wide literature search was conducted across MEDLINE and other databases using PubMed, Embase, Ovid, and the Cochrane Library (latest access: 23 November 2020). The collected publications were assessed for relevance. Only randomized controlled trials and observational studies on postoperative emergence delirium in children were included. Exclusion criteria were articles published before 2018, and studies comprising children older than 12 years of age, mental retardation, or chronic diseases. Results: The final number of studies included in this review was 44. Risk factors identified for emergence delirium were volatile inhalation anesthetics, young age, child temperament, preoperative anxiety, male gender, and specific surgical procedures. Preventive and/or intervention measures were pharmacological (e.g. TIVA, α2-adrenergic agonists (particularly dexmedetomidine), ketamine, propofol, midazolam, opioids (fentanyl)) and non-pharmacological measures (e.g. video or tablet distraction, familiarization with the operating environment, use of mother’s voice, visual preconditioning in eye surgery). Conclusion: ED should be considered a “vital sign” and recorded and documented in all children in the PACU. There is an urgent need for future research to fill in missing gaps of knowledge regarding ED. Implementation of a standardized and validated screening tool for ED are high priorities as is the impact of perioperative monitoring of children at risk to prevent ED.