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Identification of risk factors for emergence delirium in children undergoing magnetic resonance imaging
Lydia Merkel1, Mary Drouillard1, Shirley Wiggins1
1Children's Nebraska, Omaha, NE, United States of America.
Insights
Emergence delirium (ED) in children undergoing MRI is linked to faster arousal times post-sedation. Further research is needed to identify pre-procedural risk factors and develop interventions for pediatric ED.
Area of Science:
- Pediatric Anesthesiology
- Neuroscience
- Child Psychology
Background:
- Emergence delirium (ED) is a common concern in pediatric sedation and anesthesia.
- Identifying risk factors for ED is crucial for improving patient safety and care.
- Children undergoing magnetic resonance imaging (MRI) are a specific population where ED can occur.
Purpose of the Study:
- To identify risk factors for emergence delirium (ED) in children aged two to seven years.
- To investigate the association between ED and pre-procedural factors in children undergoing MRI.
- To document the incidence of ED in this pediatric population.
Main Methods:
- A descriptive, observational study was conducted in a pediatric hospital.
- Child and parent anxiety were assessed using the Child Induction Behavioral Assessment (CIBA) and Amsterdam Preoperative Anxiety and Information Scale (APAIS).
- Emergence delirium (ED) was measured using the Pediatric Anesthesia Emergence Delirium (PAED) scale, with statistical analysis of demographic and clinical characteristics.
Main Results:
- Out of 136 children, 16.9% experienced emergence delirium (ED).
- Children with ED had significantly shorter arousal times (median 8 min) compared to those without ED (median 15 min, p < 0.0001).
- While not statistically significant, midazolam premedication was associated with a higher incidence of ED (25.6% vs 13.4%).
Conclusions:
- Shorter post-procedural arousal time is a significant risk factor for ED in children undergoing MRI.
- Pre-procedural factors predicting ED in children remain unclear.
- Interdisciplinary research is needed to develop interventions to reduce pediatric ED incidence and enhance child safety.
Purpose:
Emergence delirium (ED) remains an ongoing concern for children undergoing sedation/anesthesia. The purpose of this study was to identify risk factors for ED in a population of children from two to seven years of age undergoing sedation/anesthesia for magnetic resonance imaging.
Design And Methods:
This was a descriptive, observational study taking place in a free-standing midwestern pediatric hospital. The Child Induction Behavioral assessment (CIBA) and the Amsterdam Preoperative Anxiety and Information Scale (APAIS) were used to assess child/parent anxiety. The presence of ED was documented using the Pediatric Anesthesia Emergence Delirium (PAED) scale. Associations between ED demographic and clinical characteristics were assessed using Chi-square and Wilcoxon Rank Sum tests.
Results:
Of the 136 children who underwent sedation/anesthesia for MRI, 23 (16.9 %) experienced ED. Although not significant, children who received the pre-medication midazolam experienced an increased incidence of ED (25.6 %) compared to those who did not (13.4 %, p = 0.09). Children who experienced ED took a significantly shorter time to arouse from sedation/anesthesia (median = 8 min) compared to those who did not experience ED (median = 15 min, p < 0.0001).
Conclusions:
A shorter post-procedural arousal time was a significant risk factor associated with ED in this sample of children undergoing MRI.
Implications:
It is unclear which pre-procedural factors predict children who will experience ED. There is a need for interdisciplinary research to identify interventions to decrease the incidence of pediatric ED. More research is needed to support the development of interventions to best support the safety of the child experiencing ED.
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