Risperidone in a child with untractable emergency delirium: a case report

Area of Science:

• Pediatric Anesthesiology
• Neuroscience
• Pharmacology

Background:

• Emergence delirium (ED) is a common post-anesthesia complication in pediatric patients.
• Standard treatments for ED, including reversal agents and sedatives, are not always effective.
• Uncontrolled ED can prolong recovery and pose safety risks in the post-anesthesia care unit.

Purpose of the Study:

• To report a case of successful management of refractory emergence delirium in a pediatric patient.
• To highlight the potential utility of antipsychotic medication in treating severe ED.
• To inform anesthesiologists about alternative treatment strategies for challenging ED cases.

Main Methods:

• A 6-year-old boy received deep sedation for thoracic MRI using midazolam and propofol.
• The patient experienced severe emergence delirium unresponsive to flumazenil, additional propofol, and meperidine.
• Risperidone, an antipsychotic, was administered upon psychiatric recommendation.

Main Results:

• Administration of risperidone resulted in immediate resolution of the patient's emergence delirium.
• The child became calm and relaxed following the antipsychotic treatment.
• This case demonstrates a positive outcome with an unconventional ED treatment.

Conclusions:

• Emergence delirium can be refractory to typical interventions.
• Antipsychotic agents, such as risperidone, should be considered as a treatment option for severe, uncontrolled pediatric emergence delirium.
• Further research may be warranted to establish the role of antipsychotics in managing ED.