Related Experiment Video
Updated: Nov 26, 2025
Method of Studying Palatal Fusion using Static Organ Culture
Published on: September 19, 2015
Emergence agitation after the cleft lip or palate surgery in pediatric patients: a prospective study
Yongle Shi1, Xiufeng Zhang1, Yan Sun1
1State Key Laboratory of Oral Diseases & National Clinical Research Center for Oral Diseases & Dept. of Post Anesthesia Care Unit, West China Hospital of Stomatology, Sichuan University, Chengdu 610041, China.
Insights
Pediatric patients undergoing cleft surgery frequently experience emergence agitation (EA), particularly upon entering the post-anesthesia care unit (PACU). Cleft palate and horizontal cleft surgeries showed higher EA incidence in the PACU compared to cleft lip surgeries.
Area of Science:
- Pediatric Anesthesiology
- Surgical Complications
- Craniofacial Surgery
Background:
- Postoperative complications are frequent in pediatric patients after cleft lip or palate surgery.
- Emergence agitation (EA) is a common, though often mild, complication that can mask critical signs like hypoxia.
- Effective monitoring of agitated children in the immediate postoperative period is challenging.
Purpose of the Study:
- To investigate the incidence and patterns of emergence agitation (EA) in pediatric patients following cleft lip or palate surgery.
- To establish a baseline for future interventions aimed at managing EA in this patient population.
Main Methods:
- A prospective study involving 214 pediatric patients (3 months to 6 years) undergoing cleft lip, palate, or horizontal cleft surgery.
- Emergence agitation (EA) scores (1-5 scale) were recorded upon entry to, during, and upon exit from the post-anesthesia care unit (PACU).
- Agitation was defined as a score of 3-5; scores of 4-5 indicated need for medication and care.
Main Results:
- High incidence of EA observed, with 69.63% of patients scoring 3 or higher upon entering the PACU.
- EA scores significantly decreased from PACU entry to exit (P=0.000), with the highest scores on entry and lowest on exit.
- Patients with cleft palate or horizontal cleft exhibited higher EA scores in the PACU compared to those with cleft lip (P=0.024).
Conclusions:
- Pediatric patients undergoing cleft lip, palate, or horizontal cleft surgery have a high incidence of emergence agitation (EA), particularly upon PACU admission.
- EA incidence is highest on PACU entry and lowest on PACU exit.
- Cleft palate and horizontal cleft surgeries are associated with a higher incidence of EA in the PACU compared to cleft lip surgeries.
Objective:
The pediatric patients after the cleft lip or palate surgery have high incidences of postoperative complications. Emergence agitation is a common complication. It is also a mild complication compared with lingual swelling and other airway-related complications, which are more often expected in children. However, it can cover signs of hypoxic episodes that appear immediately after surgery, because enough monitoring of an agitated child is not possible. The study aimed to discuss the occurrence of EA after cleft lip or palate surgery in pediatric patients, and further to provide a basis for later interventions.
Methods:
This prospective study included 214 patients aged 3 months to 6 years old at a tertiary stomatological teaching hospital. We calculated the EA scores for every patient when they entered PACU, were in PACU, and left from PACU, and the score ranges from 1 to 5 point. The patients occurred agitation if they scored from 3 to 5 on the 5-point scale, and the patients needed medication and care if they had a score of 4 or 5.
Result:
The results showed that the EA scores of 69.63% (n = 149) among patients were 3 or higher when they entered PACU, 40.65% (n = 87) were 3 or higher when they were in PACU, and 21.03% (n = 45) were 3 or higher when they left from PACU. Whether they are children with cleft lip, cleft palate, or horizontal cleft, the EA scores had a significant difference among different timings when entering PACU, in PACU, and leaving PACU (P = 0.000). Further comparison showed that the EA score of patients was the highest when entering PACU, and the lowest when leaving PACU. A significant difference in the EA scores was found among the patients with cleft lip, cleft palate, and horizontal cleft when they were in PACU (P = 0.024), further comparison showed that the EA score of the patients with cleft lip was lower than patients with cleft palate or horizontal cleft. While there were no statistical differences in the EA scores among the patients with cleft lip, cleft palate, and horizontal cleft when they entered PACU and left from PACU (P > 0.05).
Conclusion:
Children had a high incidence of EA after cleft lip or cleft palate or horizontal cleft surgery, especially when they entered PACU. Children after cleft palate and horizontal cleft surgery had higher incidences of EA than cleft lip surgery when they were in PACU.
Related Concept Videos
01:22Cardiopulmonary Resuscitation II: ACLS Airway Management
01:29Suctioning the Nasopharyngeal Airway
Equipment Required
01:22Aneurysm IV: Nursing Management
01:25Suctioning the Oropharyngeal Airway
After assembling the equipment, the nurse should practice hand hygiene and don appropriate PPE according to infection control guidelines to avoid the...