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Routines for reducing the occurrence of emergence agitation during awakening in children, a national survey

Pether K Jildenstål1, Narinder Rawal1, Jan L Hallén1

  • 1Department of Anesthesiology and Intensive Care, University Hospital, 701 85 Örebro, Sweden.

Springerplus
|October 22, 2014
PubMed

Insights

Emergence agitation in children after anesthesia is common and causes distress. While many Swedish anesthesiologists use preventive measures, practices vary, indicating a need for improved management strategies for post-anesthesia emergence reactions.

Area of Science:

  • Pediatric Anesthesiology
  • Neuroanesthesiology
  • Behavioral Medicine

Background:

  • Emergence agitation (EA) following anesthesia in children is a frequent occurrence.
  • EA, though typically self-limiting, causes significant distress for both pediatric patients and their parents.
  • Standardized assessment tools for EA symptoms are not routinely employed.

Purpose of the Study:

  • To survey current national practices in managing behavioral and neurocognitive disturbances after pediatric surgery and anesthesia.
  • To identify the prevalence and types of preventive and therapeutic interventions used for emergence agitation in children.
  • To assess the need for improved management protocols for EA in pediatric anesthesia.

Main Methods:

  • A national survey of Swedish anesthesia personnel was conducted.
  • The survey included a case scenario focusing on a child at risk for emergence reactions.
  • Data were collected on premedication, anesthetic techniques, and interventions before awakening.

Main Results:

  • Clonidine and midazolam were considered for premedication by 58% and 37% of responders, respectively.
  • Propofol-based anesthesia was common; sevoflurane (45%) and desflurane (8%) were also options.
  • Interventions before awakening included opioids (65%), low-dose propofol (48%), and clonidine (25%).

Conclusions:

  • Most Swedish anesthesia providers would implement preventive actions for children at risk of EA.
  • Significant variation exists in the preventive measures employed.
  • There is a clear opportunity to enhance and standardize the management of emergence agitation in pediatric anesthesia.

Keywords:
Emergence agitationGeneralanesthesiaPostoperative painPostoperative recovery and volatile anestheticsPremedicationVolatile anesthetics

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