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Magnitude of emergence agitation, its interventions and associated factors among paediatric surgical patients
Habtamu Tilahun Aniley1,2, Samrawit Tassew Mekuria3, Mebratu Abraha Kebede4
1Department of Anesthesia, MeQrez General Hospital, Addis Ababa, Ethiopia. habtishtile@gmail.com.
Insights
Emergence agitation affects nearly half of pediatric surgical patients, often delaying recovery. Propofol use and awake arrival in recovery reduced agitation, while ENT/oral surgeries increased risk.
Area of Science:
- Anesthesiology
- Pediatric Surgery
- Postoperative Care
Background:
- Emergence agitation is a common postoperative complication in children following general anesthesia.
- It can prolong recovery and cause distress.
- Understanding its prevalence and contributing factors is crucial for pediatric surgical care.
Purpose of the Study:
- To determine the magnitude of emergence agitation in pediatric surgical patients.
- To identify interventions used to manage emergence agitation.
- To investigate factors associated with emergence agitation in this population.
Main Methods:
- A hospital-based cross-sectional study with prospective follow-up was conducted.
- 150 pediatric surgical patients (aged 2-14 years) undergoing general anesthesia were enrolled.
- Data on emergence agitation, interventions, and associated factors were collected and analyzed using descriptive and inferential statistics.
Main Results:
- 42.7% of pediatric surgical patients experienced emergence agitation, with an average duration of 8.39 minutes.
- Factors associated with increased risk included Ear, Nose, and Throat (ENT) surgery and oral maxillofacial surgery.
- Propofol administration at the end of the procedure and arrival in the recovery unit awake were associated with a decreased risk of emergence agitation.
Conclusions:
- Emergence agitation is a significant issue in pediatric surgical patients, affecting nearly half of those studied.
- Specific surgical types (ENT, oral maxillofacial) are risk factors, while certain anesthetic practices (propofol, awake arrival) are protective.
- Anesthesia personnel require enhanced skills for effective perioperative management, including minimizing and treating emergence agitation.
Background:
Emergence agitation is a transient confusional state of a child associated with consciousness from general anaesthesia, commonly occurs in the postoperative setting which delays their recovery and exposes them to traumas. The main objective of the current study was to investigate the magnitude of emergence agitation, its interventions and associated factors among paediatric surgical patients at Saint Paul's Hospital Millennium Medical College, Addis Ababa, Ethiopia.
Methods:
Hospital based cross-sectional study with prospective follow-up framework was conducted on a paediatric surgical patients aged 2-14 years who underwent surgery under general anaesthesia between June 1 - October 30 2022. Stratified sampling method followed by simple random sampling technique was employed to reach study participants. Magnitude of emergence agitation and its interventions done at post-anaesthetic care units were recorded. Data analysis was carried out using a descriptive statistics method and the results were summarized using tables and diagrams. Bivariate analysis was done to identify causal relationship and multivariable analysis to assess the confounding effects of factors associated with emergence agitation. A p-value of less than 0.05 was considered statistically significant factor.
Results:
A total of 150 participants were included in the current study, where 107 (71.3%) were male and 97 (64.7%) were preschool aged. About 81 (54%) of care givers were female and majority of them have completed primary school. The mean (standard deviation) age of the participants was 6.4 (3.57) years. Around 42.7% of them developed emergence agitation with an average duration of 8.39 ± 4.45 minutes. Factors such as propofol administration at the end of procedure (OR of 0.104 with 95% CI [0.035, 0305]), Ear, nose, throat surgery and oral maxillofacial surgery (OR of 2.341 with 95% CI [1.051, 5.211]) and arrival of patient to recovery awake (OR of 0.456 95% CI [0.209, 0.994]) showed statistically significant association with emergence agitation.
Conclusion:
Almost half of the study participants experienced emergence agitation which is high magnitude. Ear, nose, throat surgery and oral maxillofacial surgeries were predictive factors of emergence agitation while propofol administration at the end of procedure and arrival of patient to recovery awake significantly decreased risk of emergence agitation. Therefore, anaesthesia personnel should have essential skills and knowledge to effectively care for children perioperatively including to minimize and treat emergence agitation.
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