The agitated child in recovery

SHung, J

doi:10.1080/22201173.2011.10872743

Cited by 5 publications

(9 citation statements)

References 17 publications

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“…The incidence of emergence delirium in children occurs in the order of 15% of patients, but incidences as high as 50% have been reported. [1][2][3][4] It is important to identify risk factors for emergence delirium, so that clinicians may prophylactically treat high-risk patients. The association between agitation at induction and emergence delirium has not been clearly delineated with contradictory results being reported.…”

Section: Introductionmentioning

confidence: 99%

Induction behaviour and race and its association with postoperative agitation in paediatric elective surgery

Swart

Rajah

Rodseth

2017

Southern African Journal of Anaesthesia and Analgesia

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Background: It has been suggested that preoperative agitation in children may be a risk factor for postoperative delirium and postoperative vomiting. Previous studies have suggested that adult African patients have a lower incidence of postoperative nausea and vomiting, but no such association has been shown in children. Aim: To determine the incidence of both postoperative delirium and postoperative vomiting in elective paediatric surgical patients in a South African hospital and their association with preoperative agitation and patient race. Methods: A retrospective database analysis was undertaken of patients 1-12 years of age undergoing elective surgery. The Watcha behavioural scale was used to assess pre-and postoperative agitation. A Watcha score > 2 defined significant preoperative agitation or postoperative delirium. Multivariable logistic regression evaluated ENT surgery, sex, age, volatile type, significant preoperative agitation and race as predictors of postoperative delirium. Sex, race, significant preoperative agitation, ENT surgery and vomiting prophylaxis were evaluated as predictors of postoperative vomiting. Results: Significant preoperative agitation occurred in 13.5% (125/928); postoperative delirium in 3.4% (32/928) and postoperative vomiting in 1.4% (12/856) of patients. Postoperative delirium occurred in 3.1% of African patients as compared with 10.4% of non-African patients (p = 0.007); and postoperative vomiting in 1.2% of African patients as compared with 4.4% of non-African patients (p = 0.074). The predictors of postoperative delirium were non-African race (odds ratio [OR] 3.67; 95% confidence interval [CI] 1.22-11.07; p = 0.021), significant preoperative agitation (OR 3.54; 95% CI 1.55-8.09; p = 0.003), and ENT surgery (OR 2.5; 95% CI 1.0-6.0; p = 0.040). Only non-African race predicted postoperative vomiting (OR 3.73; 95% CI 1.01-13.79; p = 0.049), which included other variables like ENT surgery, significant preoperative anxiety, PONV prophylaxis. Conclusion: Preoperative agitation, non-African race and ENT surgery were predictors of postoperative agitation. Postoperative vomiting was predicted only by non-African race, which correlates with the trend seen in adults, even though incidence difference between African and non-African patients was not statistically significant.

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Section: Introductionmentioning

confidence: 99%

Induction behaviour and race and its association with postoperative agitation in paediatric elective surgery

Swart

Rajah

Rodseth

2017

Southern African Journal of Anaesthesia and Analgesia

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“…Some possible causes for agitation are hypoxia, hypercarbia, hypoglycaemia, pain, airway obstruction, raised intracranial pressure, drugs, fear/anxiety and the child's temperament. 3,7 Hence, we decided to compare the incidence and severity of EA in the paediatric age group under maintenance sevoflurane (Group S) or isoflurane (Group I) anaesthesia using the PAED (Pediatric Anaesthesia Emergence Delirium) Scale. We also wanted to study the effect of preinduction anxiety on emergence agitation as well as its association with pain using the FLACC (Face Legs Activity Cry Consolability) score.…”

Section: Introductionmentioning

confidence: 99%

“…It occurs within the first 30 min after anaesthesia, lasts for a few minutes to hours but may take up to 2 days to resolve. [2][3][4] The incidence of EA ranges from 5% to 15% with some studies reporting an incidence as high as 80%. 4,5 Although emergence agitation is self-limiting, it can be very frightening and disturbing for the parents.…”

Section: Introductionmentioning

confidence: 99%

Emergence agitation in paediatric patients using sevoflurane and isoflurane anaesthesia: a randomised controlled study

Pradeep

Manissery

Upadya

2017

Southern African Journal of Anaesthesia and Analgesia

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Background: Emergence agitation (EA) is a well-recognised phenomenon often observed in children following general anaesthesia. The aim of this study was to compare the incidence and severity of EA in the paediatric age group under sevoflurane or isoflurane anaesthesia using the PAED Scale (Pediatric Anaesthesia Emergence Delirium Scale) (the primary outcome) and its correlation with preinduction agitation as well as its association with pain using the FLACC (Face Legs Activity Cry Consolability) score (the secondary outcome). Method: In this randomised controlled trial, 60 children aged between 2 and 6 years were enrolled and randomly divided into two groups. All patients were induced with sevoflurane, relaxed with atracurium and the airway secured with an appropriate device. Anaesthesia was maintained with O 2 , N 2 O and sevoflurane or isoflurane. Adequate analgesia was ensured. Post-procedure, they were observed in the post-anaesthesia care unit (PACU) for development of EA. The statistical package SPSS® version 17 was used and data were analysed using Student's unpaired t-test and a chi-square test. Statistical significance was accepted at p < 0.05. Results: The mean PAED scale was 12.9 in the sevoflurane group and 9.4 in the isoflurane group (p < 0.001). The incidence of EA was significantly related to preinduction agitation (p = 0.00). Higher FLACC scores were observed only within the initial 10 min in the sevoflurane group (p = 0.009). Conclusions: An increased incidence of EA was observed with sevoflurane maintenance anaesthesia, particularly during the initial 10-20 min of the postoperative period. EA was strongly associated with preinduction agitation, but it was poorly correlated to pain, i.e. not all patients who developed EA had a high FLACC score.

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“…Cumpre pontuar que dor pós-operatória deve ser avaliada nas crianças que apresentam i-CNPO e, se presente, tratada. 10 ESCALAS PARA DIAGNÓSTICO DE DELIRIUM NO DESPERTAR E AGITAÇÃO NO DESPERTAR [6][7][8][9] A escala comportamental de Watcha 6 (Watcha behavior scale for emergence delirium) para delirium no despertar foi utilizada para classificar o despertar de crianças de três meses a quatro anos e é graduada de 1 a 4, sendo definidos, respectivamente, criança calma, criança chorando e que pode ser consolada, criança chorando inconsolável e criança agitada/esperneando/ se debatendo. Costi et al 11 consideraram o diagnóstico de delirium no despertar se escore ≥ 3.…”

Section: Diagnósticounclassified

“…A sensibilidade da escala é de 64%, especificidade 86%, área sob a curva ROC 0,77 e os escores correlacionavam-se bem com idade, tempo até o despertar e uso de sevoflurano. 10 Os itens 4 e 5 da escala podem refletir delirium no despertar ou dor pós--operatória, uma vez que a escala Face, Legs, Activity, Cry, Consolability (FLACC) utiliza algum nível de agitação e de consolabilidade para avaliar dor em crianças; e as escalas Children's Hospital of Eastern Ontario Pain Scale (CHEOPS) e outra desenvolvida por Hannallah et al 14 também utilizam algum nível de agitação para avaliar dor. Locatelli et al 15 dividiram a escala PAED em duas partes, uma em que constavam os itens de 1 a 3 e outra com os itens 4 e 5.…”

Section: A Escala Paedunclassified

Early postoperative negative behavior in pediatric anesthesia

Leite¹,

Penholati²,

Pardini³

et al. 2017

Revista Médica De Minas Gerais

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RESUMO O comportamento negativo no pós-operatório imediato (i-CNPO) é uma alteração do comportamento e/ou da cognição, que inclui o delirium no despertar, agitação no despertar e dor pós-operatória. Dependendo da forma como foi feito o diagnóstico, o i-CNPO pode ter incidência acima de 80%. O diagnóstico é clínico e baseado em escalas. Existem várias escalas para diagnóstico de delirium e agitação no despertar. A única validada é a Pediatric Anesthesia Emergence Delirum (PAED). Essa escala avalia cinco pontos, tais quais: contato com os olhos do cuidador, consciência do ambiente, se os atos da criança são propositais e os graus de consolabilidade e de agitação da criança. Os fatores de risco incluem: faixa etária pré-escolar, anestesia para cirurgias otorrinolaringológicas e anestesia com sevoflurano ou desflurano. A prevenção é muito bem indicada nessa complicação. Pode ser feita com midazolam (0,1 mg/kg) EV no fim da cirurgia; propofol (1-3 mg/kg) EV no fim da cirurgia; clonidina VO (4 mcg/kg) como medicação pré-anestésica; dexmedetomidina EV (0,2-1 mcg/kg) como medicação pré-anestésica ou no perioperatório; fentanil (1-2,5 mcg/kg) EV no perioperatório. Anestesia venosa total também é uma forma de prevenir delirium e agitação no despertar. Por ser uma complicação autolimitada, o tratamento somente será indicado se a criança estiver muito agitada e com risco de se autoinfligir ou de perda de acessos vasculares, drenos ou curativos. O tratamento inclui midazolam, propofol, fentanil ou dexmedetomidina nas mesmas doses.

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The agitated child in recovery

Cited by 5 publications

References 17 publications

Induction behaviour and race and its association with postoperative agitation in paediatric elective surgery

Induction behaviour and race and its association with postoperative agitation in paediatric elective surgery

Emergence agitation in paediatric patients using sevoflurane and isoflurane anaesthesia: a randomised controlled study

Early postoperative negative behavior in pediatric anesthesia

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