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Pediatric emergence delirium: Canadian Pediatric Anesthesiologists' experience
H David Rosen1, Deborah Mervitz1, Joseph P Cravero2
1Department of Anesthesiology, Children's Hospital of Eastern Ontario, University of Ottawa, Ottawa, ON, Canada.
Insights
Pediatric emergence agitation/delirium (ED) is a concern for anesthesiologists. Propofol is frequently used for prevention and treatment, with most clinicians finding it effective.
Area of Science:
- Anesthesiology
- Pediatric Medicine
- Neuroscience
Background:
- Pediatric emergence agitation/delirium (ED) presents behavioral challenges post-anesthesia, impacting families and healthcare resources.
- Existing research focuses on risk factors and prevention, with limited data on established ED treatment and current practices.
Purpose of the Study:
- To investigate the incidence, definitions, and management strategies for pediatric ED among Canadian Pediatric Anesthesiologists.
- To gather expert opinions on the perceived efficacy of various preventative and treatment modalities for ED.
Main Methods:
- A web-based survey was distributed to 209 pediatric anesthesiologists who are members of the Canadian Pediatric Anesthesia Society (CPAS).
- The survey collected data on ED incidence, diagnostic criteria, preventative measures, and treatment approaches.
Main Results:
- A 51% response rate was achieved, with 42% of participants considering ED a significant issue.
- Propofol was the most common agent for both prevention (68%) and treatment (42%) of ED.
- 87% of respondents reported that ED treatments are usually effective with a single dose.
Conclusions:
- This study provides insights into current practices for pediatric ED prophylaxis and treatment among Canadian specialists.
- Further research is crucial to enhance the management of this frequent peri-anesthetic complication.
Introduction:
Pediatric emergence agitation/delirium (ED) is a cluster of behaviors seen in the early postanesthetic period with negative emotional consequences for families and increased utilization of healthcare resources. Many studies have looked at identifying risk factors for ED and at pharmacologic regimens to prevent ED. There are few published reports on treatment options and efficacy for established ED episodes, and essentially no data concerning current practice in the treatment of ED. We sought to elicit the experience and opinions of Canadian Pediatric Anesthesiologists on the incidence of ED in their practice, definitions and diagnostic criteria, preventative strategies, treatments, and their perceived efficacy.
Methods:
A web-based survey was sent to pediatric anesthesiologists working at academic health science centers across Canada. The participants were selected based on being members of the Canadian Pediatric Anesthesia Society (CPAS), which represents the subspecialty in Canada. All members of CPAS who had e-mail contact information available in the membership database were invited to participate. A total of 209 members out of the total of 211 fulfilled these criteria and were included in the study population.
Results:
The response rate was 51% (106/209). Of respondents, 42% felt that ED was a significant problem at their institutions, with 45% giving medication before or during anesthesia to prevent the development of ED. Propofol was the most common medication given to prevent ED (68%) and to treat ED (42%). Total intravenous anesthesia (TIVA) was considered by 38% of respondents as a technique used to prevent ED. Medications used for treatment included propofol (42%), midazolam (31%), fentanyl (10%), morphine (7%), and dexmedetomidine (5%), with 87% of respondents rating effectiveness of treatment as 'usually works quickly with one dose'.
Discussion:
We present information on current practice patterns with respect to prophylaxis and treatment of ED among a specialized group of pediatric anesthesiologists and highlight the importance of further research in improving the treatment of this common and challenging peri-anesthetic occurrence.