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Non-pharmacological interventions for preventing emergence delirium in children under general anesthesia: A scoping
Xiaoxia Shi1, Lili Su2, Yue Sun3
1Pediatric Intensive Care Unit, Henan Provincial People's Hospital, Zhengzhou, China; Henan Provincial Key Medicine Laboratory of Nursing, Henan Evidence-based Nursing Centre: A JBI Affiliated Group, The University of Adelaide, Zhengzhou, China.
Insights
Non-pharmacological interventions like distraction and visual preconditioning can help prevent emergence delirium in children after anesthesia. Further research is needed to confirm the effectiveness of various methods for pediatric anesthesia care.
Area of Science:
- Pediatric Anesthesiology
- Perioperative Care
- Child Psychology
Background:
- Emergence delirium is a common concern in pediatric patients post-general anesthesia.
- Non-pharmacological interventions show promise but require further investigation due to varied effectiveness.
- A comprehensive understanding of these interventions is crucial for clinical practice.
Purpose of the Study:
- To conduct a scoping review of non-pharmacological interventions for preventing emergence delirium in pediatric patients.
- To categorize these interventions, identify their core components, and examine outcome measures.
- To synthesize existing evidence on the effectiveness of non-pharmacological approaches in pediatric anesthesia.
Main Methods:
- A scoping review following Arksey and O'Malley's framework and PRISMA-ScR guidelines.
- Inclusion of experimental and quasi-experimental studies on non-pharmacological interventions for emergence delirium prevention.
- Analysis of 32 articles, including 29 randomized controlled trials, involving 4633 pediatric patients (0-18 years).
Main Results:
- Ten distinct non-pharmacological interventions were identified: distraction, visual preconditioning, virtual reality, parental participation, maternal voice, light drinking, acupuncture, auditory stimulation, monochromic light, and breathing training.
- Primary outcomes measured included emergence delirium, preoperative anxiety, and postoperative pain.
- Four assessment instruments were utilized to quantify the incidence and severity of emergence delirium.
Conclusions:
- Multiple non-pharmacological interventions are available for preventing emergence delirium in children.
- The efficacy of certain interventions requires further validation.
- Visual preconditioning and distraction interventions represent promising areas for future research and application.
Problem:
The phenomenon of emergence delirium in pediatric patients undergoing general anesthesia has garnered increasing attention in the academic community. While formal non-pharmaceutical interventions have demonstrated efficacy in mitigating this phenomenon, the diversity of intervention types and their varying degrees of effectiveness necessitate further discussion. A scoping review was conducted to identify and explicate the categorization, content elements, and outcomes measures of non-pharmacological interventions utilized to forestall the onset of emergence delirium in children undergoing general anesthesia.
Eligibility Criteria:
This review was conducted in accordance with the Arksey and O'Malley's methodology framework and PRISMA-ScR. It encompassed experimental and quasi-experimental studies that involved any non-pharmacological interventions during the perioperative period to prevent emergence delirium in children aged 0 to 18 years undergoing general anesthesia for elective surgery.
Sample:
Thirty-two articles met the inclusion criteria, of which 29 were randomized controlled trials. The total sample size of the population was 4633.
Results:
The scoping review revealed 10 non-pharmacological interventions, that included distraction intervention, visual preconditioning, virtual reality, parental participation, maternal voice, light drinking, acupuncture, auditory stimulation, monochromic light and breathing training. Emergence delirium, preoperative anxiety, and postoperative pain were the primary outcomes, and four assessment instruments were employed to measure the extent and incidence of emergence delirium.
Conclusion:
Numerous non-pharmacological interventions have been employed to prevent emergence delirium. Nevertheless, the effectiveness of some interventions is not yet evident.
Implications:
The utilization of visual preconditioning and distraction interventions appears to be an emerging area of interest.
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