Intraoperative burst suppression and emergence delirium in pediatric: A prospective observational study

Emergence delirium (ED), a common postoperative neurological disorder in children, is characterized by disturbances in consciousness, attention, disorientation, and perceptual changes. Intraoperative burst suppression has been associated with postoperative delirium in adults, and its relationship with emergence delirium in children remains unclear and controversial.

This investigation was conducted at Beijing Children's Hospital, Capital Medical University, from January 2022 to January 2023. The study incorporated children aged 6 months to 9 years who were undergoing general anesthesia with electroencephalography (EEG) monitoring. Intraoperative processed EEG and the incidence of burst suppression were recorded. Postoperative delirium was evaluated using the Pediatric Anesthesia Emergence Delirium Scale. A score of 10 points or higher on this scale was used as an indicator of the presence of emergence delirium.

Among the 207 children enrolled, the incidence of emergence delirium was 43 % in the set of children with burst suppression, whereas it was only 7 % in the non-burst suppression set. Binary logistic regression analysis pinpointed two distinct risk factors for the emergence of delirium. These were the agent used for maintenance of anesthesia and intraoperative burst suppression. Children maintained under intravenous propofol for maintenance of anesthesia experienced 57 % lower incidence of emergence delirium than those maintained under sevoflurance for anesthesia maintenance. Furthermore, children with burst suppression were eight times more likely to develop emergence delirium, according to intraoperative processed EEG monitoring.

This study demonstrated a notable association between intraoperative burst suppression and the incidence of postoperative emergence delirium. These findings suggest that processed EEG-based monitoring and tailored anesthesia strategies may help prevent emergence delirium and other unfavorable outcomes in pediatric surgical patients.