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A prospective cohort study of emergence agitation in the pediatric postanesthesia care unit
Terri Voepel-Lewis1, Shobha Malviya, Alan R Tait
1Department of Anesthesiology, Section of Pediatrics, C. S. Mott Children's Hospital, Ann Arbor, Michigan.
Insights
Emergence agitation (EA) affects 18% of children after general anesthesia. Factors like specific surgeries and anesthetic agents increase the risk of this postanesthetic complication.
Area of Science:
- Anesthesiology
- Pediatric Medicine
- Postanesthesia Care
Background:
- Emergence agitation (EA) is a common postanesthetic complication in children, impacting recovery and posing management challenges.
- Understanding the incidence and risk factors for EA is crucial for optimizing pediatric anesthetic care.
Purpose of the Study:
- To determine the incidence of EA in healthy children aged 3-7 years undergoing general anesthesia.
- To identify factors associated with and predictive of EA.
- To describe outcomes associated with EA, including postanesthesia care unit (PACU) stay.
Main Methods:
- Prospective cohort study involving 521 healthy children aged 3-7 years undergoing elective outpatient procedures.
- Perioperative care was documented, and postoperative behaviors were recorded in the PACU.
- Parents completed the Behavioral Style Questionnaire.
Main Results:
- The incidence of EA was 18% (96 out of 521 children).
- EA was associated with a prolonged PACU stay (117 min vs. 101 min).
- Independent risk factors for EA included otorhinolaryngology procedures, time to awakening, and isoflurane use.
Conclusions:
- Children undergoing general anesthesia can experience emergence agitation.
- Several factors, including specific surgical procedures and anesthetic agents, are associated with an increased risk of EA.
- These findings are vital for tailoring anesthesia management to reduce the incidence and severity of EA in pediatric patients.
Unlabelled:
Emergence agitation (EA) is a postanesthetic problem that interferes with a child's recovery and presents a challenge in terms of assessment and management. In this prospective cohort study, we sought to determine the incidence of EA, evaluate factors associated with and predictive of EA, and describe associated outcomes in healthy children. Children aged 3-7 yr who were undergoing general anesthesia for elective outpatient procedures were included. All perioperative care was documented, and postoperative behaviors in the postanesthesia care unit were recorded. Parents completed the Behavioral Style Questionnaire for 3- to 7-yr-olds. Five-hundred-twenty-one children were studied, of whom 96 (18%) had EA. Agitation lasted up to 45 min in some cases (range, 3-45 min; mean, 14 +/- 11 min), required pharmacologic intervention in 52% of children, and was associated with a prolonged postanesthesia care unit stay (117 +/- 66 min versus 101 +/- 61 min for nonagitated children; P = 0.02). Ten factors were found to be associated with EA, including age, previous surgery, adaptability, ophthalmology and otorhinolaryngology procedures, sevoflurane, isoflurane, sevoflurane/isoflurane, analgesics, and time to awakening. Of these, otorhinolaryngology procedures, time to awakening, and isoflurane were shown to be independent risk factors.
Implications:
Children may become agitated after general anesthesia. This study describes several factors that may increase the risk for agitation. These data are important in planning anesthesia care for young children.