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[Pediatric emergence agitation]
V Lehmann1, J Giest, J Wermelt
1Klinik und Poliklinik für Anästhesiologie und Operative Intensivmedizin, Universitätsklinikum Bonn, Sigmund-Freud-Str. 25, 53105, Bonn, Deutschland.
Insights
Emergence agitation in children is a significant concern for pediatric anesthesiologists. Propofol is the preferred pharmacological intervention, and parental presence post-surgery is highly valued.
Area of Science:
- Pediatric Anesthesiology
- Pediatric Surgery
- Child Psychology
Context:
- Emergence agitation in children is a common postoperative complication.
- Factors influencing its incidence include surgical procedure, patient age, and anesthetic regimen.
Purpose:
- To survey experienced pediatric anesthesiologists on their clinical practices regarding emergence agitation.
- To gather data on documentation, premedication, anesthesia, and postoperative treatment for pediatric emergence agitation.
Summary:
- A survey of 156 pediatric anesthesiologists revealed that 87% consider emergence agitation a relevant clinical problem.
- Propofol is the primary pharmacological agent for prevention and treatment, with 56% using it for treatment.
- Midazolam is used for premedication by 89%, and 56% employ total intravenous anesthesia as a preemptive measure.
Impact:
- Highlights the ongoing clinical relevance of emergence agitation in pediatric anesthesia.
- Identifies current trends in pharmacological and non-pharmacological management strategies.
- Underscores the perceived benefit of parental presence in mitigating postoperative agitation.
Background:
The origin of emergence agitation in children remains unclear; however, an association between surgical procedure, patient age and anesthetic regimen and the incidence of postoperative agitation has been described in the literature.
Aim:
The aim of this survey performed between February and April 2014 was to collect data from the daily clinical practice by experienced pediatric anesthesiologists regarding documentation, premedication, anesthesia regimen and postoperative treatment with respect to children with emergence agitation.
Material And Methods:
An online questionnaire with 33 items was developed and sent to all 525 members of the scientific committee of pediatric anesthesia (WAKKA) of the German Society of Anesthesiology and Intensive Care (DGAI). Members were asked to respond within a time period of 1 month but no reminders were sent out via email or telephone.
Results:
A total of 156 members participated in the survey and of these 143 questionnaires were fully completed and included in the final evaluation (27 %). Of the participants 77 % had more than 6 years professional experience in the field of pediatric anesthesia and for 87 % emergence agitation remains a relevant clinical problem. The estimated incidence of emergence agitation was given as 1-10 % and as high as 11-20 % by 56% and 20 % of the participants, respectively. The incidence of postoperative agitation is documented by only 11 % of the participants with a validated score, such as the pediatric anesthesia emergence delirium (PEAD) scale and 89 % of the participants use midazolam for premedication. As a preemptive intervention total intravenous anesthesia is performed by 56 % whereas clonidine is used as first line prevention by 30 %. Postoperative pharmacological treatment is performed by a bolus administration of propofol (56 %) and clonidine (26 %). Postoperative parental presence was considered beneficial by 82 %.
Conclusion:
Emergence agitation is still seen as a relevant clinical problem by experienced pediatric anesthesiologists. Propofol is first choice when it comes to pharmacological prevention and treatment of emergence agitation. Postoperative parental presence was considered beneficial by the majority of anesthesiologists.
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