Risk factors for emergence delirium in infant-toddlers undergoing sevoflurane anesthesia and its impact on negative...

Sevoflurane anesthesia is employed as the standard protocol for pediatric patients undergoing fundus examination. This study investigates the incidence of emergence delirium (ED) and its risk factors in this population, and explores the relationship between ED and negative postoperative behavioral changes (NPOBC).

A prospective observational study was conducted from May to September 2024, involving 155 children aged 0-3 years undergoing fundus examination under general anesthesia. Patient and surgery-related data were recorded. ED was assessed using the Pediatric Anesthesia Emergence Delirium (PAED) scale, with logistic regression identifying associated factors. Postoperative behaviors were evaluated one week later using the Post-Hospital Behavior Questionnaire for Ambulatory Surgery (PHBQ-AS), with linear regression analyzing the relationship between ED and NPOBC.

In 155 patients, ED incidence was 51%. In the 96 followed-up, NPOBC one week postoperatively was seen in 30.2%. Risk factors for ED included prenatal medical history (OR = 3.70, 95% CI 1.31-10.40, P = 0.013), anesthesia exposure (OR = 1.73, 95% CI 1.36-2.20, P < 0.001), preoperative anxiety (OR = 2.35, 95% CI 1.40-3.94, P = 0.001), and postoperative pain (OR = 1.69, 95% CI 1.31-2.19, P < 0.001). Increased negative behavioral scale scores were associated with anesthesia exposure (B = 0.260, 95% CI 0.123-0.396, P < 0.001) and ED occurrence (B = 1.420, 95% CI 0.598-2.234, P < 0.001).

Our study shows a high incidence of negative emotions and behaviors. Future research should focus on optimizing postoperative analgesia and preoperative anti-anxiety interventions for this high-risk group, and further exploring the connections among anesthesia exposure, ED and NPOBC.

Our study showed a high incidence of negative emotions and behaviors (emergence delirium and postoperative behavioral changes) in minimally invasive fundus examinations under total inhalation anesthesia. Risk factors for emergence delirium are prenatal medical history, anesthesia exposure, preoperative anxiety and postoperative pain. Higher negative behavior scores were associated with anesthesia exposure and emergence delirium. This is the first study to explore the incidence and risk factors of behavioral abnormalities in infants and preterm children after general anesthesia, making it easier to spot high-risk kids having fundus exams and to fine-tune anesthesia and perioperative care for short, minimally invasive procedures.