Emergence agitation in children: an update

In this review, the most recent and relevant developments in the field of emergence agitation in children, as related to its assessment, etiology, and management, are discussed.

Studies have shown that a more specific assessment tool is needed to decrease measurement errors. Such scales have been developed recently and incorporate cognitive-related assessment items in addition to agitation behaviors. Young, emotional, impulsive and less social children with anxious parents undergoing head and neck surgery are identified to be at risk for the development of emergence agitation. Factors that may influence the occurrence of this postanesthetic behavior include the level of preoperative anxiety and premedication, anesthesia drugs, as well as awakening in a hostile environment and feeling pain. Management include ruling out all possible causes, such as physiologic compromise, physical discomfort and pain. Treatment of emergence agitation is usually not required since the condition is self-limiting. If unremitting, however, treatment with opioids, benzodiazepines or small doses of hypnotics may be required.

It is recommended that children at high risk are identified in order to decrease their level of preoperative anxiety, to supplement low-solubility inhalational agents with adjuvant drugs, to prevent postoperative pain and to allow parents to be with their children during recovery from anesthesia.