Treating children for acute agitation in the PACU: differentiating pain and emergence delirium

Differentiating postoperative pain from emergence delirium in children is challenging for even the most experienced PACU nurse. This article presents a review of the literature and clinical practice experiences that will help guide the PACU nurse in recognizing and differentiating these two conditions that are common in children recovering from anesthesia. The argument is made that although differentiating the cause of postoperative agitation may be difficult, it also may be unnecessary. Treatment with opioids is recommended as the primary strategy for safely recovering the child experiencing acute postanesthesia agitation, whether from pain or emergence delirium. Tools commonly used to assess both pain and postanesthesia agitation in children are reviewed, and an algorithm to facilitate the decision-making process is provided.