Emergence delirium, pain or both? A challenge for clinicians

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Marta Somaini1, Emre Sahillioğlu, Chiara Marzorati

  • 1Department of Anaesthesia and Intensive Care, Niguarda Ca' Granda Hospital, Milan-Bicocca University, Milan, Italy.

Paediatric Anaesthesia
|January 13, 2015
PubMed

Insights

Differentiating emergence delirium (ED) from pain in children post-anesthesia is challenging. Specific behaviors like lack of eye contact indicate ED, but inconsolability and restlessness are unreliable for distinguishing pain or ED.

Area of Science:

  • Pediatric Anesthesiology
  • Postoperative Care
  • Behavioral Science

Background:

  • Children frequently exhibit negative behaviors post-anesthesia, including emergence delirium (ED) and pain.
  • Distinguishing between ED and pain is difficult for caregivers in the early postoperative period.

Purpose of the Study:

  • To evaluate the ability of validated pediatric observational scales to differentiate ED from pain in young children.
  • To assess the utility of the Paediatric Anaesthesia Emergence Delirium Scale (PAED) and the Face, Legs, Activity, Cry, Consolability (FLACC) scale.

Main Methods:

  • Prospective observational study of 150 children undergoing elective adenoidectomy/tonsillectomy.
  • Simultaneous behavioral evaluation using PAED and FLACC scales by trained observers at extubation and 5, 10, 15 minutes post-procedure.

Main Results:

  • 21% of children experienced ED, 5% pain, and 65% had both.
  • 'No eye contact,' 'No purposeful action,' and 'No awareness of surroundings' (ED1) showed high sensitivity (0.96) and specificity (0.80) for identifying ED.
  • 'Inconsolability' and 'Restlessness' (ED2) had lower sensitivity (0.69) but higher specificity (0.88) for pain, though overall reliability was limited.

Conclusions:

  • Differentiating ED and pain using FLACC and PAED scores in the immediate postoperative phase is challenging.
  • Specific ED behaviors ('No eye contact,' etc.) correlate with ED, but 'Inconsolability' and 'Restlessness' are not reliable indicators for pain or ED within 15 minutes of awakening.
Abstract

Keywords:
PACU Emergence Deliriumacute paingeneral anesthesia

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