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Emergence delirium in children: an update

Souhayl Dahmani1, Honorine Delivet, Julie Hilly

  • 1aDepartment of Anesthesiology and Intensive Care, Robert Debré University Hospital bParis Diderot University, Paris VII, Paris Sorbonne Cité cINSERM UMR 676, Robert Debré University Hospital dDepartment of Pain Management, Robert Debré University eParis Descartes University, Paris V, Paris Sorbonne Cité, Paris, France.

Current Opinion in Anaesthesiology
|May 3, 2014
PubMed

Insights

Emergence delirium in children, a common anesthesia complication, can be prevented by managing preoperative anxiety and pain. Alpha-2 agonists like dexmedetomidine are recommended for treatment due to their benefits.

Area of Science:

  • Pediatric Anesthesiology
  • Neuroscience
  • Pharmacology

Background:

  • Emergence delirium (ED) is a common yet poorly understood complication following pediatric anesthesia.
  • While fast-acting volatile anesthetics are suspected, evidence linking them to ED is limited.
  • This review synthesizes recent research on ED in children.

Purpose of the Study:

  • To review recent findings on emergence delirium in pediatric anesthesia.
  • To explore the causes, prevention, and treatment of ED.
  • To highlight the link between ED and long-term cognitive complications.

Main Methods:

  • Literature review of recent studies on emergence delirium in children.
  • Analysis of factors contributing to ED, including anesthetic agents and patient characteristics.
  • Evaluation of preventive and therapeutic strategies.

Main Results:

  • ED typically affects preschool children after sevoflurane or desflurane anesthesia, presenting as intense anxiety.
  • Both painful and non-painful procedures can trigger ED.
  • Prevention involves managing preoperative anxiety, ensuring adequate analgesia, and using intraoperative sedatives (e.g., ketamine, dexmedetomidine).
  • Treatment for severe agitation may involve propofol, opioids, or dexmedetomidine, with dexmedetomidine favored for its additional benefits.
  • ED shares risk factors with long-term cognitive issues, necessitating parental awareness.

Conclusions:

  • Emergence delirium is a frequent and preventable complication in pediatric anesthesia.
  • Effective strategies include proactive pain management and the use of alpha-2 agonists.
  • Parental education regarding ED and potential long-term behavioral changes is crucial.
Abstract

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