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Published on: November 6, 2019
Prevalence of Emergence Delirium in Children Undergoing Tonsillectomy and Adenoidectomy
Katie Liu1, Christopher Liu2, Seckin O Ulualp2
1Department of Anesthesiology and Pain Management, Division of Pediatric Anesthesiology, University of Texas Southwestern Medical Center, Dallas, TX, USA.
Insights
Emergence delirium (ED) occurred in 1.3% of pediatric tonsillectomy and adenoidectomy patients. Toddlers and males were more likely to experience ED, with males having longer anesthesia times.
Area of Science:
- Pediatric Anesthesiology
- Pediatric Otolaryngology
Background:
- Emergence delirium (ED) is a common post-anesthesia complication in children, characterized by behavioral disturbances and agitation.
- Otolaryngology procedures, including tonsillectomy and adenoidectomy (T&A), are associated with an increased risk of ED.
- ED can lead to negative patient outcomes such as self-injury, delayed discharge, and parental dissatisfaction.
Purpose of the Study:
- To determine the prevalence of ED in children undergoing T&A.
- To identify characteristics of children who develop ED.
- To assess the recovery times associated with ED in this population.
Main Methods:
- Retrospective chart review of 4974 patients undergoing T&A between January 2018 and March 2020.
- Data collected included demographics, BMI, indication for T&A, PAED scores, ASA status, anesthesia times, and PACU recovery times.
- Statistical analysis to compare ED prevalence and recovery across various patient subgroups.
Main Results:
- The overall prevalence of ED was 1.3%.
- Toddlers (2.9%) and male children (1.6%) showed a significantly higher prevalence of ED.
- Males with ED had longer total anesthesia times (41 vs. 34 minutes), and ASA I patients with ED had longer Phase I PACU times (p=0.04).
Conclusions:
- Male gender, toddler age, and preschool age are associated with a higher likelihood of ED after T&A.
- Males experiencing ED required longer total anesthesia times.
- ED in ASA I patients was linked to prolonged Phase I recovery in the PACU.
Objective:
Emergence delirium (ED) is associated with behavioral disturbances and psychomotor agitation, increased risk of selfinjury, delayed discharge, and parental dissatisfaction with quality of care. Otolaryngology procedures are associated with an increased risk of ED. The aims of this study were to determine the prevalence of ED in children who had tonsillectomy and adenoidectomy (T&A), assess the characteristics of children who had ED, and ascertain the recovery times of patients with ED.
Methods:
Charts of patients who had tonsillectomy and adenoidectomy between Jan 1, 2018 and March 26, 2020 at a tertiary children's hospital were reviewed. Data collection included demographics, body mass index, indication for T&A, Pediatric Anesthesia Emergence Delirium (PAED) score, American Society of Anesthesiologists (ASA) physical status classification, total anesthesia time, postanesthesia care phase I time, and postanesthesia care phase II time.
Results:
Of the 4974 patients who underwent T&A, ED occurred in 1.3% of patients. Toddlers (2.9%) and male children (1.6%) had a significantly higher prevalence of ED. Prevalence of ED was similar amongst patients with recurrent tonsillitis, patients with obstructive sleep disordered breathing, and patients with both obstructive sleep apnea (OSA) and recurrent tonsillitis. The prevalence of ED was not different amongst ASA I, ASA II, and ASA III. Males with ED had longer total anesthesia times (41 v. 34 minutes, p=0.02) and ASA I patients with ED had longer phase I times (p=0.04) in the postanesthesia care unit (PACU). There was no significant difference in total anesthesia time, phase I time, or phase II time when compared across the subgroups of gender, age, indication for T&A, severity of obstructive sleep apnea (OSA), and ASA score.
Conclusions:
Males, toddlers, and preschool-age children were more likely to have ED. Males with ED had longer total anesthesia times. ED was associated with longer phase I times in ASA I patients.
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