Emergence from General Anaesthesia: Can We Discriminate between Emergence Delirium and Postoperative Pain?

Area of Science:

• Pediatric Anesthesiology
• Neuroscience
• Pain Management

Background:

• Unsettled behaviors occur in up to 80% of pediatric cases post-general anesthesia.
• Emergence delirium (ED) and acute pain are primary contributors to these behaviors.
• Challenges exist in defining and measuring unsettled behaviors, hindering guideline implementation.

Purpose of the Study:

• To review current knowledge on identifying and treating emergence delirium (ED) and acute pain in children.
• To provide a practical approach for managing these conditions in clinical practice.
• To address the difficulties in differentiating ED from pain in non-fully awake pediatric patients.

Main Methods:

• Review of current literature on pediatric emergence delirium and pain.
• Analysis of diagnostic challenges and risk factors for ED.
• Discussion of treatment strategies for ED and pain.

Main Results:

• Emergence delirium (ED) incidence is estimated between 10% and 20%.
• Risk factors for ED include young age, male gender, preoperative anxiety, and specific surgeries.
• Current assessment tools struggle to reliably distinguish ED from pain in awake children.

Conclusions:

• Accurate differentiation between ED and pain is crucial for appropriate treatment.
• Misdiagnosis can lead to undertreated pain or overuse of opioids for ED.
• A pragmatic approach is needed to guide clinical practice in managing post-anesthesia unsettled behaviors.